CC BY
15
May 2016, Moscow, Russia
OF PEDIATRIC HEMATOLOGY and ONCOLOGY
TREATMENT AND CARE
SURGERY
ABSTRACT NO.: 0-077
Venous access in treating children with cancer: a 6-year experience of a single institution
M. Rykov, V. Polyakov
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia Key words: pediatric oncology, chemotherapy, venous access, implantable venous ports, central vein catheterizations
Introduction. The treatment of any oncologic disease is impossible without a venous access. What kind of properties should it possess? It has to be safe, easy to use, implanted only once during the treatment course and have minimal risks associated with implantation and use. Aim. Prevention of complications of intravenous chemotherapeutic agent administration.
Materials and methods. From 2010 to 2015 we were monitoring the treatment of 2286 children (3 months - 17 years) with oncologic diseases. 2099 (91.8 %) patients underwent 3930 subclavian vein catheterization, 187 (8.2 %) patients - 187 venous ports implantations.
Results. When installing the subclavian catheters intraoperative ultrasound navigation was performed in 23 (0.6 %) cases, intraoperative fluoroscopy was not used. For the implantation of port systems, ultrasound and fluoroscopy navigation used in all cases. Complications and technical difficulties during catheter insertion were observed in 98.3 % of cases, during venous port implantation - in 23 % of cases. Complications of subclavian catheter and venous port use were observed in 97.3 % and in only 11 % of cases, respectively. Subclavian catheters compromised cancer treatment in 45.9 % of patients, implantable venous ports - in 1.7 % of patients. Each patient with a subclavian catheter underwent central venous catheterization 4 to 19 times (mean 6 times) during treatment. Catheter dwell time exceeded the recommended limit in all patients except for cases of catheter removal by patients. On multiple occasions all patients were discharged with a subclavian catheter in place.
Conclusion. Venous ports obviously match the criteria mentioned in the introduction. Subclavian catheter use resulted in cancer treatment protocol deviation in almost 50 % of cases, thus leading to a poorer prognosis and significantly increasing the number of invasive procedures and instances where general anesthesia was needed.
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ABSTRACT NO.: 0-080
Venous access in the treatment of children with cancer: results of a multicenter study
M. Rykov1, N. Grigorieva2, A. Ulanova2, I. Volihin2, V. Kochkin3, I. Turabov2, V. Polyakov1
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia; Arkhangelsk regional children's clinical hospital named after P.G. Vyzhletsov, Russia; 3Russian Children's Clinical Hospital, Moscow, Russia
Key words: pediatric oncology, venous access, implantable venous port-systems, subclavian catheters
Introduction. The results of Russia's first multicenter study of the use of venous port systems for the treatment of patients with cancer.
Aim. Prevention of complications of intravenous chemotherapeutic agent administration at pediatric oncology.
Materials and methods. From 2006 to 2015 we were monitoring the treatment of463 children (aged 3 months to 17 years) with oncologic diseases. This patients underwent venous port implantations (IVPs).
Results. In 463 cases during insertion of 463 IVPs the following complications and technical difficulties were present.
1. Unintended puncture of the common carotid artery (CCA) during the puncture of the IJV - 19 cases (4.3 %).
2. Retrograde positioning of the distal end of the guidewire in the IJV - 67 cases (14.4 %).
3. Placement of the distal end of the guidewire into the punctured SV - 35 cases (7.6 %).
4. Difficulties driving the guidewire into the IJV after successful puncture - 43 cases (9.3 %).
5. Retrograde port catheter positioning in the IJV during ECG-guided implantation - 8 cases (1.7 %).
Despite the use of intraoperative fluoroscopy, there have been cases of the retrograde positioning of the distal end of the guidewire in the IJV due to the peculiarities of topographic anatomy of children. However, visual inspection in all cases facilitated intraoperative adjustments of these complications. The use of 463 IVPs was complicated by the following.
1. Venous port contamination - 11 cases (2.5 %).
2. Occlusion of the IVP by a thrombus - 23 cases (5 %).
3. Subcutaneous fat layer thinning above the port chamber - 7 cases (1.7 %).
Venous port contamination was caused by violation of rules of operation - Huber needle clinicians used more than a month without replacement. This resulted in infection of the tissues around the port chamber. This has resulted in the removal of the IVP. Subsequently, these patients were implanted port systems on the opposite side. Conclusion. IVPs are safe, implanted only once during the treatment course and have minimal risks associated with implantation and use. Unfortunately, in the Russian port systems are used only in several hospitals.
