A single centre matched pair series comparing minimally invasive and open surgery for the resection of pediatric renal tumours

Abstract

IntroductionMinimally invasive nephrectomy (MIN)for the resection of pediatric renal tumors is controversial. We compared patients who underwent laparoscopic MIN according to our unit protocol with matched patients who underwent open surgery (ON). MethodA single centre retrospective analysis of prospectively collected data for MIN. Tumor volume was calculated from pre-operative imaging and volume matched ON patients were identified from the regional tumor database. Demographics, complications, operative time, length of stay, number of nodes resected, status of margins, radiotherapy (RT)requirement, length of follow-up and outcomes were analysed. ResultsFourteen MINs performed between September 2016 and 11/2019 (M:F 5:9; median age 37 (range 2–73)months) were matched with ON controls (7:7 M:F, median age 42 (1–74)months). Diagnoses in the MIN group were Wilms Tumour (WT)in11 and one each of mesoblastic nephroma (MN), malignant rhabdoid tumour of the kidney (MRTK), nephroblastomatosis and in the ON group were 13 WT and 1 MN. Median operating time for MIN was 180 (125–300)minutes, with 4 conversions and 155 (1-3-480)minutes in ON.There were no intra-operative ruptures. Three tumors in each group had positive margins. A median of 4 (0–6) nodes were removed during MIN and 4 (2–22) during ON. Median length of stay (LoS)was 4 (2–15)days following MIN and 4 (2–9) following MIN.Six ON and 3 MIN patients required radiotherapy. Differences were not significant.Median follow up of 30 (6–44)months for MIN and 73 (34–109)months for ON patients was significantly different. There have been no local recurrences but the child with MRTK died following brain tumor recurrence. ConclusionMIN for pediatric renal tumors has similar short term outcomes to ON in carefully selected patients.