RESUMEN
OBJECTIVE: To present the experience of laparoscopic nephrectomies and kidney resections in children. MATERIAL AND METHODS: There were 28 minimally invasive surgeries for renal tumors between July 2015 and March 2023 (92 months). There were 16 (57%) boys and 12 (43%) girls who underwent 22 nephrectomies and 6 kidney resections. The median age of patients was 54 (38; 76.5) months. RESULTS: In the laparoscopic nephrectomy group, the median surgery time was 135 (108-188) min, blood loss - 10 (3.75-15) ml. Total resection was confirmed in all patients. In the group of minimally invasive kidney resections, these values were 182.5 (157.5; 265) min and 50 (42.5; 117.5) ml, respectively. Histological examination confirmed total resection in all patients. In both groups, none patient developed postoperative complications. Event-free survival was 86.72% with a median follow-up of 82 months, and local recurrence-free survival was 95.8% with a median follow-up of 89.8 months. CONCLUSION: Minimally invasive nephrectomies and resections are safe in children in case of careful patient selection.
Asunto(s)
Neoplasias Renales , Riñón , Laparoscopía , Nefrectomía , Humanos , Masculino , Femenino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Nefrectomía/métodos , Nefrectomía/efectos adversos , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Niño , Preescolar , Riñón/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tempo Operativo , Resultado del Tratamiento , Evaluación de Procesos y Resultados en Atención de Salud , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Federación de Rusia/epidemiologíaRESUMEN
Liver resections with transplantation technologies have been recognized as safe procedures for the last decades. These procedures may be the only curative option or alternative to liver transplantation in some cases. Moreover, these surgeries can also provide parenchyma-sparing liver resection. Nevertheless, higher postoperative morbidity and mortality compared to traditional hepatectomy require careful research of indications for liver resections with transplantation technologies, the role of vascular liver exclusion, methods of vascular reconstructions with or without anticoagulation. These challenges are more important for pediatric surgery due to few literature data on this issue. This review is devoted to liver resections with transplantation technologies.
Asunto(s)
Hepatectomía , Neoplasias Hepáticas , Humanos , Niño , Hepatectomía/efectos adversos , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Hígado/cirugía , Hígado/irrigación sanguínea , Vena Cava Inferior/cirugía , Venas Hepáticas/cirugíaRESUMEN
OBJECTIVE: To analyze the initial data on future liver remnant volume and its function evaluated by 99mTc-Bromesida hepatobiliary scintigraphy in children with liver tumors. MATERIAL AND METHODS: Extended liver resections were performed in 58 patients aged 2 months - 208 months (median 26 months) for various neoplasms. Before hepatectomy, all children underwent contrast-enhanced CT with volumetry and hepatobiliary scintigraphy with 99mTc-Bromezida and subsequent quantitative assessment of its accumulation in the future liver remnant. All consecutive patients eligible for extended liver resection were retrospectively analyzed. RESULTS: The analysis included patients who underwent extended liver resection between June 2017 and March 2021. Among 91 liver resections, 58 (64%) procedures were extended hepatectomies including 2 ALPPS procedures. Median volume of future liver remnant was 44.5% (16.5-91.4), median future liver remnant function - 10.14%/min/m2 (1.8-30). Four patients with adequate liver function had insufficient volume of future liver remnant. Insufficient future liver remnant volume and its appropriate function were observed in 2 patients. Not life-threatening post-resection liver failure developed in 2 patients. CONCLUSION: Evaluation of future liver remnant function is the most sensitive method to predict post-hepatectomy liver failure in children. The cut off value of future liver remnant volume in children is below 25% and probably below 16.5%. Further data collection and research are warranted to determine significant values. These data will contribute to define the new indications for two-staged hepatectomies in children.