ABSTRACT NO.: 0P-087
Possibilities of endosurgery in diagnosis of tumor diseases of thoracic and abdominal localization at children
D. Rybakova, А. Kazantsev, P. Kerimov, M. Rubanskiy, A. Khizhnikov
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia
Key words: endosurgery, children oncology
Introduction. Use of endosurgery in the diagnostic purposes is directed on specification of nature of the changes revealed at noninvasive methods of research, receiving enough tumor material for all types of morphological research and an assessment of prevalence of process. Diagnostic endosurgery is successfully approved in adult oncology and there are data on use of this method in children oncology in foreign literature.
Aim. To define possibilities of endosurgery in diagnosis of tumor of thoracic and abdominal localization at children.
Materials and methods. in our institute endosurgery operations at patients with various tumor pathology are regularly performed since 2007. From 2007 to 2012 with the diagnostic purpose it is carried out the 160th operation at 153 children, from which 63 laparoscopic and 44 thoracoscopic biopsies. Except diagnostic biopsies it was executed ^ 53 thoracoscopic resections of lungs at 51 children for the purpose of diagnostics of progressing of a disease, confirmation of metastatic defeat or inflammatory process that made
3 33 % of all diagnostic operations.
Results. The age of patients varied from 2 months to 19 years. The ratio on a floor was approximately equal: boys was - 76 (49.7 %), girls - 77 (50.3 %). And children about one year there were 9.8 % (15 children). Duration the thoracoscopic and laparoscopic biopsies made from 20 minutes to 260 minutes, on average 59 minutes. Blood loss during diagnostic operations averaged 78.3 ml. Intraoperative complications are in 5 cases, and postoperative in - 8. After the endosurgery operations at 59.3 % of patients special treatment was carried out, 7.4 % had a repeated operation, but already in radical volume and in 33.3 % were written out on continuation treatment in a residence or in profile establishment. Terms of an initiation of treatment of special treatment varied from several hours to 20-30 days because of complications during operation. The average time of the beginning of special treatment made 4 days.
Conclusion. Advantages of use of endosurgery in children's oncology are: early terms of the beginning of special treatment, small injury, the minimum blood loss, low number of postoperative complications, early activation of the patient and reduction of terms staying in a hospital, good cosmetic effect. Performance the endosurgery of operations at children with malignant tumors it is possible aged from several weeks, thus the oncological principles of performance of surgery aren't broken, and also the age of the child isn't the limiting
i_ factor for performance the endosurgery of operations.
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OF PEDIATRIC HEMATOLOGY and ONCOLOGY
ABSTRACT NO.: 0P-088
Surgical treatment of children with solid pseudo papillary tumors of the pancreas
D. Rybakova, A. Kazantsev, P. Kerimov, M. Rubanskiy, A. Khizhnikov
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia
Key words: solid pseudopapillary tumor, laparoscopy, endosurgery
Introduction. Solid pseudopapillary pancreatic tumor (SPT) are rare neoplasms of low malignant potential, account for less than 3 % of the tumors. Aim. To determine the tactics and the possibility of surgical treatment of children with SPT pancreas.
Materials and methods. From 2007 to 2015 operated on 11 children diagnosed with pancreatic SPT. We analyzed the clinical and diagnostic data, the volume of transactions, the results of treatment and during follow-up.
Results. All patients were girls aged 9 to 15 years (mean age 12 years). The disease in most cases was bessiptomnoe, but have 2 children experienced pain in the epigastric region, and 1 child had nausea and vomiting. According to a survey in 5 patients tumor was located in the tail of the pancreas, in 3 - body 3 and - in the head. The maximum size of the tumor was 8.7 sm in diameter and located in the head of the pancreas. In 5 children underwent laparoscopic distal pancreatectomy, in 2 - gastropancreatoduodenal resection , from 2 -central pancreatic resection, and 1 case is made distal subtotal resection of the pancreas, resection hooklike process pancreatic resection with duodenal wall. Operation time was from 90 to 290 minut maximum blood loss left 200 ml. Complications occurred in 6 patients: 4 cases - postoperative pancreatitis with pancreatic fistula formation, bleeding in 1 pancreatic branches of the splenic artery in 1 case - pneumonia. The follow-up of patients 8 years and 1 month. All patients were alive without evidence of disease recurrence. Conclusion. SPT the pancreas is a rare disease in children, which usually occurs in girls' puberty. The main treatment is surgery, the use of endosurgical possible, but very strictly necessary to define the indications for this type of treatment and the risk of postoperative complications.
