With minimally invasive nephrectomy becoming significantly more common among adult kidney patients, investigators have now found that the use of this surgery is expanding in the pediatric population as well.
“At the time we began our research project, little was known about the usage of laparoscopic or robotic kidney removal in pediatric patients, although many studies have been done about minimally invasive kidney surgery in adults,” noted senior study author Jack S. Elder, MD, Chief of Pediatric Urology at the Vattikuti Urology Institute of the Henry Ford Health System in Detroit, in a prepared statement. “As we expected, the use of [minimally invasive nephrectomy] in children, like in the adult population, is on the rise.”
As Dr. Elder and colleagues described in The Journal of Urology, they evaluated national data on approximately 27,615 children who underwent nephrectomy between 1998 and 2010. The annual incidence of pediatric nephrectomy was 2.90/100,000 patients per year, and remained stable.
The operation was most common in children aged 0-1 year (36%), and least common among those aged 6-9 years (14%). Children aged 3-4 years underwent nephrectomy for malignancy more often than children in other age groups. In the study, most nephrectomies (73.8%) were performed for benign conditions; only 2.2% were for malignancy.
Although open nephrectomy still accounts for more than 85% of pediatric nephrectomies, the use of minimally invasive nephrectomy rose from 1.1% to 11.6% over the study period. Multivariable analysis showed the rate to be lower among children with malignancy.
Increasing age, treatment at a teaching institution, and increasing hospital volume all were associated with higher utilization of minimally invasive nephrectomy.
Minimally invasive nephrectomy is arguably the current gold-standard treatment for renal tumors requiring kidney removal in adults, but this is not the case for children, according to Vattikuti’s Jesse D. Sammon, DO, lead author of the study. Because open incisions are smaller in pediatric patients than in adult patients, children suffer less pain and blood loss from the open-nephrectomy approach.
“Consequently, there is less incentive for pediatric urologists to adopt the [minimally invasive] procedure, particularly when treating malignant conditions,” Dr. Sammon explained.