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Taghavi K, Glenisson M, Loiselet K, Fiorenza V, Cornet M, Capito C, Vinit N, Pire A, Sarnacki S, Blanc T. Robot-assisted laparoscopic adrenalectomy: Extended application in children. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108627. [PMID: 39214030 DOI: 10.1016/j.ejso.2024.108627] [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: 05/30/2024] [Revised: 08/04/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Minimally invasive surgery for paediatric adrenal tumours has evolved, but robot-assisted laparoscopic adrenalectomy (RALA) in children remains poorly studied. The current prospective study aims to demonstrate the safety and efficacy of RALA in treating children with adrenal tumours. METHODS A prospective institutional analysis of children presenting with neuroblastic and endocrine tumours treated with RALA was undertaken over a six year-period. For each child, clinical parameters were collected relating to diagnosis, surgery and outcomes. RESULTS A total 50 RALA were performed; 23 for unilateral neuroblastic tumours (87 % neuroblastomas) and 27 for endocrine tumours. Eight neuroblastic tumours (35 %) had image-defined risk factors (all due to tumour invading the renal pedicle). Median length of stay was two days. Resection margins were macroscopically clear in all cases. After median follow-up of 2.9 years (1.6-3.9), two children are under treatment for metastatic relapse (high-risk disease) and three died due to refractory disease. Sixteen children had endocrine tumours: pheochromocytoma (n = 13), or bilateral nodular adrenocortical hyperplasia with Cushing's syndrome (n = 14). One child required non-emergent conversion, and one complication occurred (grade IIIb) after median follow-up of 3.3 years (1.0-5.7). CONCLUSIONS The current study is the largest reported experience in the literature and confirms the safety and effectiveness of RALA in carefully selected children with adrenal tumours. Through an iterative process and in the setting of a dedicated paediatric robotic surgical team indications have been clarified and extended. The current study confirms RALA has particularly utility in patients with severe disease (IDRF + metastatic neuroblastomas) or genetic predisposition syndromes.
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Affiliation(s)
- Kiarash Taghavi
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Departments of Paediatric Urology, Monash Children Hospital, Melbourne, Victoria, Australia; Departments of Paediatrics, Monash University, Melbourne, Victoria, Australia. https://twitter.com/kiarash_taghavi
| | - Mathilde Glenisson
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris Cité, Paris, France
| | - Klervie Loiselet
- Université de Paris Cité, Paris, France; Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Venusia Fiorenza
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mariana Cornet
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris Cité, Paris, France
| | - Aurore Pire
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris Cité, Paris, France. https://twitter.com/hopital_necker
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Kawakubo N, Maniwa J, Irie K, Tamaki A, Fukuta A, Souzaki R, Obata S, Nagata K, Matsuura T, Tajiri T. Successful endoscopic approach for peripheral neuroblastic tumors in children. Pediatr Int 2024; 66:e15754. [PMID: 38924208 DOI: 10.1111/ped.15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Recently, reports of endoscopic approaches for neuroblastoma, ganglioneuroblastoma, and ganglioneuroma (peripheral neuroblastic tumor; PNTs) have been increasing. This study aimed to clarify the indications for endoscopic surgery for PNTs. METHODS Pediatric patients who underwent endoscopic surgery for PNTs at our institution were included in this study. Image-defined risk factors (IDRFs) were analyzed using preoperative computed tomography (CT). RESULTS Twenty-four patients underwent endoscopic surgery for PNTs. The diagnoses included neuroblastoma (n = 11), ganglioneuroma (n = 10), and ganglioneuroblastoma (n = 3). Regarding the tumor site, there were 18 cases of adrenal tumors, five cases of mediastinal tumors, and one case of retroperitoneal tumors. Image-defined risk factors were positive in eight cases (contacted with a renal vessel, n = 6; compression of principal bronchi, n = 2). Complete resection was accomplished in 21 cases (14 of 16 IDRF-negative cases and seven of eight IDRF-positive cases). All patients survived without recurrence during the follow-up period. CONCLUSIONS The CT findings of contact with renal vessels and compression of principal bronchi do not seem to be indicators of incomplete resection. An endoscopic approach to PNTs in pediatric patients is feasible with a good prognosis if patients are selected strictly.
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Affiliation(s)
- Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junnosuke Maniwa
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiko Irie
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsuhisa Fukuta
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Obata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Morin CE, Hasweh R, Anton C, Dillman JR, Orscheln E, Smith EA, Kotagal M, Weiss BD, Ouyang J, Zhang B, Trout AT, Towbin AJ. Gadolinium-based contrast media does not improve the staging of neuroblastoma image-defined risk factors at diagnosis. Pediatr Blood Cancer 2024; 71:e30724. [PMID: 37845799 DOI: 10.1002/pbc.30724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neuroblastoma risk stratification relies on prognostic risk factors and image-defined risk factors (IDRFs). Evaluating neuroblastoma typically involves magnetic resonance imaging (MRI) with gadolinium-based contrast media (GBCM, "contrast"). However, there are concerns regarding adverse effects and cost of GBCM. We aimed to assess the impact of intravenous GBCM on interobserver agreement for neuroblastoma staging on baseline MRI. PROCEDURE We reviewed baseline MRI scans of 50 children with abdominopelvic neuroblastomas confirmed by histopathology. Duplicate sets of images were created, with post-contrast T1-weighted sequences removed from one set. Four pediatric radiologists independently analyzed the scans in a randomized manner. They recorded primary tumor size, presence of IDRFs, and metastatic lesions. Agreement among the reviewers was measured using kappa and Fleiss kappa statistics. RESULTS Mean age of included children was 3.3 years (range: 0.01-14.9 years), and 20 [40%] were females. Mean tumor size was 5.7 cm in greatest axial diameter. Pre-contrast versus post-contrast MRI showed excellent agreement for tumor measurement. Overlapping confidence intervals (CIs) were seen in nearly all categories of interobserver agreement on the presence or absence of individual IDRFs, with agreement ranging from poor to substantial, regardless of the presence of contrast. The overall interobserver agreement on the presence of at least one IDRF was substantial with contrast (kappa = .63; 95% CI: .52-.75) and moderate without contrast (kappa = .5; 95% CI: .39-.61); although the overlapping CIs suggest a lack of meaningful difference. Similarly, interobserver agreement on the presence or absence of individual sites of metastatic disease ranged from poor to substantial. The interobserver agreement on the overall determination of presence of metastatic disease was fair with contrast (kappa = .49; 95% CI: .38-.61) and moderate without contrast (kappa = .71; 95% CI: .59-.826). CONCLUSIONS Contrast does not improve tumor size measurement or radiologist agreement on the presence or absence of IDRFs or metastatic disease in children with newly diagnosed neuroblastoma.