ABSTRACT N0.: 0-119
The use of a single endoscope access at neoplasms of internal genital organs in girls
V.B. Makhonin1, R.R. Bayramgulov1, 2, V.U. Sataev2, S.Yu. Muslimova2, V.A. Paramonov1, R. Hasanov2
Republican Children Clinical Hospital, Ufa, Republic of Bashkortostan; 2Bashkirian State Medical University, Ufa, Republic of Bashkortostan
Key words: SILS, endosurgery, YST, myoma
Introduction. Pediatric endoscopic surgery continues to evolve, improving the quality of life of the patient in the postoperative period. NOTES technology was presented in a variety of studies by many surgeons, however, SILS-technology in our opinion is the most appropriate for children. The technique uses a single port introducing through the umbilical ring for the camera and 2 reticulators. This provides a minimally invasive approach, less traumatic and results in excellent cosmetic effect. Aim. To assess the the possibility of using NOTES in surgical gynecology in children.
Materials and methods. 17 endoscopic surgical procedures for tumors of the internal genital organs in girls using a set of SILS-TM Port (Covidien) and specialized tools was done in the clinic of pediatric surgery of the Bashkir State Medical University. Age of patients ranged from 12 to 15 years. All the girls standard preoperative examination was done. The structure of diseases: cysts and benign tumors of the ovary - 14, myoma - 2 and malignant ovarian tumor - 1 case.
Results. Surgical treatment was performed under endotracheal anesthesia. Technology of single laparoscopic approach allowed carrying out complete surgical procedure in all cases. The following operations were performed: cystectomy - 10, ovariectomy - 2, adnexectomy - 2, enucleation of the uterine myoma - 2 and separation of adhesions, resection of the omentum and biopsy of the peritoneum (a second-look-operation in patient with YST after 3 cycles of chemotherapy) - 1 patient. Conversions were not observed. In the postoperative period, there was no pain (narcotic analgesics not required), the lack of intra- and postoperative complications, reducing the time of staying patients in hospital (no ICU admissions, discharge at day 3-4 after the operation), high cosmetic results.
Conclusion. Thus, the use of a single laparoscopic approach has allowed to perform operations in an adequate extent in girls with tumors of internal genital organs, and has improved the results of treatment.
ABSTRACT N0.: 0P-131
Bronchial blockers in pediatric thoracic surgical oncology
L. Martynov, N. Matinyan, A. Saltanov
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia
Key words: pediatric oncology, bronchial blockers, one lung ventilation, thoracic surgery
Introduction. In pediatric oncology, the lungs are the most frequent target of metastasis of various malignant tumors, so diagnostic and therapeutic surgeries are required. Currently, video-assisted thoracoscopic surgery (VATS) techniques are performed for thoracic surgeries and biopsies, including mediastinum tumors. To guarantee optimal conditions for the surgery, collapse of operated lung is required, thus one lung ventilation (0LV) should be performed. Until recently, the separation of the lungs in younger children was performed using a single lumen endotracheal tube placed in main bronchus, in older children - with double-lumen tubes (DLT). The use of DLT in children can be traumatic and is often associated with
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pain in the throat and aphonia postoperatively. A newer devices for the lung separation, such as bronchial blockers (BB) Cohen, EZ-Blocker and Arndt allow to achieve lung collapse avoiding traumatisation of trachea and other complications. Our experience of use of BB in older children is presented. Aim. To improve the efficiency and safety of lung ventilation in thoracic surgical oncology in children.
Materials and methods. During September 2014 - January 2016, 32 surgeries in patients 10-17 years old were performed for lung resection and biopsies. OLV was achieved and mantained using BB. BB was introduced through the lumen of video endobronchial tube VivaSight-SL and was placed into the bronchus under continuous video control. Installation of Arndt BB was conducted under endoscopic control. In 14 cases (43 %) the right main bronchus was blocked, in 18 cases (57 %) - the left main bronchus was blocked. Lung ventilation was maintained in pneumoprotective mode. Time of BB installation, lung collapse score after installation of thoracoscopic ports, hemodynamics during surgery, the frequency of postoperative complications such as sore throat and aphonia were evaluated.
