Takafumi Kawano1, Ryota Souzaki2, Wataru Sumida3, Tetsuya Ishimaru4, Jun Fujishiro5, Tomoro Hishiki6, Yoshiaki Kinoshita7, Hiroshi Kawashima4, Hiroo Uchida3, Tatsuro Tajiri8, Akihiro Yoneda9, Takaharu Oue10, Tatsuo Kuroda11, Tsugumichi Koshinaga12, Eiso Hiyama13, Masaki Nio14, Yukihiro Inomata15, Tomoaki Taguchi2, Satoshi Ieiri16. 1. 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. 2. Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 4. Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan. 5. Department of Pediatric Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. 6. Department of Pediatric Surgery, Chiba University, Chiba, Japan. 7. Department of Pediatric Surgery, Niigata University, Niigata, Japan. 8. Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Division of Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan. 10. Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan. 11. Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan. 12. Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan. 13. Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan. 14. Department of Pediatric Surgery, Tohoku University, Sendai, Japan. 15. Kumamoto Rosai Hospital, Yatsushiro, Japan. 16. 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. sieiri@m.kufm.kagoshima-u.ac.jp.
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.
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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