Cirugía mínimamente invasiva en Oncología Pediátrica. Experiencia en un centro terciario / Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience

Objetivos. Describir nuestra experiencia en el uso de técnicas de cirugía mínimamente invasiva (CMI) en un centro terciario con unidad específica de cirugía pediátrica oncológica. Material y métodos. Revisión retrospectiva de los pacientes intervenidos mediante técnicas de CMI en la unidad de cirugía oncológica pediátrica entre enero de 2011 y diciembre de 2014. Se consideraron procedimientos CMI las técnicas realizadas tanto por toracoscopia como por laparoscopia y con intención tanto diagnóstica como terapéutica. Resultados. Durante el periodo de estudio se realizaron 56 procedimientos de CMI, 4 fueron diagnósticos y el resto terapéuticos. Por tipos de técnica, 13 fueron toracoscópicos (7 metastasectomías, 6 masas torácicas) y 43 laparoscópicos (3 masas hepáticas, 3 masas pancreáticas, 7 masas abdominales, 2 masas ováricas, 2 tiflitis, 1 masa esplénica y 25 ooforectomías para criopreservación ovárica). En 5 casos (2 masas torácicas, 1 masa pancreática y 2 masas abdominales) fue necesaria la conversión a cirugía abierta para finalizar el procedimiento (2 por precaución ante la falta de control vascular, 1 por sangrado y 2 por falta de espacio). En todos los casos se respetaron los principios de seguridad en cirugía oncológica. Conclusiones. Si se realiza una selección adecuada de los pacientes, las técnicas de CMI son seguras, reproducibles y cumplen los objetivos de calidad de la cirugía oncológica

Aims. To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Methods. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. Results. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Conclusions. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery

[Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience]. / Cirugía mínimamente invasiva en Oncología Pediátrica. Experiencia en un centro terciario.

AIMS: To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. METHODS: Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. RESULTS: 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. CONCLUSIONS: Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

OBJETIVOS: Describir nuestra experiencia en el uso de técnicas de cirugía mínimamente invasiva (CMI) en un centro terciario con unidad específica de cirugía pediátrica oncológica. MATERIAL Y METODOS: Revisión retrospectiva de los pacientes intervenidos mediante técnicas de CMI en la unidad de cirugía oncológica pediátrica entre enero de 2011 y diciembre de 2014. Se consideraron procedimientos CMI las técnicas realizadas tanto por toracoscopia como por laparoscopia y con intención tanto diagnóstica como terapéutica. RESULTADOS: Durante el periodo de estudio se realizaron 56 procedimientos de CMI, 4 fueron diagnósticos y el resto terapéuticos. Por tipos de técnica, 13 fueron toracoscópicos (7 metastasectomías, 6 masas torácicas) y 43 laparoscópicos (3 masas hepáticas, 3 masas pancreáticas, 7 masas abdominales, 2 masas ováricas, 2 tiflitis, 1 masa esplénica y 25 ooforectomías para criopreservación ovárica). En 5 casos (2 masas torácicas, 1 masa pancreática y 2 masas abdominales) fue necesaria la conversión a cirugía abierta para finalizar el procedimiento (2 por precaución ante la falta de control vascular, 1 por sangrado y 2 por falta de espacio). En todos los casos se respetaron los principios de seguridad en cirugía oncológica. CONCLUSIONES: Si se realiza una selección adecuada de los pacientes, las técnicas de CMI son seguras, reproducibles y cumplen los objetivos de calidad de la cirugía oncológica.

Tumores benignos esplénicos en la edad pediátrica / Pediatric splenic benign tumors

Los tumores esplénicos primitivos benignos en la edad pediátrica son poco frecuentes. Se presentan tres casos: un hamartoma de pulpa roja en un niño de 4 años que cursó con esplenomegalia y déficit inmunológico, y dos quistes simples de revestimiento mesotelial que presentaron espleno megalia. Se realiza una revisión de la literatura respecto a sus características epidemiológicas, diagnósticas y terapéuticas (AU)

[Evolution of conservative treatment in traumatic spleen injuries. Report of 54 cases]. / Evolución en el tratamiento conservador de las lesiones esplénicas traumáticas: presentación de 54 casos.

The spleen is the organ most frequently affected in abdominal trauma. Conservative treatment of traumatic spleen injuries is already generally accepted, avoiding surgery whenever possible. We present a wide serie (54 cases) of traumatic spleen injuries along a period of ten years (1990-2000) during which 83% of these were solved with conservative therapy we analyse our treatment procedure and post-treatment follow-up of these patients.

Evolución en el tratamiento conservador de las lesiones esplénicas traumáticas: presentación de 54 casos / Evolution of conservative treatment in traumatic spleen injuries. Report of 54 case

El bazo es el órgano que con más frecuencia se afecta en los traumatismos abdominales. En la edad pediátrica el tratamiento conservador de las lesiones esplénicas traumáticas está ya generalmente aceptado, evitando la cirugía siempre que sea posible. Presentamos una amplia serie (54 casos) de lesiones esplénicas traumáticas, en un período de 10 años (1990-2000), en la que el 83% delas mismas se resolvieron con tratamiento conservador. Analizamos nuestra pauta de tratamiento y seguimiento en estos enfermos (AU)

[Surgical treatment of pediatric pulmonary metastases]. / Tratamiento quirúrgico de las metástasis pulmonares pediátricas.