Results. The mean time of intubation and BB installation was 255 ± 88 seconds. In all cases it was possible to achieve satisfactory lung collapse, but in 10 cases aspiration of air through the channel of BB had to be performed. Ensuring the collapse of the right lung presents some difficulties due to the anatomical and physiological features as higher embranchement of the right upper lobe bronchus. In this case the use of EZ-Blocker BB is preferable as it is designed to provide stability with respect to carina, making it less likely to displace during surgery. In surgeries of the left lung the use of Cohen BB is more preferable.
Conclusion. The use of BB require expensive high-tech equipment for video or endoscopic control, and the well trained staff with skills of BB installation and maintaining OLV. Nevertheless, the use of BB in the thoracic surgery in pediatric oncology is a promising technique to achieve the effective collapse of the lung on the side of the operation with minimal traumatisation, fewer complications postoperatively and rapid rehabilitation of patients after anesthesia.
ABSTRACT NO.: P-132
Superselective ophtalmic arterial chemotherapy for retinoblastoma in children
I. Letyagin, N. Milaschenko, L. Martynov, N. Matinyan, A. Saltanov
Pediatric Oncology and Hematology Research Institute of N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia
Key words: retinoblastoma, ophthalmic artery, intraarterial melphalan, trigemino-cardiac reflex
Introduction. Superselective ophthalmic artery injection of chemotherapy with melphalan has significantly reduced the need for enucleation in patients with retinoblastoma. Aim. To describe our experience with superselective ophthalmic artery chemotherapy (SOAC) in retinoblastoma and to report the serious adverse cardio-respiratory reactions we have observed.
Materials and methods. Between February 2011 and March 2015 in Pediatric Oncology and Hematology Institute 54 eyes in 45 patients were treated. 17 patients with unilateral retinoblastoma and 28 patients with bilateral retinoblastoma were included in the study. 104 cases of catheterization procedures were performed using a standardized protocol for general anesthesia. All patients before procedure received heparin sulfate IV (30 IU-kg-1) and during procedure the same dose of heparin sulfate was administered. Results. There were no deaths or major complications. Adverse cardio-respiratory reactions developed during 15 procedures (14 %). All reactions occurred during second or subsequent catheterization procedures and were characterized by hypoxia, reduced lung compliance (the patients end tidal C02 (EtC02) decreased from 35 mmHg to 19 mmHg (normal 33-40 mmHg) followed by a subsequent deterioration in the oxygen saturation (Sp02) to 70 % (normal 97-100 %). Hypotension (BP 54/20 mmHg) and tachycardia (130-150 bpm) were also registered. The microcatheter was withdrawn and ventilation with 100 % oxygen was initiated. Adverse events were successfully treated during 10-15 min in all patients by vasopressor support with Phenylephrine (0,05-1 mcg/kg/min) and atropine sulfatis administration. One procedure was abandoned due to prolonged hemodynamic instability. 5 patients required prolonged vasopressor support in early postoperative period. In 3 cases children had an acute ishemic stroke, which was confirmed by MRI (treated quickly and effectively).
Conclusion. Adverse cardio-respiratory reactions are commonly observed in SOAC for retinoblastoma. We believe that the adverse clinical signs represent an autonomic reflex response, akin to the trigemino-cardiac or oculorespiratory reflexes, and all patients should be considered at-risk. Reactions occur only during second or subsequent procedures and can be life-threatening. The routine use of intravenous atropine does not seem to have altered the incidence or severity of these reactions. Anesthesiolgists and interventional neuroradiologists involved in SOAC must be vigilant to ensure adverse reactions, when they develop, are treat them quickly and effectively. The symptoms described may represent an acute onset of pulmonary hypertension mediated by release of vasoactive hormones or secondary to a vagal response triggered by stimulation of the ophthalmic artery. However, further investigations are needed to improve the understanding of the manifestations, management, and clinical significance of the described oculopulmonary reflex occured only during second or subsequent SOAC procedures.
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ABSTRACT NO.: OP-136
Microsurgical reconstruction of maxilla and mandible in patients with head and neck tumors - pediatric experience
N.S. Grachev1, S.V. Tereshchuk2, N.V. Babaskina1, I.N. Vorozhcov1, P.D. Pryanikov1, M.P. Kalinina1
1Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia; 2Main Military Clinical Hospital named after N.N. Burdenko, Moscow, Russia
Key words: microsurgery, free flap, maxilla reconstruction, mandible reconstruction
Introduction. 5 surgical operation with simultaneous microsurgical reconstructions of maxilla or mandible were performed in patients with head and neck tumors aged between
6 and 17 years in department of pediatric surgery and oncology in Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev.