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Affiliation(s)
- Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Hasweh
- Division of Radiology, Al-Balqa Applied University, Al-Salt, Jordan
| | - Chris Anton
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily Orscheln
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ethan A Smith
- Department of Surgery, University of Cincinnati College of Medicine, Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meera Kotagal
- Cancer and Blood Disease Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian D Weiss
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jiarong Ouyang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Avanzini S, Dall'Igna P, Bjornland K, Braungart S, Cross K, Flores P, Gabra HOS, Gomez-Chacon J, Irtan S, Lobos P, Loh A, Matthyssens LE, Metzelder M, Parodi S, Pio L, Van de Ven CP, Fuchs J, Losty PD, Sarnacki S. Beyond image defined risk factors (IDRFs): a delphi survey highlighting definition of the surgical complexity index (SCI) in neuroblastoma. Pediatr Surg Int 2023; 39:191. [PMID: 37140693 DOI: 10.1007/s00383-023-05477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Preoperative evaluation of Image Defined Risk Factors (IDRFs) in neuroblastoma (NB) is crucial for determining suitability for upfront resection or tumor biopsy. IDRFs do not all carry the same weighting in predicting tumor complexity and surgical risk. In this study we aimed to assess and categorize a surgical complexity (Surgical Complexity Index, SCI) in NB resection. METHODS A panel of 15 surgeons was involved in an electronic Delphi consensus survey to identify and score a set of shared items predictive and/or indicative of surgical complexity, including the number of preoperative IDRFs. A shared agreement included the achievement of at least 75% consensus focused on a single or two close risk categories. RESULTS After 3 Delphi rounds, agreement was established on 25/27 items (92.6%). A severity score was established for each item ranging from 0 to 3 with an overall SCI range varying from a minimum score of zero to a maximum score of 29 points for any given patient. CONCLUSIONS A consensus on a SCI to stratify the risks related to neuroblastoma tumor resection was established by the panel experts. This index will now be deployed to critically assign a better severity score to IDRFs involved in NB surgery.
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Affiliation(s)
- S Avanzini
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo G, Gaslini 5, 16147, Genoa, Italy.
| | - P Dall'Igna
- Pediatric Surgery, Dipartimento di Medicina di Precisione e Rigenerativa a Area Jonica, Azienda Ospedaliera-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - K Bjornland
- Department of Pediatric Surgery, Oslo University Hospital/University of Oslo, Oslo, Norway
| | - S Braungart
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Cross
- Great Ormond Street Hospital for Children, Specialist Neonatal and Pediatric Surgery, NHS Foundation Trust, London, UK
| | - P Flores
- Pediatric Surgery Department Garrahan Hospital, Buenos Aires, Argentina
| | - H O S Gabra
- Department of Paediatric Surgery, The Great North Children Hospital, Newcastle University Hospitals Foundation Trust, Newcastle Upon Tyne, UK
| | - J Gomez-Chacon
- Department of Pediatric Surgery, Surgical Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Irtan
- Department of Visceral Pediatric and Neonatal Surgery, Sorbonne Université, Armand Trousseau Hospital, AP-HP, Paris, France
| | - P Lobos
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - L E Matthyssens
- Department of Gastrointestinal and Pediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - M Metzelder
- Department of Pediatric and Adolescent Surgery, Medical University of Vienna, Vienna, Austria
| | - S Parodi
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Pio
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo G, Gaslini 5, 16147, Genoa, Italy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - C P Van de Ven
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Tübingen, Germany
| | - P D Losty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Sarnacki
- Department of Pediatric Surgery, APHP Centre, University Hospital Necker Enfants Malades, University Paris Cité, Paris, France
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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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Zenitani M, Yoshida M, Matsumoto S, Sakai T, Matsuura R, Umeda S, Usui N. Feasibility and safety of laparoscopic tumor resection in children with abdominal neuroblastomas. Pediatr Surg Int 2023; 39:91. [PMID: 36695959 DOI: 10.1007/s00383-023-05371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility and safety of laparoscopic resection of abdominal neuroblastoma by comparing operative and long-term oncologic outcomes between open and laparoscopic surgeries. METHODS This single-center retrospective study included patients who underwent laparoscopic tumor resection, between January 2000 and June 2021, with a maximum tumor diameter of ≤ 60 mm and without image-defined risk factors (IDRFs) at surgery. Data from 35 abdominal neuroblastoma resections were reviewed and compared between the laparotomy and laparoscopic groups. RESULTS Nineteen patients underwent laparotomy and 16 had laparoscopic tumor resection. All laparoscopic surgeries achieved complete resection without conversion to open surgery. Median blood loss was significantly lower in the laparoscopic group (0.6 mL/kg) than in the laparotomy group (8.4 mL/kg) (P < 0.0001). There were two locoregional recurrences in the laparoscopic group and two metastatic recurrences in the laparotomy group. Five-year overall survival was 93.8% in both groups. CONCLUSION Laparoscopic resection of abdominal neuroblastomas in children is a feasible and safe procedure for tumors ≤ 60 mm in diameter with no IDRFs at surgery, with long-term outcomes equivalent to laparotomy.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan.
