Juan P Gurria1, Marcus M Malek2, Todd E Heaton3, Alison Gehred4, Timothy B Lautz5, Daniel S Rhee6, Elisabeth T Tracy7, Christa N Grant8, Reto M Baertshiger9, Jennifer Bruny10, Emily R Christison-Lagay11, David A Rodeberg12, Peter F Ehrlich13, Roshni Dasgupta14, Jennifer H Aldrink15. 1. Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. 2. Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. 3. Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Grant Morrow III Library, Nationwide Children's Hospital, Columbus, OH. 5. Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL. 6. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 7. Division of Pediatric Surgery, Duke University Medical Center, Durham, NC. 8. Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Hershey Medical Center, Hershey, PA. 9. Division of Thoracic and General Pediatric Surgery, Hospital for Sick Children, Toronto, CA. 10. Department of Surgery, Division of Pediatric Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO. 11. Division of Pediatric Surgery, Yale University School of Medicine, New Haven, CT. 12. Department of Surgery, Division of Pediatric Surgery East Carolina University, Greenville, NC. 13. Section of Pediatric Surgery, University of Michigan School of Medicine, Ann Arbor, MI. 14. Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 15. Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. Electronic address: Jennifer.aldrink@nationwidechildrens.org.
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.
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.