Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience

Thomas Blanc^#^{1

2

3}, Pierre Meignan^#^{4

5}, Nicolas Vinit⁴, Quentin Ballouhey⁶, Luca Pio⁴, Carmen Capito⁴, Caroline Harte⁷, Fabrizio Vatta⁴, Louise Galmiche-Rolland⁸, Véronique Minard⁹, Daniel Orbach¹⁰, Laureline Berteloot¹¹, Cécile Muller⁴, Jules Kohaut⁴, Aline Broch⁴, Karim Braik⁵, Aurélien Binet⁵, Yves Heloury^{4

12}, Laurent Fourcade⁶, Hubert Lardy⁵, Sabine Sarnacki^{4

12}

Affiliations

¹ Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. thomas.blanc@aphp.fr.
² Université de Paris, Paris, France. thomas.blanc@aphp.fr.
³ Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France. thomas.blanc@aphp.fr.
⁴ Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Department of Pediatric Surgery, Hôpital Clocheville, Tours, France.
⁶ Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France.
⁷ Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁹ Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France.
¹⁰ Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France.
¹¹ Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹² Université de Paris, Paris, France.

^# Contributed equally.

PMID: 34523002
DOI: 10.1245/s10434-021-10777-6

Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience

Thomas Blanc et al. Ann Surg Oncol. 2022 Feb.

. 2022 Feb;29(2):1315-1326.

doi: 10.1245/s10434-021-10777-6. Epub 2021 Sep 14.

Authors

Affiliations

¹ Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. thomas.blanc@aphp.fr.
² Université de Paris, Paris, France. thomas.blanc@aphp.fr.
³ Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France. thomas.blanc@aphp.fr.
⁴ Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Department of Pediatric Surgery, Hôpital Clocheville, Tours, France.
⁶ Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France.
⁷ Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁹ Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France.
¹⁰ Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France.
¹¹ Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹² Université de Paris, Paris, France.

^# Contributed equally.

PMID: 34523002
DOI: 10.1245/s10434-021-10777-6

Erratum in

Correction to: Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience.
Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Blanc T, et al. Ann Surg Oncol. 2021 Dec;28(Suppl 3):901. doi: 10.1245/s10434-021-10861-x. Ann Surg Oncol. 2021. PMID: 34601667 No abstract available.

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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References

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Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience

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Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience

Authors

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Erratum in

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References

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Medical