| | - Masayuki Yoshida
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Sayaka Matsumoto
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Takaaki Sakai
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Rei Matsuura
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
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Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111707. [PMID: 36360435 PMCID: PMC9688519 DOI: 10.3390/children9111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
Background: Neuroblastoma (NB) is the most common pediatric extracranial solid tumor and the most common cancer encountered in children younger than 12 months of age. Localized tumors have a good prognosis, but some cases undergo treatment failure and recurrence. The aim of the study was to analyze the link between the neuroblastoma risk factors and the prognosis for patients diagnosed with NB. Method: All patients admitted to the department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, between 1 January 2010 and 1 July 2022 were included in this analysis when diagnosed with neuroblastoma. Results: Thirty-one patients with NB were admitted to the surgical department, 20 boys and 11 girls. We observed an association between large tumors and positive imaging-defined risk factor (IDRF) status; The Fisher test showed an association between the tumor’s diameter when bigger than 8 cm and a positive IDRF status, with p < 0.001. We supposed that positive IDRF status at diagnosis may be linked to other prognostic factors. We discovered that an NSE value over 300 was associated with IDRF status (p < 0.001, phi = 0.692) and death. Conclusions: This study confirms the impact of IDRF status at diagnosis as it can be clearly correlated with other risk factors, such as a high level of NSE, MYCN amplification status, large tumor size, incomplete tumor resection, and an unfavorable outcome.
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Wang H, Li T, Chen X, Zhu J, Xie M, Zhang L, Ding H, Qin J, He L. Correlations Between Preoperative Radiographic Vascular Involvement of Abdominal/Pelvic Neuroblastomas on Computed Tomography and Intraoperative Vascular Injuries: Experience From a Tertiary Children's Hospital. Acad Radiol 2022:S1076-6332(22)00501-3. [DOI: 10.1016/j.acra.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 11/01/2022]
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Sosnowska-Sienkiewicz P, Strauss E, Bućko E, Dopierała M, Mańkowski P, Januszkiewicz-Lewandowska D. Are There Any Limiting Factors of Minimally Invasive Adrenalectomy in Children? Over 20-Year Single-Center Experience. POLISH JOURNAL OF SURGERY 2022; 94:46-53. [DOI: 10.5604/01.3001.0015.7783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Laparoscopic adrenalectomy is more widely recognized as a valuable treatment method for benign and malignant tumours. </br></br> <b>Aim:</b> This study reviews over 20-year experience with laparoscopic adrenalectomy in children in Central-West Poland. </br></br> <b>Materials and methods:</b> During the last 21 years, 5041 laparoscopic procedures were performed, among them 39 adrenalectomies in children aged from 2 days to 17 years. The following data were analysed: patient's age at diagnosis and surgery, lesion volume in CT/MRI examination, duration of surgery, the incidence of complication after surgery, and length of hospitalization. </br></br> <b>Results:</b> The volume of adrenal lesion visualized by CT or MRI before surgery varied from 0.5 cm3 up to 490 cm3, with a median of 14 cm3. As many as 80% of adrenalectomies allowed radical removal of the lesion and 92% of those procedures were performed without any complications. From all data analysed, only age, both at diagnosis and at surgery, was significantly lower in patients with a malignant lesion. </br></br> <b>Conclusions:</b> Laparoscopic adrenalectomy is a valuable method to use in paediatric patients for both benign and malignant adrenal lesions. However, in patients with malignant adrenal lesions it may be expected that the procedure will be more difficult due to the lower age and larger lesion size.
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Affiliation(s)
| | - Ewa Strauss
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Ewa Bućko
- Karol Jonscher Hospital, Poznan, Poland
| | - Maria Dopierała
- Student Scientific Group of Pediatric Surgery, Poznan University of Medical Sciences, Poland
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10
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CO 2 pneumoperitoneum effects on proliferation and apoptosis in two different neuroblastoma cell lines. Pediatr Surg Int 2022; 38:457-464. [PMID: 35083505 DOI: 10.1007/s00383-022-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The proto-oncogene MYCN is considered a transcription factor involved in the regulation of neuroblastoma (NB) cell biology. Since minimally invasive-surgery represents a debated treatment of NB, we investigated CO2 effects on proliferative activity and apoptotic pathway in two NB cell lines, SH-SY5Y (MYCN-non-amplified) and IMR-32 (MYCN-amplified). METHODS SH-SY5Y and IMR-32 were exposed to CO2 (100%) at a pressure of 15 mmHg for 4 h and then moved to normal condition for 24 h. Cell proliferation, caspase 3 activity and transcript levels of BAX, BCL-2, cyclin B, cyclin D and MMP-2 were evaluated. RESULTS CO2 exposure caused a decrease in cell proliferation associated to increases in BAX/BCL-2 ratio and caspase 3 activity in SH-SY5Y, while opposite effects have been found in IMR-32. CO2 exposure induced a decrease of cyclin B1 in SH-SY5Y, while an increase in cyclin B1 and D1 was observed in IMR-32. A slight up-regulation of MMP-2 expression in SH-SY5Y and a significant increase of 2.2 folds in IMR-32 was observed (p < 0.05). CONCLUSIONS Our results suggest that CO2 exposure may cause different effects on various NB cell lines, likely due to MYCN amplification status. Further in vitro and in vivo studies are needed to highlight the role of laparoscopy on NB behaviour.
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de Campos Vieira Abib S, Chui CH, Cox S, Abdelhafeez AH, Fernandez-Pineda I, Elgendy A, Karpelowsky J, Lobos P, Wijnen M, Fuchs J, Hayes A, Gerstle JT. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines. Ecancermedicalscience 2022; 16:1356. [PMID: 35510137 PMCID: PMC9023308 DOI: 10.3332/ecancer.2022.1356] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/14/2022] Open
Abstract
Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries. The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High- (HICs) and Low- and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer. We hope that this initiative will benefit children worldwide in the best way possible. Simone Abib, IPSO President Justin T Gerstle, IPSO Education Committee Chair Chan Hon Chui, IPSO Secretary.
