Place de la chirurgie mini-invasive dans la prise en charge du neuroblastome de l'enfant

Since the 1990s, minimally invasive surgery has gradually emerged as a therapeutic alternative to open surgery approach in the management of pediatric tumors, not only for diagnostic purposes by performing biopsy, but also for therapy with complete resection of the tumor. This literature review has analyzed more specifically the role of minimally invasive surgery in the treatment of neurogenic tumors in children, differentiating the thoracoscopic and laparoscopic approach. A biopsy was performed in 14 patients by thoracoscopy and in 64 by laparoscopy, obtaining the histology of the tumor in 100 % of cases. One hundred and twenty-one patients having a thoracic neurogenic tumor underwent a thoracoscopic resection. Mean operative time was 150 minutes with a conversion rate of 3.5 %. The most frequent complications were chylothorax and Horner's syndrome. A total of 233 patients underwent a laparoscopy to remove an abdominal tumor. Mean operative time was 125 minutes with a tumor diameter around 3-4 cm. The conversion rate was 10 %, related to bleeding risk and exposure difficulties. The implementation of the new classification INRGSS (International Neuroblastoma Risk Group Staging System) allowed to have a more standardized approach, the emergence of Image-Defined Risk Factors as a predictor of complete resection of the tumor and the anatomical location of the tumor became two main parameters in the surgical decision-making process.