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The paper aims to define the actual place and benefits of the minimal invasive techniques in the diagnosis and treatment of tumors in children. There are reviewed the indications, limits and complications of this method in digestive tract, liver, pancreatic, adnexal, testicular and renal tumors, in lymphomas, as well as in tumors with intra-thoracic location. The benefits of the minimal access approach, such as the decrease of the parietal complications as well as the negative impact of the surgical act upon the body have a particular significance in pediatric cancer patients. Their quicker recovery allows an early subsequent initiation of the chemo- or/and radiotherapy. Within the complex treatment of tumors in children, the minimal invasive surgery has a diagnostic value through inspection and directed biopsy. The laparoscopic inspection decreases the number of non-therapeutic laparotomies in non-operable patients with tumors that were not preoperatively diagnosed using imaging methods. The laparoscopic resection of the tumors within oncological limits is possible in the localized types (stage I). As a particular aspect of the laparoscopic approach in children, it is worth mentioning the difficulties related to the necessity of using adequate-size instruments and to the less favorable relation between the size of the tumor and the diminished working space.

Surgical treatment for locally advanced digestive cancers (invasion beyond the serosa, adjacent structures penetration and perforated tumors) is followed by a high rate of peritoneal recurrence and distant metastasis. Simultaneous intraperitoneal chemotherapy with surgical resection, which is continued over the early postoperative period act on the tumor cells which can be mobilized during the surgical dissection. This adjuvant treatment could lead to better control of local recurrence. Moreover, high levels of the agents are reached in the portal circulation which could be profitable for preventing hepatic metastasis. The main drawback of the method is represented by the impaired immunologic activity of the peritoneum, which can cause, at least theoretically, detrimental complications.The efficiency of the intraoperative and early postoperative intraperitoneal chemotherapy is the subject of a prospective randomized study, started 8 months ago in our department.Patients with locally advanced (penetration of the tumor beyond serosal layer, without liver metastasis) are randomized for adjuvant intraperitoneal chemotherapy or standard treatment. Intraoperative chemotherapy is commenced after surgical resection but before accomplishing any anastomosis. We use 50 mg of cisplatinum for washing the peritoneal cavity and continue to instill 20 mg/m2 of cisplatinum intraperitoneally in the first four days after surgery. (8 patients were selected to be treated according to this protocol).Immediate postoperative outcome does not seem to be influenced by this treatment. The disease free interval and the overall survival rates can not be assessed at this moment of the study.

We have retrospectively studied 1243 malignancies of the infradiaphragmatic tract treated in the First Surgical Clinic between 1978-1994 (678 gastric, 300 rectal and 256 colonic malignancies). Out of these 39 cases have been encountered in young patients (14 gastric, 13 colon and 12 rectal malignancies). The following particularities have been noted in this group: hereditary predisposition, more advanced stage at diagnosis, predominance of non-Hodgkin lymphomas and poorly differentiated forms. Young age does not significantly influence prognostic, with the control group. In young people the most important prognostic factors are tumor stage, cellular grading and tumor DNA index as determined by flow cytometry.

One hundred twenty-two benign tumors of subdiaphragmatic digestive tract admitted in the interval 1975-1988 at the III-rd Surgical Clinic of Iaşi are reported. Out of these patients 120 required surgical treatment, the remainder of 2 being treated conservatively (diffuse intestinal angiomatosis, Peutz-Jeghers' syndrome). The clinical evolution being atypical, the surgical intervention was required, in most of the cases, due to hemorrhagic and occlusive complications. Histologically, the polyps and schwannomas were prevalent. The diagnostic difficulties, especially in the cases with jejuno-ileal localization, are mentioned.

The authors present 6 cases of lipomas of the digestive pathways, five in females and one in a male. The patients were aged between 31 and 75 years and an average age of 51 years. The benign lipomatous tumor was unique in all the cases. It was located in the antrum in 3 of the patients and in the ileum, the right segment of the colon and on the sigmoid in each of the three other patients respectively. In all the cases the radiological examination confirmed the clinical diagnosis of digestive tumour. The radiological aspects were typical for benignity in four of the cases and suggested malignancies in the other two. Gastric lipomas were characterized from the clinical viewpoint by dyspeptic disturbances that were not systematized, as well as by bleeding while the ileal and the colic tumours were accompanied by repeated invagination. The sigmoid tumour was accompanied by colic and disturbances of the transit. The surgical solution consisted in 3 of the cases in a simple exeresis of the lipoma (two gastric lipomas and the sigmoid tumour). In one of the gastric lipomas a limited resection was performed, and for the colic and ileal tumours, complicated by invagination a right hemicolectomy was carried out.