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Affiliation(s)
- Simone de Campos Vieira Abib
- Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, Rua Pedro de Toledo, 572 - Vila Clementino, São Paulo, SP 04021-001, Brazil
| | - Chan Hon Chui
- Surgery Centre for Children, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510, Singapore
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St Jude Research Hospital 262 Danny Thomas Place. MS133, Memphis, TN 38105, USA
| | - Israel Fernandez-Pineda
- Department of Pediatric Surgery, Virgen del Rocio Children’s Hospital, Av Manuel Siurot S/NN, Sevilla 41013, Spain
| | - Ahmed Elgendy
- Surgical Oncology Unit, Faculty of Medicine, Tanta University, Elgiesh Street, 31111, Tanta, Gharbeya, Egypt
| | - Jonathan Karpelowsky
- Department of Paediatric Surgery, Children’s Hospital at Westmead, Westmead NSW 2145, Australia
| | - Pablo Lobos
- Pediatric Surgery Division, Hospital Italiano de Buenos Aires, Andrés Lamas 812, Buenos Aires 1406, Argentina
| | - Marc Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Huispostnummer KE 01.129.2, Postbus 85090, Utretcht 3508AB, The Netherlands
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany
| | - Andrea Hayes
- Department of Surgery, Howard University Hospital, 1851 9th Street NW, 4th Floor, Washington, DC 20059, USA
| | - Justin T Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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12
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Delforge X, De Cambourg P, Defachelles AS, Haffreingue A, Rod J, Kassite I, Chabani N, Lauriot-Dit-Prevost A, Gourmel A, Arnaud A, Duchesne C, Thebaud E, Leclair MD. Unresectable thoracic neuroblastic tumors: Changes in image-defined risk factors after chemotherapy and impact on surgical management. Pediatr Blood Cancer 2021; 68:e29260. [PMID: 34302705 DOI: 10.1002/pbc.29260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/23/2021] [Accepted: 07/14/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Neuroblastoma management in children is multimodal and depends on multiple factors, including the possibility of complete surgical resection. Image-defined risk factors (IDRFs) are used to assess the feasibility of primary surgery. We studied the changes in IDRFs after neoadjuvant chemotherapy for thoracic neurogenic tumors. METHODS We performed a multicenter review of 27 patients presenting with unresectable thoracic neurogenic tumors. Patients received neoadjuvant chemotherapy, according to their risk group. IDRF at diagnosis and before surgery were retrospectively analyzed by a radiologist and a surgeon, blind to the initial assessment. Surgical and oncologic outcomes were reviewed. RESULTS None of the patients presented MYCN amplification, and 78 IDRFs were identified at diagnosis. Vascular IDRFs were the most frequent, with 28 vascular IDRFs detected in 18 patients, 22 of which disappeared after chemotherapy. Reductions of tumor volume were associated with a regression of IDRFs. Patients undergoing minimally invasive surgery had smaller tumor volumes than those undergoing open surgery, and no vascular IDRF. Two patients received two additional courses of chemotherapy to reduce tumor volume sufficiently for surgery. One patient with ganglioneuroblastoma underwent early surgery due to a lack of response to initial chemotherapy. CONCLUSION Tumor volume reduction with neoadjuvant chemotherapy eliminates most IDRF in thoracic neurogenic tumors. Vascular IDRF are rapidly resolved at this site, making surgical resection and minimally invasive surgery possible.
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Affiliation(s)
- Xavier Delforge
- Department of Pediatric Surgery, CHU Amiens Picardie, Amiens, France.,Department of Pediatric Surgery, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Pauline De Cambourg
- Department of Radiology, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Nantes, France
| | | | - Aurore Haffreingue
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Julien Rod
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Ibtissam Kassite
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Tours, France
| | - Nassima Chabani
- Department of Pediatric Surgery, CHU Amiens Picardie, Amiens, France
| | | | - Antoine Gourmel
- Department of Pediatric Oncology, CHU Amiens Picardie, Amiens, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Rennes, France
| | - Camille Duchesne
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Rennes, France
| | - Estelle Thebaud
- Department of Pediatric Oncology, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Marc-David Leclair
- Department of Pediatric Surgery, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Nantes, France
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13
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Ryabov AB, Poddubniy IV, Trunov VO, Kubirov MS, Khizhnikov AV, Milashchenko TA, Manzhos PI, Imanalieva AA. [Surgical treatment of retroperitoneal neurogenic tumors in children]. Khirurgiia (Mosk) 2021:59-67. [PMID: 34608781 DOI: 10.17116/hirurgia202110159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate feasibility and advantages of laparoscopic access in children with retroperitoneal neurogenic tumors. MATERIAL AND METHODS A comparative analysis of postoperative results was performed in 2 groups of patients with retroperitoneal neurogenic tumors without IDRF risk factors. Different surgical approaches were applied. The main group (laparoscopic access) consisted of 18 patients. The control group included 22 patients after laparotomy. We compared the following variables: surgery time, blood loss, postoperative need for analgesics, intraoperative and postoperative complications, timing of postoperative enteral feeding, postoperative hospital-stay and regional recurrence rate. RESULTS Duration of laparoscopic and open surgery was similar (80.5 vs. 86.5 min, p>0.05). Intraoperative blood loss was significantly lower in the laparoscopy group (10 vs. 17 ml/kg, p<0.05). Two patients required conversion of laparoscopic approach. In laparotomy group, massive intraoperative bleeding occurred in 1 patient. Early postoperative period was more favorable in the main group compared to the control group. There were no local and metastatic recurrences in delayed postoperative period after laparoscopic surgery. One (4.5%) patient had metastatic recurrence after laparotomy. There were no regional recurrences in this group. CONCLUSION Laparoscopic resection of neurogenic retroperitoneal tumors in children is feasible if great vessels are not involved in neoplastic process. Open surgery is preferable in patients with invasion of great vessels.
