Laparoscopic Radical Nephrectomy for Unilateral Renal Cancer in Children

Abstract

At the present time, the standard approach for renal cancer in children is open surgery, and the role of laparoscopic approach remains to be defined. We report our preliminary experience in the treatment by laparoscopic radical nephrectomy (LRN) for unilateral renal cancer in children. Five children, whose mean age was 4 years old, were operated for unilateral renal malignant tumors by laparoscopic approach in our unit from October 2005 to June 2007. Four cases were suspected of Wilms tumors and one of them presented bilateral lung metastases. They were preoperatively treated with chemotherapy according to the International Society of Pediatric Oncology 2001 protocol: vincristine and actinomicyn D for 4 weeks. The fifth case was a 10-year-old child, treated 8 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 tumors were placed in a bag before being extracted intact without morcellation through a low suprapubic incision. All tumors and lymph node samples were removed completely by laparoscopy without rupture. No conversion to laparotomy was necessary and there was neither intraoperative bleeding nor complications. The mean operative time was 90 minutes (60 to 117 min). Postoperatively, 1 child presented an intestinal perforation and suture closure was performed by laparoscopy on the third postoperative day; the discharge was after 10 days, and the others were discharged after 2 or 3 days. In all cases, the resection was microscopically complete. The histology was 3 unilateral Wilms tumor, 1 clear-cell sarcoma and 1 juvenile renal-cell carcinoma with t(X;17). No lymph node was positive for the tumors. None of these patients presented evidence of tumoral recurrences, port-site implantation or short-term complications at a mean of 18 months of follow-up (range: 12 to 32 mo). LRN for renal cancer in children is feasible after preoperative chemotherapy, with the same oncologic strategies as open surgery. A long follow-up and more cases are necessary to evaluate and compare the results of laparoscopic approach with the open procedures.