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DOI: 10.1055/s-0034-1396902
Introduction to the Review Papers Series on Novelties and State of the Art in Pediatric Surgical Oncology
Publikationsverlauf
Publikationsdatum:
24. Dezember 2014 (online)
![](https://www.thieme-connect.de/media/ejps/201406/lookinside/thumbnails/10.1055-s-0034-1396902-1.jpg)
The current issue of the European Journal of Pediatric Surgery (EJPS) is largely devoted to pediatric surgical oncology. There have been several invited contributions from well-known experts representing leading institutions from various countries, including Dr. Michael LaQuaglia from Memorial Sloan Kettering Center in United States, Professor Jan Godzinski from Poland (surgical chair of the SIOP Renal Tumors Study Group), or Dr. Giovanni Cecchetto from Italy (former president of the International Society of Pediatric Surgical Oncology).
They present literature reviews and current state of the art in various areas: new imaging modalities in pediatric oncology, role of minimally invasive surgery in the treatment of solid tumors, surgical approach to neuroblastoma (NB), surgical approach to Wilms tumor, review of surgical techniques in bladder-prostate rhabdomyosarcoma, initial experiences with sentinel biopsy in pediatric patients, and advances in fibrolamellar hepatocellular carcinoma.
In the past decade, there has been tremendous progress in the field of translational research in pediatric oncology, namely, in the fields of immunology, molecular biology, and genetics. These efforts can lead to incorporation of genetic and molecular factors into risk-group assignments, identification of involved genetic pathways, and ultimately should lead to the development personalized medical oncology approach. Because of significant improvement in overall survival rates in pediatric solid tumors, the focus has been shifted to achieve good functional results, avoid late treatment sequelae, and improve quality of life without compromising current survival rates. This can be contributed not only by a better cooperation between various study groups at a truly international level but, first of all, by progress in surgical approaches and standardization of surgical care.
Although it seems that the progress in pediatric oncologic surgery has stabilized and not paralleled fully the heights of translational research, a very significant progress has been achieved in the field of imaging. This is summarized in a review written by Alex Towbin and Derek Roebuck. They particularly focus on quantitative imaging modalities, that is, positron emission tomography-computed tomography (PET-CT), diffusion weighted imaging—magnetic resonance imaging (MRI), as well as other MRI new techniques: whole body imaging and hepatocyte-specific contrast agents.
In the current issue of EJPS, the reader may also update the knowledge on a current role of videosurgery in biopsy and removal of solid tumors located within the abdomen and the chest, which is based on a systematic and detailed review of articles published between 2009 and 2014 and focusing on indications and results of the technique. Minimally invasive surgery (MIS) is a relatively new field in pediatric surgical oncology with no randomized trials available, hence only case-control studies can be used to assess its noninferiority to open approach. It seems to be efficient and safe, at least in experienced hands. Nevertheless, the need for an absolute respect of oncological rules should be underlined. However, to assess its place in pediatric oncology in a reliable manner, a long-term follow-up is mandatory.
In another article, the risk- and function-adapted surgical approach to Wilms tumor is presented. Special stress is put on nephron sparing surgery, as well as guidelines on minimally invasive nephrectomy, which should not be viewed as competitive to partial nephrectomy in unilateral tumors but rather complimentary. What is important is that the prognosis is not only risk factors (tumor rupture, lymph nodes involvement, and tumor volume and its histology) related, but also surgeon's dependent. Specifically, an importance of lymph nodes sampling is underlined.
Another review by Dr LaQuaglia deals with the role of surgery in NB which is a broad and controversial topic with various confliction opinions of international leaders. Dr. LaQuaglia is one of the most renowned experts in this area. Although the surgical treatment of NB varies greatly depending on the risk group, in the past years, there have been several advancements in NB surgery and various recent studies have emphasized the importance of complete and near-complete resections in intermediate and high-risk disease. Otherwise surgical approaches to difficult thoracic and abdominal tumors, as well as the role for minimally invasive surgery in the management of NB, are presented.
Another review by Michael LaQuaglia deals with fibrolamellar hepatocellular carcinoma. Still little is known about the biology of this rare tumor. Recent progress in the development of serum markers, as well as insights into its molecular origin, and alternative therapeutic possibilities are presented with a complete surgical resection still being the cornerstone of the treatment.
In the article by P. Dall'Igna and G. Cecchetto, initial experience with sentinel lymph node biopsy is presented and discussed, including its technical details. It seems that it is a feasible and reliable technique that allows for a targeted sampling of regional lymph nodes. It leads to avoidance of aggressive operations or random biopsies, providing an accurate tumor staging without complications. However, its indications seem to be limited to selected cases of soft tissue sarcomas (STS), mainly alveolar rhabdomyosarcoma (RMS) of the extremities. In non-RMS STS, because of the rarity of lymph nodes involvement, this technique seems to be somehow less recommended.
Finally, a review of surgical approach to bladder/prostate RMS (B/P RMS) is presented by me and my colleagues. Treatment outcomes in children with B/P RMS have considerably improved in the last few decades with current multimodal therapy. The possibility to spare the bladder reaches approximately 40 to 60% with the present surgical approach. This is dependent, however, on the tumor localization and its response to chemotherapy. It seems that a combination of surgery and local brachytherapy is particularly effective and may increase the bladder salvage rate in difficult cases. Nevertheless, it needs to be stressed that functional long-term results seem to be far from ideal. They are adversely affected by the use of radiation therapy. Indications to pancystectomy are presented too, as well as various reconstructive techniques of the urinary tract are proposed and discussed.
I believe that aforementioned reviews will contribute to increased knowledge of the current standard of surgical care in the treatment of selected solid tumors in children, acquaintance of the audience with various surgical techniques applied worldwide, as well as recognition of future trends and new approaches that are being developed.