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Affiliation(s)
- A B Ryabov
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia.,Hertzen Moscow Cancer Research Institute, Moscow, Russia
| | - I V Poddubniy
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V O Trunov
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - M S Kubirov
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - A V Khizhnikov
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | | | - P I Manzhos
- Russian Peoples' Friendship University, Moscow, Russia
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14
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Minimally invasive surgery for neuroblastic tumours: A SIOPEN multicentre study: Proposal for guidelines. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:283-291. [PMID: 34489122 DOI: 10.1016/j.ejso.2021.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Surgery plays a key role in the management of Neuroblastic tumours (NB), where the standard approach is open surgery, while minimally invasive surgery (MIS) may be considered an option in selected cases. The indication(s) and morbidity of MIS remain undetermined due to small number of reported studies. The aim of this study was to critically address the contemporary indications, morbidity and overall survival (OS) and propose guidelines exploring the utility of MIS for NB. MATERIALS & METHODS A SIOPEN study where data of patients with NB who underwent MIS between 2005 and 2018, including demographics, tumour features, imaging, complications, follow up and survival, were extracted and then analysed. RESULTS A total of 222 patients from 16 centres were identified. The majority were adrenal gland origin (54%) compared to abdominal non-adrenal and pelvic (16%) and thoracic (30%). Complete and near complete macroscopic resection (>95%) was achieved in 95%, with 10% of cases having conversion to open surgery. Complications were reported in 10% within 30 days of surgery. The presence of IDRF (30%) and/or tumour volume >75 ml were risk factors for conversion and complications in multivariate analysis. Overall mortality was 8.5%. CONCLUSIONS MIS for NB showed that it is a secure approach allowing more than 95% resection. The presence of IDRFs was not an absolute contraindication for MIS. Conversion to open surgery and overall complication rates were low, however they become significant if tumour volume >75 mL. Based on these data, we propose new MIS guidelines for neuroblastic tumours.
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15
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Kawano T, Souzaki R, Sumida W, Ishimaru T, Fujishiro J, Hishiki T, Kinoshita Y, Kawashima H, Uchida H, Tajiri T, Yoneda A, Oue T, Kuroda T, Koshinaga T, Hiyama E, Nio M, Inomata Y, Taguchi T, Ieiri S. Laparoscopic approach for abdominal neuroblastoma in Japan: results from nationwide multicenter survey. Surg Endosc 2021; 36:3028-3038. [PMID: 34143289 DOI: 10.1007/s00464-021-08599-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some neuroblastoma (NB) cases are suitable for minimally invasive surgery (MIS), but indication and technical issue are unclear. We assessed the current status of MIS for abdominal NB after mass screening period in Japan. METHODS Preliminary questionnaires requesting the numbers of NB cases that underwent MIS from 2004 to 2016 were sent to 159 Japanese institutes of pediatric surgery. The secondary questionnaires were then sent to the institutions that reported MIS cases of NB in order to collect detailed data. RESULTS One hundred and thirty-four (84.2%) institutions responded to the preliminary questionnaires, and 83 (52.2%) reported managing operative cases. The total number of operative cases was 1496. MIS was performed for 175 (11.6%) cases, of which the completed forms of 140 patients were returned, including 100 abdominal NB cases. The male/female ratio was 51/49. Forty-seven cases underwent a laparoscopic biopsy, and 2 (4.3%) cases were converted to laparotomy due to bleeding. Sixty-five cases underwent MIS for radical resection, and 7 (10.8%) were converted to laparotomy. The reasons for open conversion were bleeding and severe adhesion. Regarding open conversion, there were no significant relationships between conversion and neo-adjuvant chemotherapy, biopsies, stage, size, or MYCN amplification. We found no relationship between resectability and vascular encasement in this study. There was relationship between the resected tumor size and the patients' height, which was expressed using the following formula: [Formula: see text] (x, patients height, y, tumor size; p = 0.004219, SE: 1.55566). Postoperative complications after radical resection were recognized in 7 (10.8%) cases. CONCLUSIONS MIS was performed in limited cases of abdominal NB. A laparoscopic biopsy with careful attention to bleeding is feasible. The resected tumor size was shown to correlate with the patients' height. Tumor size within 6 cm of maximum diameter can be resected safely.
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Affiliation(s)
- Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University, Chiba, Japan
| | | | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihiro Yoneda
- Division of Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Masaki Nio
- Department of Pediatric Surgery, Tohoku University, Sendai, Japan
| | | | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan.
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16
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Zhang R, Fang YF, Wu DM, Lin Y, Zhang B, Liu MK, Bai JX, Chen F. Comparison of the Efficacy of Minimally Invasive and Open Surgery on Children with Neuroblastoma: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 31:829-838. [PMID: 34076504 DOI: 10.1089/lap.2020.0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Evaluate the clinical efficacy and safety of minimally invasive surgery (MIS) and open surgery in the treatment of neuroblastoma (NB) in children by a meta-analysis. Materials and Methods: This is a meta-analysis. We searched for random or nonrandomized controlled study of MIS group and OPEN surgery group for the treatment of childhood NB included in PubMed, ClinicalTrials, EMBASE, and Cochrane library before January 31, 2020. Data extraction was performed in a standard format for the included studies, including tumor diameter, operation time, intraoperative bleeding, length of hospital stay (LOHS), complications, recurrence, and MYCN. Results: Seven retrospective studies were finally included, with a total of 571 children, including 162 in MIS group and 409 in the OPEN surgery group. Compared with the OPEN surgery group, the MIS group had reduced intraoperative bleeding (mean difference [MD] = -12.72, 95% CI: -24.84 to -0.61, P < .05), and reduced l LOHS (MD = -3.35, 95% CI: -5.55 to -1.15, P < .05) and decreased postoperative recurrence (MD = 0.20, 95% CI: 0.05-0.75, P < .05). The differences between the groups were statistically significant. There was no significant difference between groups in tumor diameter (MD = -18.84, 95% CI: -48.12 to 10.43, P > .05), operation time (MD = -21.7, 95% CI: -97.52 to 54.13, P > .05), and MYCN results (odds ratio = 2.27, 95% CI: 0.56-9.18, P > .05). Conclusions: Preliminary evidence indicates that the treatment of NB with MIS has the advantages of less intraoperative bleeding, shorter LOHS, and less postoperative recurrence compared with open surgery.
