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Utilization of Minimally Invasive Partial Nephrectomy by Age and Tumor Pathology in Pediatric Patients, 2009-2010
Daniel Pucheril*, Jesse Sammon, Akshay Sood, Detroit, MI, Quoc-Dien Trinh, Boston, MA, Jack Elder, Detroit, MI

INTRODUCTION AND OBJECTIVES: Minimally invasive partial nephrectomy (MIPN) in the pediatric population may have several advantages over open partial nephrectomy (OPN). The primary objective of this study is to understand contemporary patterns for the use of MIPN across age and indication.

METHODS: Pediatric patients, 0-17 years old, undergoing MIPN or OPN between 2009-2010 were extracted from the Nationwide Inpatient Sample (n=857). The patients were then segregated into one of five age categories (<2, 2-5, 6-9, 10-13, or 14- 17 years); rates of MIPN (robotic and laparoscopic) vs. OPN were determined for the overall cohort and also the cohort divided by indication (malignant vs. benign). The Chi-Square test was used to assess significance across populations.

RESULTS: Overall, 857 pediatric patients underwent partial nephrectomy between 2009-2010. Pediatric PN was most common in infants < 2 years of age (n=419, 48.9%). In total, 14.7% of partial nephrectomies were performed using a minimally invasive technique; however, in patients older than nine, more than 25% of the cases were performed using a minimally invasive approach (p<0.001). Among those undergoing MIPN, LPN was more frequently used in children less than six, conversely RAPN was more frequently chosen in children older than six (p<0.001). In total, 89.8% of the partial nephrectomies were performed for a benign indication and MIPN was only utilized for malignant lesions if the patient was an adolescent (5.8% of PN for malignancy).

CONCLUSIONS: Despite the increasing availability of minimally invasive surgical approaches, a large majority of pediatric partial nephrectomies continue to be performed with an open technique and for benign lesions in children less than nine years of age. LPN was the minimally invasive technique preferred in children less than six, while RAPN was preferred in children older than six. PN was used rarely for malignant lesions and MIPN was only used for resection of a malignant lesion if the patient was an adolescent.

Source of Funding: none

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