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Lecompte JF, Sarnacki S, Irtan S, Piolat C, Scalabre A, Talon I, Rod J, Panait N, Rodesch G, Luis Huertas AL, Abbo O, Demarche M, Habonimana E, Ballouhey Q, Valteau-Couanet D, Guérin F. Thoracoscopy for Pediatric Thoracic Neurogenic Tumors-A European Multi-Center Study. Cancers (Basel) 2023; 15:5467. [PMID: 38001727 PMCID: PMC10670815 DOI: 10.3390/cancers15225467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. METHODS We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. RESULTS We identified 119 patients with a median age of 4 years old (3 months-17 years). The diameter was 5.7 cm (1.1-15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9-T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7-24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0-46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner's syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4-195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9-T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). CONCLUSION Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.
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Affiliation(s)
| | - Sabine Sarnacki
- Necker Enfants Malade Hospital, Université Paris-Cité, GHU Centre Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Sabine Irtan
- Trousseau Hospital, Université Paris-Sorbonne, GHU-Paris Sorbonne Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France;
| | | | - Aurélien Scalabre
- Saint-Etienne University Hospital, 42270 Saint-Priest-en-Jarez, France;
| | - Isabelle Talon
- Hopital Hautepierre, CHRU Strasbourg, 67200 Strasbourg, France
| | | | - Nicoleta Panait
- La Timone Hospital, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Gregory Rodesch
- Hôpital Universitaire des Enfants Reine Fabiola, 1020 Bruxelles, Belgium
| | | | - Olivier Abbo
- Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France;
| | | | | | - Quentin Ballouhey
- Hôpital de la mère et de l’enfant, Centre Hospitalier Universitaire de Limoges, 87000 Limoges, France
| | | | - Florent Guérin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), 94270 Le Kremlin Bicêtre, France
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Zarfati A, Martucci C, Persano G, Cassanelli G, Crocoli A, Madafferi S, Natali GL, De Ioris MA, Inserra A. Preoperative Spinal Angiography for Thoracic Neuroblastoma: Impact of Identification of the Adamkiewicz Artery on Gross Total Resection and Neurological Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1116. [PMID: 37508612 PMCID: PMC10378327 DOI: 10.3390/children10071116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Patients with thoracic neuroblastoma (TNB) are at high risk of postoperative neurologic complications due to iatrogenic lesions of the artery of Adamkiewicz (AKA). The role of performing a preoperative spinal angiography (POSA) in these patients must be clarified. The present study sought to further understand the relationship between POSA and TNB, as well as the effects of identifying the AKA on surgical excision and neurological consequences. METHODS Data from patients with TNB who underwent POSA between November 2015 and February 2022 at our tertiary pediatric center were retrospectively analyzed. RESULTS Six patients were identified, five of whom (83%) were considered eligible for surgical excision. Gross total resection (GTR) was achieved in three patients (60%), which included two patients with an AKA contralateral to the tumor, and one with an homolateral AKAl. After a median follow-up of 4.1 years from diagnosis, no patients developed neurological complications; five (83%) were alive and well, and one died from refractory recurrence. CONCLUSIONS Among patients with TNB, POSA was useful for identifying the AKA and defining the optimal surgical strategy. POSA should be considered in the preoperative evaluation of TNB to increase the likelihood of GTR and reduce the threats of iatrogenic neurologic sequelae.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgio Persano
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cassanelli
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Silvia Madafferi
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Gian Luigi Natali
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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High-Risk Neuroblastoma: A Surgical Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020388. [PMID: 36832517 PMCID: PMC9955866 DOI: 10.3390/children10020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
High-risk neuroblastoma requires multimodal treatment including systemic chemotherapy, surgical resection, radiation therapy, stem cell transplant, and immunotherapy. Surgeons play a vital role in obtaining local control of neuroblastoma and must therefore be knowledgeable about this complex pathology. This article provides a review of the optimal timing and extent of resection, the impact of various image-defined risk factors on surgical planning, and surgical approaches and techniques to enhance the resection of tumors in different anatomic locations.
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