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Affiliation(s)
- Rong Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yi Fan Fang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Dian Ming Wu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Bing Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Ming Kun Liu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Jiang Xi Bai
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Fei Chen
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
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17
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Zenitani M, Tsukada R, Masahata K, Nakamura K, Takama Y, Umeda S, Soh H, Yoneda A, Yonekura T, Usui N, Oue T, Okuyama H. Safety and Feasibility of Laparoscopic Resection of Neuroblastoma Without Image-Defined Risk Factors Performed by Pediatric Surgical Trainees: A Multicenter Comparison Study. J Laparoendosc Adv Surg Tech A 2021; 31:954-958. [PMID: 34030470 DOI: 10.1089/lap.2020.0957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Laparoscopic resection has gradually been adopted for neuroblastoma patients; however, some authors reported that, due to its technically demanding procedures, this operation should be performed only by highly experienced surgeons. The aim of this study was to evaluate the safety and feasibility of laparoscopic resection of abdominal neuroblastoma by pediatric surgical trainees. Subjects and Methods: In this multicenter, retrospective study, including 18 children with abdominal neuroblastoma indicated for 19 laparoscopic resections (1 with bilateral neuroblastomas) from 1999 to 2018, the clinical data were retrospectively reviewed and compared between trainee and attending surgeons. Results: None of the cases had image-defined risk factors (IDRFs) at surgery. All patients successfully underwent complete laparoscopic resection without blood transfusion, open conversion, or intraoperative or postoperative complications. Of the 19 cases, 6 were performed by pediatric surgical trainees under the guidance of attending surgeons, and 13 were performed by attending surgeons. With comparable tumor, largest diameter, operative time, and bleeding amount were not significantly different between the two groups. In the trainee surgeon group, one local recurrence occurred at a secondary resection site in the bilateral neuroblastoma patient with Stage L2. Conclusions: Laparoscopic resection of neuroblastoma could be safe and feasible when limited to absent IDRFs at surgery by pediatric surgical trainees under the guidance of experienced attending surgeons, as well as by attending surgeons.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Tsukada
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyoko Nakamura
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Hideki Soh
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takeo Yonekura
- Department of Pediatric Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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18
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Bhoopathi P, Mannangatti P, Emdad L, Das SK, Fisher PB. The quest to develop an effective therapy for neuroblastoma. J Cell Physiol 2021; 236:7775-7791. [PMID: 33834508 DOI: 10.1002/jcp.30384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Neuroblastoma (NB) is a common solid extracranial tumor developing in pediatric populations. NB can spontaneously regress or grow and metastasize displaying resistance to therapy. This tumor is derived from primitive cells, mainly those of the neural crest, in the sympathetic nervous system and usually develops in the adrenal medulla and paraspinal ganglia. Our understanding of the molecular characteristics of human NBs continues to advance documenting abnormalities at the genome, epigenome, and transcriptome levels. The high-risk tumors have MYCN oncogene amplification, and the MYCN transcriptional regulator encoded by the MYCN oncogene is highly expressed in the neural crest. Studies on the biology of NB has enabled a more precise risk stratification strategy and a concomitant reduction in the required treatment in an expanding number of cases worldwide. However, newer treatment strategies are mandated to improve outcomes in pediatric patients who are at high-risk and display relapse. To improve outcomes and survival rates in such high-risk patients, it is necessary to use a multicomponent therapeutic approach. Accuracy in clinical staging of the disease and assessment of the associated risks based on biological, clinical, surgical, and pathological criteria are of paramount importance for prognosis and to effectively plan therapeutic approaches. This review discusses the staging of NB and the biological and genetic features of the disease and several current therapies including targeted delivery of chemotherapy, novel radiation therapy, and immunotherapy for NB.
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Affiliation(s)
- Praveen Bhoopathi
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Padmanabhan Mannangatti
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Luni Emdad
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Swadesh K Das
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul B Fisher
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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19
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Wu Y, Zeng L, Qiu R, Zhang J, Su J, Liao M, Deng X. Two-stage laparoscopic resection of giant hepatoblastoma in infants combined with liver partial partition and artery ligation. World J Surg Oncol 2021; 19:63. [PMID: 33632257 PMCID: PMC7908728 DOI: 10.1186/s12957-021-02156-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Laparoscopic resection of giant hepatoblastoma (HB) in children has long been a subject of controversy. Here, a new procedure of two-stage laparoscopic resection of giant HB in infants was firstly reported and the feasibility was discussed. Methods The clinical data of three infants with HB were retrospectively reviewed, all of which received 3–5 cycles of neoadjuvant chemotherapy. Stage 1 laparoscopic selective hepatic artery ligation and liver partial partition were performed. Stage 2 laparoscopic hepatectomy was performed 2 weeks later. Results The results demonstrated that (1) the tumors shrank considerably in size and had relatively clear boundaries after neoadjuvant chemotherapy; (2) after stage 1 surgery, the tumor volume further reduced, while the intratumoral necrosis expanded; (3) 2 weeks later, stage 2 laparoscopic hepatectomy was performed successfully; (4) none of the cases had intraoperative complications such as tumor rupture, air embolism, hemorrhage, biliary fistula, or liver failure, and there was no recurrence or metastasis during follow-up. Conclusions Two-stage laparoscopic hepatectomy associating selective hepatic artery ligation and liver partial partition for HB in infants has the benefits of small invasiveness, fast recovery, improved safety, and high feasibility. However, more cases and longer follow-up are needed to assess its long-term efficacy.
