Laparoscopic Radical Nephrectomy For Renal Cancer In Children

Abstract

PURPOSE We report our preliminary experience in the treatment by Laparoscopic Radical Nephrectomy (LRN) for unilateral renal cancer in children. MATERIAL AND METHODS Six children, with mean age was 3,6 years old, were operated for unilateral renal malignant tumours by laparoscopic approach in our unit from October 2005 until october 2008. Five cases were suspected of Wilms’ tumours (WT) and one of them presented bilateral lung metastases. They were preoperatively treated with chemotherapy according the SIOP 2001 protocol. The sixth case was a ten year old child, treated eight years before with chemotherapy for a cerebellar vermis medulloblastoma history; a percutaneous biopsy was performed preoperatively and the histology showed a juvenile renal cell carcinoma. All cases subsequently underwent LRN. Four trocars were used in each case and the tumours were placed in a bag before to be extracted without morcellation through a low suprapubic incision. RESULTS All tumours as well as lymph node samples were removed completely by laparoscopy without rupture. No conversion to laparotomy was necessary and there were neither intraoperative bleeding nor complications. The mean operative time was 90 min. In postoperative, one child presented an intestinal perforation and was suture clousure by laparoscopy; the discharge was at 10 days, and the others were discharged after two or three days. In all cases, the resection was microscopically complete. None of these patients presented evidence of recurrences, port-site implantation and short-term complications. The histology was 4 unilateral WT, 1 clear cell sarcoma and 1 juvenile renal cell carcinoma with t(X;17). CONCLUSIONS LRN for renal cancer in children is feasible and safe after preoperative chemotherapy, with the same oncological strategies than open surgery. A long follow-up and more cases are necessary to evaluate and compare the results of laparoscopic approach with the open procedures.