OF PEDIATRIC HEMATOLOGY and ONCOLOGY
Aim. Considering good results of free flap reconstruction in children we hope to encourage extension of microsurgical treatment in pediatric practice. Materials and methods. 5 surgical operations were performed in patients with benign (3) and malignant (2) tumors of upper (1) and lower (4) jaws with simultaneous reconstruction with fibula (2) or ileac crest (3) osteomuscular free flaps. In all cases arterial and venous anastomosis were made, and osseous parts of free flaps were fixed to intact segments of jaw bones with medical hardware.
Results. Vascular anastomosis passability and free flap tissue viability were examined and proved in postoperational period in all cases. Postsurgical complications were revealed in 2 of 5 cases, in both cases microsurgical reconstruction was performed with iliac crest free flap. First case required wound revision on second postoperative day because of hematoma occurrence and finally resulted in wound contamination and partial necrosis of free flap bone part; in second case wound revision and fractional necrectomy were performed on 14 postoperative day because of partial osteomyelitis of free flap bone. In both cases we succeeded in avoiding total free flap removal and after stepwise wound revisions with local tissue reconstructions organ functionality was reached. Aesthetic and functional results of treatment including dental prosthetics in postoperational period promoted full social adaptation of patients. Post operation follow-up period in the time of writing ranges from 2 months to 1.5 years, in all cases no evidence of disease recurrence or continued tumor growth was revealed. Conclusion. Simultaneous microsurgical reconstruction allows combination of total tumor eradication and functional preservation that enables full rapid social adaptation of patient which is extremely important in children. Good blood supply and functionality of free flaps were maintained in all 5 cases including the two cases that required additional postoperative surgical sanitizing and reconstructive interventions. In child adequate free flap nutrition allows synchronous graft grow with bordering tissues so that multiple corrective surgical operations may become unnecessary to acquire optimal functional and aesthetic results.
ABSTRACT NO.: 0P-150
Minimally invasive surgery for the splenic lymphoma with splenomegaly
M.A. Teplyakova, A.V. Drey, V.A. Romanenko, O.I. Kit
Rostov State Medical University, Rostov-on-Don, Russia
Key words: minimally invasive surgery, splenomegaly, lymphoma
Introduction. Minimally invasive surgery has become the golden standard of care in the management of surgical diseases of the spleen. Such approach helps to reduce intraoperative and postoperative complications. Also, use of the method decreases intraoperative blood loss, shortens patient's recovery and hospital stay and can lead to better cosmetic outcomes. Aim. Our goal was to determine the indications for the use of intracorporeal shrinkage technique during laparoscopic splenectomy, to introduce the method into practice and to improve outcomes in patients with the splenic lymphoma.
Materials and methods. This method has been applied in 10 patients, 6 of whom were women and 4 men, the age of the patients was 27-35 years. Results. Splenic size and weight remain the most important criteria of patient selection for minimally invasive splenectomy and often these characteristics predict the success of laparoscopic splenectomy. Most authors report that size of craniocaudal axis more than 20-25 sm. is the limit of minimally invasive approach using. Spleen weight more than 2000 g. is the acceptable upper limit. For a successful management of patients with bigger spleen, hybrid technologies are used such as HALS (hand assisted laparoscopic splenectomy). Our method allows abandoning the use of hand assisted port, which need for HALS approach. We have achieved this result by using of liposactor. A cannula of liposactor is inserted thru one of the trocar punctures. After spleen mobilization and cutoff, the cannula is inserted into directly spleen pulpa. This procedure helps us to remove excess volume of tissue. Further we can use methods of extracting the spleen application analogous to those that are carried out under standard procedures. Operation time is 90-120 minutes. Intraoperative blood loss, on average, is 50 ml. The conversion was carried out in one patient (1 %).
Conclusion. Our original technique eliminates the additional port setting, saves time and cost of operations. This approach can also shorten patient's recovery and hospital stay and can lead to better cosmetic outcomes.
