Klin Onkol 2003; 16(Suppl 2003): 113-116.
Summary: The authors present contemporary possibilities of surgery in the therapy of tumors in children. There are solid tumors of thoracic wall and cavity, abdomen and retroperitonaeum in question. Our experience is based upon 175 children with neuroblastoma operated on between 1987 1997. In this time 148 chldren had abdominal form of neuroblastoma and 27 mediastinal one. 39% of our patients had I-st and II-nd stage of the disease, their survival was as high as 92,5%. Another frequent solid tumor of retroperitonaeum in children is Wilms_ tumor. Between 1988 1997 we have operated on 172 children for nephroblastoma. The survival of patients with favourable histology is approximately 90. We have performed surgery of malignant liver tumors in 42 children between 1991 2000. 37 of them had primary liver tumor, 5 had metastatic disease of other solid tumor. We have experienced a substantialy higher survival of patients with hepatoblastoma. In the meantime 85% of 28 patients with hepatoblastoma have survived. The basic requirement is close cooperation of all involved experts. The role of surgery in some tumors is essential, in others it is more or less auxiliary (biopsy, partial resection) The exact diagnosis and preoperative care are of utmost importance.The operation may include primary resection of the tumor after chemotherapy and radiotherapy or urgent procedures in case of life threatening complications like bleeding and perforations . The surgery of reccurencies , predominantly after chemotherapy and radiotherapy is demanding. In majority of solid tumors the aim of surgery is the radical removal of the tumor either primarily or after chemotherapy. Up to now the open thoracic or abdominal surgery is prevailing . In the paediatric age group a thoracoscopy a laparoscopy are being used more and more frequently (e.g. for biopsies of mediastinal tumors, m. Hodgkin or lymphoma non-Hodgkin). In the resection of lung metastases we employ the photothermic effect of Neodym-YAG laser. CUSA (ultrasonic arpirator) is usefull in resection of liver, pancreas spleen and kidney. To bridge the gap after an extensive resection of the thoracic wall the Gore-tex has proved its quality.