OBJECTIVE: We comment and update the surgical treatment for pulmonary metastases (PM) within a multidisciplinary approach for paediatric cancer. MATERIAL AND METHODS: We analyse patients with PM who have been operated between 1976-1996. Scientific literature published in the last 25 years (Cancerlit and Medline) was reviewed. RESULTS: PM from 13 patients were removed. Seven were males and 6 females with a mean age 5 4/12 years (range: 11 months- 12 3/12 years). Diagnoses were Wilms' tumour (7), osteosarcoma (3), Ewing sarcoma (1), rabdomiosarcoma (1), Yolk sac tumour (1). PM were unilateral in 7 cases and bilateral in six cases. PM appeared synchronically in four patients and metacronically in nine cases (3 of these after chemotherapy). All patients received chemotherapy and four of them local radiotherapy. Surgery consisted on radical segmentectomy and only one patient needed lobectomy due to a local relapse. Nowadays five patients (38%) are in complete remission with a mean follow-up from surgery of 11 11/12 years (range: 6 3/12-20 years). CONCLUSIONS: Metastasectomy is an important surgical technique in global treatment of children with PM and for a selected group of patients it can offer the only opportunity for curation.

[Pancreatitis and pancreatic pseudocysts in children: a 12-year review]. / Pancreatitis y pseudoquistes pancreáticos en la infancia: revisión en 12 años.

Pancreatitis in children is uncommon, but can be associated with severe morbidity rates. Eleven patients (14 months to 9.5 years of age) with acute pancreatitis and one patient with chronic idiopathic pancreatitis beginning the second year of life, were treated over a 11-year period. Half of them had history of blunt abdominal trauma. The most frequent clinical presentations included abdominal pain and vomiting. Diagnosis of pancreatic injury was suggested by hypera-amylasemia, being the computerized tomography scan the most useful radiologic investigation. Medical treatment consisted of intravenous fluids, nasogastric suction and total parenteral nutrition. One third of the patients developed pancreatic pseudocysts (4); spontaneous resolution after observation and conservative therapy occurred in two and the others were treated by surgery. Ranson and Imrie scores can help predicting the severity of this disease in children; three of four pancreatic pseudocysts were judged to have severe pancreatitis by this criteria.

[Neonatal tumors]. / Tumores neonatales.

We review the cases of congenital and neonatal tumors treated at the Children's Hospital La Fe, Valencia. A total of 25 cases of neonatal benign tumors and 27 cases of malignant tumors were diagnosed. The most frequent benign tumor was solid teratoma (12 cases). The most frequent malignant tumor was neuroblastoma (14 cases). Variations in histology, clinical evolution and therapy in relation to age are described. The results obtained are compared with those previously published.

[Laparoscopy in pediatrics]. / Laparoscopia en pediatría.

Laparoscopy has been performed in 68 infants and children. In 50 cases of non-palpable testis; 7 cases of liver diseases; 4 cases of abdominal trauma; 7 cases for various other indications. In our experience, laparoscopy was a considerable advantage in the diagnosis and management of a number of pediatrics disorders.

[Gastric duplication. Presentation of 4 cases localized in the antropyloric region]. / Duplicación gástrica. Presentación de cuatro casos localizados en región antropilórica.

Gastric duplications are very rare, especially those located at the pyloric region. Four cases are reported with gastric duplication in patients of two days, eight months, two and a half and three and a half years old, a review is made including symtomatology, diagnostic, treatment and anatomopathological studies. In all four cases post-operative evolution was satisfactory.

[Treatment of portal hypertension in children]. / Tratamiento de la hipertensión portal en la infancia.

Esophageal transection by means of an anastomotic clip or button is a simple and useful approach to the management of haemorrhage due to esophageal varices. We have used this technique in four cases (three Prioton clips, and one autosuture) and completed the procedure with periesophageal, left gastric and fundal veins ligation. The patients have been followed up for periods ranging between five months and six years. No one has rebled. Splenoportographic controls showed good results of disconnection, and endoscopic follow up revealed variceal cure. There was no GER and in one single case we had to dilate for mild stenosis. This is a simple and effective procedure for the control of variceal haemorrhage in the short and middle ranges, and can induce cure directing portal flow through other alternative ways.

[Benign tumors of the spleen in pediatrics]. / Tumores benignos del bazo en Pediatría.

Primitive bening spleen tumors are very rare in pediatrics. They can be solid or cystic. Authors report two cases of spleen tumors: one hamartoma of red pulp in a 4 1/2 year old male, with symptoms of an enlarged spleen and immunological deficit; and the other case a simple cyst, that developed as an enlarged spleen, lined by mesotelium. Based on this experience, they comment on frequency, clinical and radiologic diagnosis, pathology and treatment of these tumors.

[Cystic lymphangioma of the scrotum]. / Linfangioma quistico de escroto.

The authors present a case of cystic lymphangioma of the scrotum. They stress the rarity of this location. They also comment upon the embriology, clinical picture and treatment of these benign tumours.