ABSTRACT NO.: OP-165
Transnasal endoscopic surgery in children with and without image guidance
N.S. Grachev, I.N. Vorozhcov, S.S. Ozerov
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia
Key words: endoscopic surgery, CT-navigation ^
Introduction. Transnasal endoscopic surgery of neoplasms in children performed with and without CT-navigation. 3
Aim. To compare the quality of transnasal endoscopic surgical treatment of neoplasms of the nasal cavity, the nasopharynx, the paranasal sinuses (PNS) and the skull base (SB) in children performed with and without CT-navigation.
Materials and methods. 71 patients aged between 22 days and 18 years who had undergone surgery of neoplasms of various degrees of surgical difficulty were included into the study. All patients were classified into 2 groups: the primary one consisting of 36 children who had undergone surgery with CT-navigation (17 children had had a surgery of the 1st degree of difficulty (I) constituting the 1st subgroup and 19 children - a surgery of the 2nd degree of difficulty (II) - the 2nd subgroup) and the control one made up by 35 children who had undergone surgery without CT-navigation (19 children had had a surgery of the 1st degree of difficulty (I) constituting the 3rd subgroup and 16 children - a surgery of the 2nd degree of difficulty (II) - the 4th subgroup). The statistical data analysis using Student's t-criterion (P > 0.05) and Fisher's exact F-criterion (P > 0.05) did not show any differences in patients' gender and age distribution in the analyzed subgroups.
Results. The analysis of surgery duration and intraoperative blood loss volume in the 1st and the 3rd subgroups did not show any significant differences (P = 0.96 and P = 0.44 respectively, Mann-Whitney U-criterion). In contrast, the duration of surgery differed in the 2nd and the 4th group significantly, with the difference comprising more than 30 min (P = 0.046, Student's t-criterion), and the volume of intraoperative blood loss in the 2nd subgroup was significantly lower as compared with the 4th subgroup (P = 0.025, Mann-Whitney U-criterion).
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There was no significant statistical difference in the need for anterior nasal packing and the duration of nasal packing between the 1st and the 3,d subgroup (P = 0.28, Fisher's F-criterion, and P=0.34, Mann-Whitney U-criterion respectively). In contrast, the need for anterior nasal packing in patients of the 2nd subgroup decreased significantly (P=0.002, Fisher's F-criterion) in regard to that one in patients of the 4th group. As for the duration of nasal packing, in case of the patients of the 2nd subgroup it was 3 times shorter than in case of the patients of the 4th subgroup (P = 0.001, Mann-Whitney U-criterion).
We did not find any significant statistical difference in the median quantity of bed-days between the 1st and the 3"1 subgroup (P = 0.076, Student's t-criterion). In contrast, the difference between the 2nd and the 4th subgroup comprised 2 days on the average. The difference was statistically significant (P = 0.02, Student's t-criterion). The comparison of morphological data showed that the frequency of a radical removal of benign neoplasms was significantly higher in the primary group than in the control group (P=0.02, Fisher's F-criterion). Conclusion. We think that the application of a CT navigation system in transnasal endoscopic surgery of neoplasms of the nasal cavity, the nasopharynx, PNS and SB in children is justified. The results of the study reflect the efficacy of this method in the context of complex surgical manipulations. The duration of a surgery and the volume of blood loss decrease significantly, the need for postoperative nasal packing is reduced leading consequently to a quicker rehabilitation of children.
ABSTRACT NO.: OP-299
Technology biopsy of tumors of the urinary bladder
Z. Sabirzyanova, A. Pavlov
Russian Scientific Center of Roentgenoradiology, Moscow, Russia
Key words: bladder, biopsy, rabdomyosarcoma
Introduction. Among the entities of the bladder in children usually find primary malignant tumors, benign - are rare. Of malignant tumors sarcomas are more frequently (fibromyosarcoma and chondrosarcoma) and myxomas, and of benign fibroid are observed, fibroepetelioma, hemangiomas. Since most entities originate from the muscle wall of the bladder "gold standard" for initial diagnostics and "second look" is open biopsy of the bladder.
Aim. We assessed the possibilities of different minimally invasive bladder biopsy technologies depending on the localization of tumor in 16 patients with tumors of the bladder in the age from 1.5 to 15 years.
