TY - JOUR
T1 - Minimally invasive surgery of neuroblastic tumors in children
T2 - Indications depend on anatomical location and image-defined risk factors
AU - Irtan, Sabine
AU - Brisse, Hervé J.
AU - Minard-Colin, Véronique
AU - Schleiermacher, Gudrun
AU - Canale, Sandra
AU - Sarnacki, Sabine
N1 - Publisher Copyright:
© 2014 Wiley Periodicals, Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs). Procedure: Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n=20), retroperitoneoscopic (n=1) or laparoscopic approaches (n=18). The tumor locations were paravertebral (n=18; thoracic n=15, lumbar n=3), perivascular (n=5; abdominal n=2; thoracic n=3), adrenal (n=13), pleural (n=2) and pelvic (n=1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35mm for thoracic tumors (range: 7-85mm) and 34mm for abdominal tumors (range: 10-75mm). Mean follow-up was 25 months (range: 5-116 months). Results: Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%. Conclusion: In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized.
AB - Background: Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs). Procedure: Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n=20), retroperitoneoscopic (n=1) or laparoscopic approaches (n=18). The tumor locations were paravertebral (n=18; thoracic n=15, lumbar n=3), perivascular (n=5; abdominal n=2; thoracic n=3), adrenal (n=13), pleural (n=2) and pelvic (n=1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35mm for thoracic tumors (range: 7-85mm) and 34mm for abdominal tumors (range: 10-75mm). Mean follow-up was 25 months (range: 5-116 months). Results: Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%. Conclusion: In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized.
KW - IDRF
KW - Laparoscopy
KW - Minimally invasive surgery
KW - Neuroblastoma
KW - Thoracoscopy
UR - http://www.scopus.com/inward/record.url?scp=84927520170&partnerID=8YFLogxK
U2 - 10.1002/pbc.25248
DO - 10.1002/pbc.25248
M3 - Article
C2 - 25284263
AN - SCOPUS:84927520170
SN - 1545-5009
VL - 62
SP - 257
EP - 261
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 2
ER -