Retroperitoneoscopic para-aortic lymph node sampling in bladder rhabdomyosarcoma

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S88 PURPOSE

ESPU Programme 2009

To present our experience with laparoscopic radical nephrectomy in children with Wilms’ tumor.

are sectioned. A lymphatic sample is obtained from the peri-hilar region. The tumoral kidney is removed through a Pfannenstiehl incision. The incision and accesses are closed without drainage.

MATERIAL AND METHODS

RESULTS

Fifteen selected children with nonmetastatic unilateral Wilms’ tumor, with preoperative chemotherapy and significant reduction in the tumoral size, were submitted to laparoscopic radical nephrectomy. After colonic and hepatic (or splenic) mobilization, the kidney is exposed and the renal vessels dissected and sectioned. After ureteral section, the kidney is dissected with its perirenal fat, and the adherences to the neighboring structures

The patients aged 10-108 months (~47.2) and weighed 8-27 kg (~18.2). Removal of the tumoral kidney and lymphatic samples was possible in all cases. The formation of a tumoral capsule, due to preoperative chemotherapy, allowed the safe mobilization of the kidney, preventing rupture. There was no bleeding nor injury to the neighboring structures. Mean operative time was 149.6 min. (120-180). The weight of the

specimen was ~124.7g (55-234). Postoperative course was uneventful and discharge varied from 2-3 days. Adjuvant chemotherapy was made in all patients, and there were no recurrences. All resected kidneys had a pre-operative tumoral diameter on CT less than 10% of the children’s height.

CONCLUSIONS Laparoscopic radical nephrectomy is a feasible and safe alternative in the treatment of non-metastatic unilateral Wilms’ tumor after chemotherapy, with significant advantages over open surgery, considering the post-operative course and cosmesis.

# S15-2 (O) RETROPERITONEOSCOPIC PARA_AORTIC LYMPH NODE SAMPLING IN BLADDER RHABDOMYOSARCOMA Naima SMEULDERS, Simon BLACKBURN and Abraham CHERIAN Great Ormond Street Hospital NHS Trust, Paediatric Urology, London, UNITED KINGDOM

Determining lymph node status is an important step in the pre-treatment evaluation of clinically or radiographically positive nodes in non-metastatic rhabdomyosarcoma. We describe retroperitoneoscopy for para-aortic lymph node biopsy in a four year-old boy with embryonal rhabdomyosarcoma of the bladder with pelvic and para-aortic lymph node enlargement on MRI.

prone. Three 5mm ports were sited in the left loin: below the tip of the 12th rib, along the lateral border of the erector spinae muscles and above the iliac crest. A working space was developed superficial to Gerota’s fascia using the Gaur balloon technique. Minimal further blunt and sharp dissection permits displacement of the left kidney anteriorly and exposure of the distal aorta to the bifurcation. Para-aortic lymph nodes were dissected and placed in a cut finger of a powder-free glove for safe extraction.

MATERIAL AND METHODS

RESULTS

Enlarged pelvic lymph nodes were sampled using a separate laparoscopic transperitoneal procedure. The patient was then placed

Histology demonstrated reactive changes in the para-aortic lymph nodes only. Rhabdomyosarcoma was confirmed in the

INTRODUCTION

local pelvic nodes. On the third postoperative day, the patient commenced 9 weeks of ifosfamide, vincristine and actinomycin D chemotherapy.

CONCLUSIONS This is the first report of retroperitoneoscopy for para-aortic lymph node biopsy in children with rhabdomyosarcoma of the bladder. This technique affords access to the distal aorta using minimal dissection, permitting quick recovery and early commencement of chemotherapy.

# S15-3 (O) LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL CANCER IN CHILDREN Francois VARLET1, Emmanuelle GUYE1, Michel FRANCOIS1 and Manuel LOPEZ2 1

University Hospital of Saint Etienne "Hoˆpital Nord, Department of Pediatric Surgery, Saint Etienne, FRANCE, 2university hospital of Saint Etienne "Hoˆpital Nord, Pediatric Surgery, Saint Etienne, FRANCE

PURPOSE

MATERIAL AND METHODS

We report our preliminary experience in the treatment by Laparoscopic Radical Nephrectomy (LRN) for unilateral renal cancer in children.

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

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