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Affiliation(s)
- Yaohao Wu
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lexiang Zeng
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ronglin Qiu
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie Zhang
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianhang Su
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minyi Liao
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaogeng Deng
- Department of Pediatric Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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20
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Gurria JP, Malek MM, Heaton TE, Gehred A, Lautz TB, Rhee DS, Tracy ET, Grant CN, Baertshiger RM, Bruny J, Christison-Lagay ER, Rodeberg DA, Ehrlich PF, Dasgupta R, Aldrink JH. Minimally invasive surgery for abdominal and thoracic neuroblastic tumors: A systematic review by the APSA Cancer committee. J Pediatr Surg 2020; 55:2260-2272. [PMID: 32151400 DOI: 10.1016/j.jpedsurg.2020.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Minimally invasive surgery has broad applicability to pediatric diseases, including pediatric cancer resection. Neuroblastic tumors of childhood are highly variable in presentation, and so careful selection of appropriate candidates for minimally invasive resection is paramount to achieving safe and durable surgical and oncological outcomes. METHODS The American Pediatric Surgical Association Cancer Committee developed questions seeking to better define the role of minimally invasive surgery for neuroblastic tumors. A search using PubMed, Medline, Embase, Web of Science, ProQuest Dissertations, and Clinical Trials was performed for articles published from 1998 to 2018 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. RESULTS The evidence identified is all retrospective in nature. Minimally invasive surgical resection of neuroblastic tumors is safe for carefully selected smaller (4-6 cm) image defined risk factor (IDRF)-negative abdominal tumors when oncologic principles are followed. Size is a less-well defined criterion for thoracic neuroblastic tumors. Open approaches for both abdominal and thoracic tumors may be preferable in the presence of IDRF's. CONCLUSION Small tumors without IDRF's are reasonable candidates for minimally invasive resection. Surgical oncologic guidelines should be closely followed. The quality of data supporting this systematic review is poor and highlights the need for refinement in the study of such surgical techniques to improve knowledge and outcomes for patients with neuroblastic tumors. TYPE OF STUDY Systematic Review. LEVEL OF EVIDENCE Level III and Level IV.
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Affiliation(s)
- Juan P Gurria
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Todd E Heaton
- Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Gehred
- Grant Morrow III Library, Nationwide Children's Hospital, Columbus, OH
| | - Timothy B Lautz
- Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Hershey Medical Center, Hershey, PA
| | - Reto M Baertshiger
- Division of Thoracic and General Pediatric Surgery, Hospital for Sick Children, Toronto, CA
| | - Jennifer Bruny
- Department of Surgery, Division of Pediatric Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO
| | | | - David A Rodeberg
- Department of Surgery, Division of Pediatric Surgery East Carolina University, Greenville, NC
| | - Peter F Ehrlich
- Section of Pediatric Surgery, University of Michigan School of Medicine, Ann Arbor, MI
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
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21
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Parhar D, Joharifard S, Lo AC, Schlosser MP, Daodu OO. How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis. Pediatr Surg Int 2020; 36:897-907. [PMID: 32533235 DOI: 10.1007/s00383-020-04696-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Since their introduction to the International Neuroblastoma Risk Group (INRG) staging system in 2009, the role of Image-Defined Risk Factors (IDRFs) in predicting outcomes has been studied in heterogeneous populations with varying results. We conducted a systematic review and meta-analysis in order to determine quantitative measures of precisely how well pre-treatment IDRFs predict surgical outcomes and survival. METHODS A systematic review was performed for studies between January 1990 and July 2019 that compared surgical outcomes and/or survival in pediatric neuroblastoma patients with one or more IDRFs to patients without IDRFs. Summary risk ratios (RR) and hazard ratios (HR) were calculated using a random-effects model. RESULTS 19 retrospective cohort studies were included, representing data from 1132 patients. The risk ratio (RR) of incomplete surgical resection in IDRF-positive patients compared to IDRF-negative patients was 2.45 (95% CI 1.51-3.97). The RR of surgical complications was 2.30 (95% CI 1.46-3.61). The hazard ratio (HR) for 5-year EFS was 2.08 (95% CI 2.93-4.13) while the 5-year HR for OS was 2.44 (95% CI 1.46-4.08). CONCLUSION IDRF-positive neuroblastoma patients have a higher risk of incomplete surgical resection, surgical complications, and 5-year mortality and/or relapse. Our results affirm that IDRFs remain a useful prognostic tool for neuroblastoma patients both for short and long-term outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Dennis Parhar
- Department of Radiology, University of British Columbia, Gordon & Leslie Diamond Health Centre, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Shahrzad Joharifard
- Departément de Chirurgie, Division de Chirurgie Pédiatrique, Université de Montréal, Montréal, QC, Canada
| | - Andrea C Lo
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Mary-Pat Schlosser
- Department of Pediatric Medicine, Division of Immunology, Hematology/Oncology, Palliative Care and Environmental Medicine, University of Alberta, Edmonton, AB, Canada
| | - Oluwatomilayo O Daodu
- Department of Surgery, Division of Pediatric Surgery, University of Calgary, Calgary, AB, Canada
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22
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Abdelhafeez A, Ortega-Laureano L, Murphy AJ, Davidoff AM, Fernandez-Pineda I, Sandoval JA. Minimally Invasive Surgery in Pediatric Surgical Oncology: Practice Evolution at a Contemporary Single-Center Institution and a Guideline Proposal for a Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2019; 29:1046-1051. [PMID: 31241404 DOI: 10.1089/lap.2018.0467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the lack of randomized or controlled trials for minimally invasive surgery (MIS) in pediatric surgical oncology, the integration of MIS into the surgical practice of pediatric oncology has become increasingly popular. The aim of this study was to evaluate the implementation of MIS in a pediatric tertiary cancer center and compare present use of MIS to that in a previous analysis at our center. Methods: We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. Results: A total of 252 MIS procedures were performed: 73 laparoscopic (29%) and 179 thoracoscopic (71%). MIS was used for diagnostic purposes in 59% (146 thoracoscopic and 34 laparoscopic) and the therapeutic resection in 24% (39 laparoscopic cases and 33 thoracoscopic cases). Conversion to an open procedure occurred in 18 tumor resections (6%) and in 22 diagnostic biopsies (7%), mostly due to technical challenges in identifying or mobilizing tumors. Complications occurred in seven tumor resections (2%) and included three pneumothoraces, two bleeding complications, one bowel injury, and one wound infection. Complications occurred in 10 diagnostic biopsies (3%), mostly pneumothoraces. No tumor upstaging or trocar site recurrences occurred (follow-up time, 1-15 years). Conclusions: Over the last decade, we demonstrate the evolution of MIS in the management of solid tumors in children. We encourage surgeons and oncologists to join the call to arms to establish prospective trials evaluating MIS in pediatric surgical oncology.
