Тhe role of surgery in treatment of patients with neuroblastoma of difficult anatomical localization

Abstract

High risk of life threatening complications is distinctive for surgery of tumors, which are in contact with large main vessels. Planning for the removal of the primary focus of neuroblastoma (NB), characterized by similar localization, includes determining the timing and method of the operation, the required resection volume, predicting complications, developing ways to prevent them and relieve them. The study was approved by the Independent Ethics Committee and Scientific Board of N.I. Pirogova of RussianNationalResearchMedicalUniversity. The results of complex treatment of 11 children with NB of thoracoabdominal localization, aged from 9 to 55 months, are present in the research. 7 (64%) of them were stratified into a high-risk group, 3 (27%) – intermediate, 1 (9%) – low, according to the criteria of the NB-2004 protocol. The results were analyzed depending on the features of the operation and the course of the early postoperative period. The number of variants of tumor syntropy which coincided image-defined risk factors, revealed by computed tomography with contrast enhancement, was in the range from 2 to 7 (median – 5). The median volume of the removed part of the tumor was 95% (range from 92 to 98%). Among intraoperative complications aortic wall (1 (9%) observation), superior mesenteric vein (1 (9%) observation), right renal vein (2 (18%) observations), left renal vein (2 (18%) observations), inferior vena cava (2 (18%) observations) injury should be noted, which were sutured without subsequently detected hemodynamic disturbances and organ function. Complications in the early postoperative period were: partial ileus (1 (9%) observation), renal artery thrombosis (1 (9%) observation), inferior vena cava thrombosis (1 (9%) observation), pancreatic necrosis (1 (9%) observation). They demanded reoperation in two children: nephrectomy in a child with renal artery thrombosis at the fourth posroparative day and performing of anastomosis between the pancreas and small intestine at the 74 posroparative day in a patient with pancreatic necrosis. Among patients in the intermediate and high-risk groups, the event-free two-year survival rate was 50%, the total two-year survival rate was 88%. The prognosis of the disease does not reliably correlate with the duration of the relief of postoperative complications (p = 0.53) and the resection volume (p = 0.46). Surgical intervention and postoperative observation in children with NB of thoracoabdominal localization should be carried out by a team that has experience of similar operations, owning vascular suture technique, with a preliminary assessment of the image-defined risk factors. The purpose of the operation should be a resection aimed at cytoreduction and elimination of the mass-effect, without striving to remove all areas of the tumor.