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

  • Pediatric Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 02 October 2021

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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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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).

Funding

No sources of funding were used to assist in the preparation of this study.

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Author notes

  1. Thomas Blanc and Pierre Meignan have contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Thomas Blanc MD, PhD, Pierre Meignan MD, Nicolas Vinit MD, Luca Pio MD, Carmen Capito PhD, Fabrizio Vatta MD, Cécile Muller PhD, Jules Kohaut MD, Aline Broch MD, Yves Heloury PhD & Sabine Sarnacki PhD

  2. Université de Paris, Paris, France

    Thomas Blanc MD, PhD, Yves Heloury PhD & Sabine Sarnacki PhD

  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 MD, PhD

  4. Department of Pediatric Surgery, Hôpital Clocheville, Tours, France

    Pierre Meignan MD, Karim Braik MD, Aurélien Binet MD & Hubert Lardy PhD

  5. Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France

    Quentin Ballouhey PhD & Laurent Fourcade PhD

  6. Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Caroline Harte MD

  7. Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Louise Galmiche-Rolland PhD

  8. Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France

    Véronique Minard PhD

  9. Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France

    Daniel Orbach PhD

  10. Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Laureline Berteloot MD

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  1. Thomas Blanc MD, PhD
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Corresponding author

Correspondence to Thomas Blanc MD, PhD.

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Disclosures

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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