Abstract
Background
While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection.
Methods
This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Société Internationale d’Oncologie Pédiatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board.
Results
Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6–13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms’ tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2–4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms’ tumor) presented with pleural recurrence. One girl with Wilms’ tumor died of central nervous system metastasis.
Conclusions
Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application.
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Change history
02 October 2021
A Correction to this paper has been published: https://doi.org/10.1245/s10434-021-10861-x
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Acknowledgment
The authors thank Deborah Nock (Medical WriteAway, Norwich, UK) for medical writing support, and Caroline Elie, Sandra Colas, Emilie Ervilus, Mégane Régina, and Sarah Bouchard (URC/CIC Paris Descartes Necker Cochin, Paris, France) for their help in the protocol management. This project was funded by a grant from Necker-Enfants Malades Hospital (Assistance Publique–Hôpitaux de Paris, Clinical Research and Innovation Delegation) and is registered at ClinicalTrials.gov (ID: NCT03274050).
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No sources of funding were used to assist in the preparation of this study.
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Thomas Blanc is an official proctor for Intuitive Surgical. Laurent Fourcade has a financial relationship with Intuitive Surgical as a proctor, helping teams performing robotic surgery. Pierre Meignan, Nicolas Vinit, Quentin Ballouhey, Lucas Pio, Carmen Capito, Caroline Harte, Fabrizio Vatta, Louise Galmiche-Rolland, Véronique Minard, Daniel Orbach, Laureline Berteloot, Cécile Muller, Jules Kohaut, Aline Broch, Karim Braik, Aurélien Binet, Yves Heloury, Hubert Lardy, and Sabine Sarnacki have no conflicts of interest to declare.
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The original online verion of this article was revised: Luca Pio’s given name was corrected.
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Blanc, T., Meignan, P., Vinit, N. et al. Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors—A Nationwide Experience. Ann Surg Oncol 29, 1315–1326 (2022). https://doi.org/10.1245/s10434-021-10777-6
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DOI: https://doi.org/10.1245/s10434-021-10777-6