Materials and methods. Of these 8 patients had got bladder rhabdomyosarcoma, 2 with lejomyofibroma, 2 with hemangioma, 2 with bladder cancer and 2 with papilloma. On localization of 6 patients tumor was localized in the the bladder neck and posterior urethra, 5 in the triangle L'eto, 2 on the front wall of the bladder and in the area of the bottom, 3 on the side and back wall. According to the previously performed ultrasound and MRI tumors had its noninvasive growth in 6 cases, in the others it was in all bladder wall. Results. Transurethral bladder biopsy proved to be informative in 7 cases with noninvasive tumors, as well as in the localization of rabdomyosarcomas in the posterior urethra. In the bladder neck and the back wall tumors trans rectal biopsy under ultrasound control was informative in 4 patients from 5. 1 patient with tumor in the front wall was successfully held percutaneous biopsy under ultrasound control. Thus, the traditional open biopsy of bladder tumors was necessary only in 4 patients.
Conclusion. Minimally invasive biopsy of tumors of the bladder may be performed. Transurethral biopsy should be used in cases of noninvasive tumors, as well as in the tumor in the posterior urethra. Tumor of the bladder neck miniinvasive biopsy can be performed under ultrasound control transrectal, and front wall tumor should biopsied percutaneously.
ABSTRACT NO.: P-332
Specific features of ovarian surgery in girls with oncological and hematological diseases
R. Oganesyan1, S. Talypov1, E. Andreev1, N. Uskova1, N. Grachev1, D. Bizhanova2, S. Varfolomeeva1, D. Kachanov1
1Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia;
2Russian Children's Clinical Hospital, Moscow, Russia
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Key words: ovarian surgery, germ cell tumor, oncology
Introduction. According to different statistics the incidence rate of ovarian lesions in girls vary from 1 to 5 %. oc Aim. To estimate the possibilities of ovarian surgery in girls in oncohematological practice.
ij Materials and methods. Since 2012 we performed 30 operations on ovaries (approximately 4.4 % of all abdominal operations for the same period), 12 of which were in girls with
3 unilateral ovarian lesion which required radical operation or enucleation. From 30 operations 9 were removal of ovaries with tumors and ipsilateral tubes , 3 - enucleation of bening
00 ovarian tumors, 6 - biopsy of ovarian tissue for subsequent ovarian cortex cryopreservation prior to combined therapy in cases with high gonadotoxic risk, 6 - ovarian transposition
before radiation therapy. Others were performed as diagnostic measures or in acute surgical conditions. m When the tumor is highly suspicious for malignancy we adhere to the rule of strict execution of several important stages.
1. Tumoroophorectomy of affected side without destruction of capsula.
2. Biopsy of opposite ovary.
3. Omentectomy.
4. Revision of retroperitoneal space, biopsy of suspicious lymph nodes.
5. Sample of ascetic fluid should be taken for cytological analysis.
Results. 30 % of all girls had radical operations on account of germ cell tumors.
In cases of histologically malignant germ cell tumors all girls were administred adjuvant chemotherapy in the context of MAKEI-96 protocol. In 4 cases there were bening tumors, including bening cysts and mature teratomas.
There was 1 postoperative complication which had happened in 2 month after laparotomy, tumoroophorectomy in 10-month old girl with germ cell tumor of ovary. It was
OF PEDIATRIC HEMATOLOGY and ONCOLOGY
strangulated intestinal obstruction, which required resection of small intestine. Specimens of ovarian tissue for ovarian cortex cryopreservation for future autotransplant were harvested laparoscopically with neither postoperative complications nor delay of the oncological treatment.
Oophoropexy in girls with oncohematological diseases is quite specific procedure prior to radiation therapy. We performed such operation as independent operation or as a stage of operation on the organs of small pelvis.
Conclusion. In regard to ovarian surgery it is very important to have multidisciplinary team of oncologist, pediatric surgeon, pediatric gynecologist, radiation oncologist and fertility specialist.
ABSTRACT NO.: P-402
Experience of treatment of newborns with tumours from 2003 to 2015
A.A. Podshivalin, G.E. Chigvintsev
Children's Republican Clinical Hospital, Kazan, Republic of Tatarstan
Key words: experience, mass lesion, surgery, newborn
Introduction. Official statistics shows the tendencies of growth of birth-rate, at that the growth of primary diagnosed cases is registered too. Leading positions in the structure of disease taking the diseases of lungs and congenital malformations (CM). Increasing of CM is connected not only with true growth of pathology, but with improving of prenatal diagnosing. The number of patients with multiple CM increased. This tendency is registered not only in Tatarstan Republic but in hole World. The number of tumours is growing progressively. Diseases rate in Russia is 9.5-13 per 100 000 of children.
