Is it time to make minimally invasive surgery in pediatric oncology inclusive?

Purpose Minimally invasive surgery (MIS) in pediatric oncology remains controversial. Our unit aims to surgically stratify patients for MIS and here we present our data. Methods Oncology patients who had undergone surgery were identified from prospectively collected databases and retrospectively analyzed. Results Between 04/2004 and 12/2019, 905 procedures in 757 patients were identified. Patients were excluded if their intervention was superficial leaving 585 procedures in 451 patients. In Group 1 (G1) (2004–2011), there were 250 procedures in 175 patients: 26 (10.4%) MIS and 167 (67%) open. In Group 2 (G2) (2012–2019,) there were 335 procedures in 276 patients: 113 (33.7%) MIS and 185 (55.2%) open. The remainder were percutaneous biopsies. The 139 MIS cases included 23 neural crest tumors; 18 ovarian; 19 renal; 14 rhabdomyosarcoma; 23 thoracic; 20 other abdominal tumors; and 22 cryopreservation. Mean age at surgery was 78 months. In the MIS group, 3 patients had recurrent disease of whom 1 died. In the open group 38 patients had recurrent disease; there were 36 deaths of whom 22 died following recurrent disease. MIS cases have gone from 3.7/year in G1 to 16.1/year in G2 representing an increase of 435%. Conclusions This is the biggest single series of pediatric oncology resections by MIS. It shows an almost exponential increase in the number of MIS resections per year whilst maintaining excellent outcomes. Is it time to make MIS in pediatric oncology inclusive and not exclusive?