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Affiliation(s)
| | | | - Andrew J Murphy
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A Sandoval
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
- 2HSHS Medical Group Pediatric Surgery, St. John's Children's Hospital, Springfield, Illinois
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23
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Phelps HM, Ndolo JM, Van Arendonk KJ, Chen H, Dietrich HL, Watson KD, Hilmes MA, Chung DH, Lovvorn HN. Association between image-defined risk factors and neuroblastoma outcomes. J Pediatr Surg 2019; 54:1184-1191. [PMID: 30885556 PMCID: PMC6628713 DOI: 10.1016/j.jpedsurg.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current neuroblastoma (NBL) staging system employs image-defined risk factors (IDRFs) to assess numerous anatomic features, but the impact of IDRFs on surgical and oncologic outcomes is unclear. METHODS The Vanderbilt Cancer Registry identified children treated for NBL from 2002 to 2017. Tumor volume (TV) and IDRFs were measured radiographically at diagnosis and before resection. Perioperative and oncologic outcomes were evaluated. RESULTS At diagnosis of 106 NBL, 61% were IDRF positive. MYCN-amplified and undifferentiated NBL had more IDRFs than nonamplified and more differentiated tumors (p = 0.001 and p = 0.01). Of 86 NBLs resected, 43% were IDRF positive, which associated with higher stage, risk, and TV (each p < 0.001). The presence of IDRF at resection was also associated with increased blood loss (p < 0.001), longer operating times (p < 0.001), greater incidence of intraoperative complications (p = 0.03), more frequent ICU admissions postoperatively (p < 0.001), and longer hospital stays (p < 0.001). IDRF negative and positive tumors did not have significantly different rates of gross total resection (p = 0.2). Five-year relapse-free and overall survival was similar for IDRF negative and positive NBL (p = 0.9 and p = 0.8). CONCLUSIONS IDRFs at diagnosis were associated with larger, less differentiated, advanced stage, and higher risk NBL and at resection with increased operative difficulty and perioperative morbidity. However, the frequency of gross total resection and patient survival after resection were not associated with the presence of IDRFs. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hannah M. Phelps
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN,Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Corresponding author at: Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37232-9780. (H.M. Phelps)
| | - Josephine M. Ndolo
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kyle J. Van Arendonk
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Heidi Chen
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Katherine D. Watson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa A. Hilmes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Harold N. Lovvorn
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
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24
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Van Arendonk KJ, Chung DH. Neuroblastoma: Tumor Biology and Its Implications for Staging and Treatment. CHILDREN-BASEL 2019; 6:children6010012. [PMID: 30658459 PMCID: PMC6352222 DOI: 10.3390/children6010012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 01/11/2023]
Abstract
Neuroblastoma, the most common extracranial solid tumor of childhood, has widely variable outcomes dependent on the specific biology of the tumor. In this review, current biologic principles that are used to stratify risk and guide treatment algorithms are discussed. The role for surgical resection in neuroblastoma is also reviewed, including the indications and timing of surgery within the greater treatment plan.
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Affiliation(s)
- Kyle J Van Arendonk
- Department of Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Dai H Chung
- Department of Surgery, Children's Medical Center Dallas, UT Southwestern Medical Center, Dallas, TX 75235, USA.
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25
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Luo YB, Cui XC, Yang L, Zhang D, Wang JX. Advances in the Surgical Treatment of Neuroblastoma. Chin Med J (Engl) 2018; 131:2332-2337. [PMID: 30246719 PMCID: PMC6166470 DOI: 10.4103/0366-6999.241803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB). DATA SOURCES The online database ScienceDirect (201-2018) was utilized. The search was conducted using the keywords "neuroblastoma," "neuroblastoma resection," "neuroblastoma surgery," and "high-risk neuroblastoma." STUDY SELECTION We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis. RESULTS A total of 7800 English language articles were found containing references to NB (201-2018). The 163 articles were searched which were related to the surgical treatment of NB (201-2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial. CONCLUSIONS NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.
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Affiliation(s)
- Yan-Bing Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Xi-Chun Cui
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Lin Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Da Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Jia-Xiang Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
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26
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Ezekian B, Englum BR, Gulack BC, Rialon KL, Kim J, Talbot LJ, Adibe OO, Routh JC, Tracy ET, Rice HE. Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor. Pediatr Blood Cancer 2018; 65. [PMID: 28792662 DOI: 10.1002/pbc.26755] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/07/2017] [Accepted: 07/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) has been widely adopted for common operations in pediatric surgery; however, its role in childhood tumors is limited by concerns about oncologic outcomes. We compared open and MIS approaches for pediatric neuroblastoma and Wilms tumor (WT) using a national database. METHODS The National Cancer Data Base from 2010 to 2012 was queried for cases of neuroblastoma and WT in children ≤21 years old. Children were classified as receiving open or MIS surgery for definitive resection, with clinical outcomes compared using a propensity matching methodology (two open:one MIS). RESULTS For children with neuroblastoma, 17% (98 of 579) underwent MIS, while only 5% of children with WT (35 of 695) had an MIS approach for tumor resection. After propensity matching, there was no difference between open and MIS surgery for either tumor for 30-day mortality, readmissions, surgical margin status, and 1- and 3-year survival. However, in both tumors, open surgery more often evaluated lymph nodes and had larger lymph node harvest. CONCLUSION Our retrospective review suggests that the use of MIS appears to be a safe method of oncologic resection for select children with neuroblastoma and WT. Further research should clarify which children are the optimal candidates for this approach.
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Affiliation(s)
- Brian Ezekian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian R Englum
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kristy L Rialon
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jina Kim
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lindsay J Talbot
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Obinna O Adibe
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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