Luca Pio1, Stefano Avanzini2, Girolamo Mattioli3, Giuseppe Martucciello3, Angela Rita Sementa4, Massimo Conte5, Annarita Gigliotti6, Claudio Granata7, Ernesto Leva8, Anna Maria Fagnani8, Umberto Caccioppoli9, Nino Tedesco9, Jurgen Schleef10, Elisa Tirtei11, Fortunato Siracusa12, Paolo D'Angelo13, Pierluigi Lelli Chiesa14, Lucia Miglionico15, Bruno Noccioli16, Elisa Severi16, Claudio Carlini17, Francesco Vaccarella17, Francesco Camoglio18, Simone Cesaro19, Alessandra Narciso20, Giovanna Riccipetitoni21, Giovanni Cecchetto22, Alessandro Inserra20. 1. Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova. Electronic address: lucakeats@hotmail.it. 2. Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova. 3. Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova. 4. Pathology Unit, Istituto Giannina Gaslini, Genova. 5. Oncology Unit, Istituto Giannina Gaslini, Genova. 6. Epidemiology Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genova. 7. Radiology Unit, Istituto Giannina Gaslini, Genova. 8. Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano. 9. Surgical Oncology Unit, A.O.R.N. Santobono Pausilipon, Napoli. 10. Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Torino. 11. Oncology Unit, Ospedale Infantile Regina Margherita, Torino. 12. Policlinico Universitario P. Giaccone, Palermo. 13. Oncology Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospital, Palermo. 14. Pediatric Surgery Unit, Ospedale Santo Spirito, Pescara. 15. Oncology Unit, Casa Sollievo della Sofferenza, San Giovanni Rotondo. 16. Pediatric Surgery Unit, Ospedale Pediatrico Meyer, Firenze. 17. Pediatric Surgery Unit, ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria. 18. Pediatric Surgery Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona. 19. Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona. 20. Pediatric Surgery Unit, Ospedale Pediatrico Bambino Gesù, Roma. 21. Pediatric Surgery Unit, Ospedale Pediatrico Buzzi, Milano. 22. Azienda Ospedaliero-Universitaria, Padova.
Abstract
BACKGROUND: Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. METHODS: A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. RESULTS: From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36months (range 4-96months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. CONCLUSION: Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. LEVEL OF EVIDENCE: IV.
BACKGROUND:Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. METHODS: A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. RESULTS: From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36months (range 4-96months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. CONCLUSION: Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. LEVEL OF EVIDENCE: IV.
Authors: Simone de Campos Vieira Abib; Chan Hon Chui; Sharon Cox; Abdelhafeez H Abdelhafeez; Israel Fernandez-Pineda; Ahmed Elgendy; Jonathan Karpelowsky; Pablo Lobos; Marc Wijnen; Jörg Fuchs; Andrea Hayes; Justin T Gerstle Journal: Ecancermedicalscience Date: 2022-02-17