Surgical Incisions in Pediatric Surgical Oncology

The surgical treatment of pediatric cancer is a complex, multidisciplinary process aimed at optimizing outcomes and minimizing complications and must take into account the questions of what procedure to perform, when to perform it, and how to approach resection (Surgical Checklist). Choosing an optimal approach for resecting a tumor is a critical first step to a successful resection. An incision that limits exposure to the necessary field of resection will be associated with both poorer outcomes and more complications. For instance, the approach to a neuroblastoma which partially encases the aorta, celiac, and superior mesenteric artery roots will be facilitated by a thoracoabdominal approach which allows access to the proximal and distal aorta. Similarly, while minimally invasive approaches (MIS) are increasingly applied, the surgeon choosing this approach must be confident that an MIS approach offers an equivalent oncologic resection [1]. Data from lymph node resections obtained during laparoscopic resection of Wilms’ tumor suggest that lymph node yield is lower than with open cases with some patients not undergoing any lymph node sampling, potentially leading to tumor under-staging [2, 3]. Common incisions to tumors in the neck, chest, abdomen, and pelvis are described below as a preliminary guide to a surgical approach (Table 9.1).