Average rate of every year registering children with tumours in Russia increased during the last decade on 20 % and reached 6.45 thousands. Aim. Analysis of treatment of newborns with oncological diseases (tumours of different etiology), treated in the department of surgery of newborns from 2003 to 2014. Materials and methods. Ninety four patients with mass lesions of different localization were treated and analyzed: lymphangioms - 12 (12.7 %) of patients, cystic ovary -22 (23.5 %), lung sequestering - 11 (11.8 %), hepatoblastoma - 2 (2.1 %), cystic forms of duplications of tracheobronchial tree - 5 (5.3 %), drenal hematoma - 9 (9.5 %), neuroblastoma - 17 (18.2 %), Wilm's tumour - 2 (2.1 %), soft tissue lesion - 4 (4.2 %).
Results. All mass lesions were underwent surgery, in 98 % of cases the lesions were removed totally, in 2 % - biopsy was done. Patients were treated with surgeon and hematologist/ oncologist in the following. In 2 % of patients which underwent surgery the metastases were revealed.
Conclusion. Radical tumourectomy is the surgery type of choice at newborns. Treatment must be multidisciplinary including surgeons, neonatologists and hematologist/oncologist. Following monitoring and control observations (ultrasonic and CT-scans) are obligatory in post-surgery period.
ABSTRACT NO.: OP-404
Summing up the results of endoprosthesis for children with bone sarcomas: The East-European sarcoma group (EESG)
D. Nisichenko, A. Dzampaev, M. Kubirov, D. Hestanov, M. Aliev
N.N. Blokhin Russian Cancer Research Centre, Moscow, Russia
Key words: endoprosthesis, sarcoma, limb salvage
Introduction. Limb salvage using endoprosthesis is currently the gold standard for the treatment of bone tumors in children and adults. Modern implants allow to increase its length with the growth of the child.
Aim. Our aim was to retrospectively analyze outcomes of tumor endoprosthesis for upper and lower limbs in primary and secondary implantations.
Materials and methods. 268 children were treated in our clinic from 2000 to 2012. We performed 291 operations, among them 265 primary and 26 revisionary. Three patients came
straight for reimplantation after treating in another clinic.
Research group includes boys: 145/268 (54 %), girls: 123/268 (46 %). The most frequent diagnosis were osteosarcoma - 74 % and Ewing saroma - 19 %. oc
Average age - 12.6 years, minimal age - 3.5 years, max. - 18 years. After 18 patients continues their treatment in adult department of our clinic.
Speaking about the quantity of endoprosthesis - we shared them for 2 huge groups: standard zones (n=254) of affection and accordingly, typical kinds of endoprosthesis and second group that includes rare kinds of endoprosthesis, such as diaphysis of humer, radialis, femur, tibia and two cases of distal tibia. As far as those operations took a rare place, we cannot achieve reliable evidence. Further we excluded those facts from the discussion.
We used endoprosthesis made by Wright (USA), W. Link (Germany), MUTARS - Implantcast (Germany), ProSpon (Chech Republic), Stanmore (England). lu
Results. Average follow up - 39 months. Min - 2 days (as a result of thrombosis we had to make an amputation), maximum monitoring time - 159 months (more then 13 years). Femur involvement was 144/268 (53 %): distal femur 114/144 (79 %), diaphysis - 2/144 (1.4 %), proximal femur 11/144 (7.8 %), and total femur - 17/144 (11.8 %). Tibia involvement was 80/268 (30 %): proximal part - 92.5 %, diaphysis - 5 %, distal tibia 2/80 (2.5 %). Total humer was in 14/41 (34 %) cases.
Two-year overall survival - 65 %. Infectious complication we observed in 44/251 (15 %) cases: distal femur - 5.6 %, proximal tibia - 20.5 %, total femur - 17.3 %. Aseptic loosing we observed in 52/291 (18 %) cases. Local relapse - 22/268 (8 %). Twelve patients (6.7 %) finished treatment or went on reendoprosthesis in adult department of our clinic -by reasons of instability, infection fail or shorting of lower limb.
Conclusion. For making limb salvage operations for children with bone sarcoma and do not yet reached skeletal immature we need to plan operations carefully and consider age of patient and possible further reoperations and disease prognosis.
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