Laparoscopic Radical Nephrectomy for Unilateral Renal Cancer in Children
Bibliographic record
Abstract
PURPOSE: At the present time, the standard approach for renal cancer in children is open surgery, and the role of laparoscopic approach remains to be defined. We report our preliminary experience in the treatment by laparoscopic radical nephrectomy (LRN) for unilateral renal cancer in children. METHODS: Five children, whose mean age was 4 years old, were operated for unilateral renal malignant tumors by laparoscopic approach in our unit from October 2005 to June 2007. Four cases were suspected of Wilms tumors and one of them presented bilateral lung metastases. They were preoperatively treated with chemotherapy according to the International Society of Pediatric Oncology 2001 protocol: vincristine and actinomicyn D for 4 weeks. The fifth case was a 10-year-old child, treated 8 years before with chemotherapy for a cerebellar vermis medulloblastoma history. A percutaneous biopsy was performed preoperatively and the histology showed a juvenile renal-cell carcinoma. All cases subsequently underwent LRN. Four trocars were used in each case and the tumors were placed in a bag before being extracted intact without morcellation through a low suprapubic incision. RESULTS: All tumors and lymph node samples were removed completely by laparoscopy without rupture. No conversion to laparotomy was necessary and there was neither intraoperative bleeding nor complications. The mean operative time was 90 minutes (60 to 117 min). Postoperatively, 1 child presented an intestinal perforation and suture closure was performed by laparoscopy on the third postoperative day; the discharge was after 10 days, and the others were discharged after 2 or 3 days. In all cases, the resection was microscopically complete. The histology was 3 unilateral Wilms tumor, 1 clear-cell sarcoma and 1 juvenile renal-cell carcinoma with t(X;17). No lymph node was positive for the tumors. None of these patients presented evidence of tumoral recurrences, port-site implantation or short-term complications at a mean of 18 months of follow-up (range: 12 to 32 mo). CONCLUSIONS: LRN for renal cancer in children is feasible after preoperative chemotherapy, with the same oncologic strategies as open surgery. A long follow-up and more cases are necessary to evaluate and compare the results of laparoscopic approach with the open procedures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".