H O Gabra1, S Irtan2, K Cross3, P Lobos4, A Froeba-Pohl5, L Pio6, C Virgone7, G Guillén Burrieza8, J Gómez Chacón Villalba9, G Riccipetitoni10, F Guérin11, M Nightingale12, Y Heloury12, S Faraj13, M Leclair13, A Scalabre14, G Mattioli15, S W Warmann16, J Fuchs16, N Basta17, K Bjørnland18, L E Matthyssens19, P D Losty20, S Sarnacki6. 1. The Great North Children's Hospital- Newcastle University Teaching Hospitals, Paediatric Surgery, Newcastle Upon Tyne, United Kingdom. Electronic address: hany.gabra@nhs.net. 2. Sorbonne Université, Armand Trousseau Hospital-Assistance Publique Hôpitaux de Paris, Visceral and Neonatal Pediatric Surgery Department, Paris, France. 3. Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom. 4. Hospital Italiano, Pediatric Surgery, Buenos Aires, Argentina. 5. Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany. 6. Necker Enfants-Malades Hospital-Université de Paris, Department of Pediatric Surgery, Paris, France. 7. Department of Women's and Children's Health- University of Padua, Pediatric Surgery, Padua, Italy. 8. Hospital Universitario Vall d'Hebron, Servicio de Cirugía Pediátrica, Barcelona, Spain. 9. Hospital Universitario y Politécnico La Fe, Unidad de Cirugía Oncológica Pediátrica, Valencia, Spain. 10. V. Buzzi Children's Hospital, Pediatric Surgery, Milan, Italy. 11. Hôpitaux Universitaires Paris Sud- Hôpital Bicêtre Assistance Publique Hôpitaux de Paris- Université Paris XI, Pediatric Surgery, Paris, France. 12. The Royal Children's Hospital, Paediatric Surgery, Melbourne, Australia. 13. University Children Hospital, Pediatric Surgery& Urology, Nantes, France. 14. CHU-hôpital Nord, Service De Chirurgie Pédiatrique, Saint-Etienne, France. 15. Pediatric Surgery Unit- Istituto Giannina Gaslini- Genova. DINOGMI University of Genoa, Pediatric Surgery Unit, Genoa, Italy. 16. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. 17. Population Health Sciences Institute, Newcastle University, United Kingdom. 18. Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway. 19. Princess Elisabeth Children's Hospital, Ghent University Hospital, Department of Gastrointestinal and Paediatric Surgery, Ghent, Belgium. 20. Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, School of Health and Life Science, University of Liverpool, Liverpool, United Kingdom.
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.
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.