Günther P, Tröger J, Holland-Cunz S, Behnisch W, Hinz U, Romero P, Schenk J-P
Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany.
Eur J Pediatr Surg. 2009 Oct;19(5):297-303. doi: 10.1055/s-0029-1220681. Epub 2009 May 15.
Surgical complications after tumor operations are frequent in children, with rates of up to 30% cited in the literature. Various approaches to reduce these complication rates have been attempted, with preoperative chemotherapy holding pride of place. One approach to minimize surgical complications is better preoperative preparation. In a retrospective analysis, we evaluated the complications associated with tumor surgery.
We retrospectively analyzed patient data from 1991 to 2007. The distribution of the various tumors, the type of surgery, and complications were evaluated. For neuroblastomas a differentiated analysis of complications was performed, which included staging and radiologically defined surgical risk factors (SRFs). Patients were divided into two groups: A and B. Intensified surgical planning with 3D visualization was used in patients of group B.
A total of 145 operations for abdominal tumors were performed in 123 patients. The three most common diseases were neuroblastoma (36%), nephroblastoma (26%), and ovarian tumor (19%). In 68% of patients complete resection and in 19% of cases partial resection of the tumor was carried out; open biopsy was performed in 13%. A total of 15 (10.3%) complications developed: the incidence of complications for group A was 11.8% and 7.7% for group B (p=0.5). For nephroblastoma these figures were 27.9% and 21.2% (p=1.0). In the group of patients with neuroblastoma, six complications developed in patients from group A (21.4%) and one in a group B patient (4.2%) (p=0.107). 54% of neuroblastomas were completely and 33% partially resected; these figures and the distribution of SRFs were similar in the two groups. A significant increase in the risk of complications could be seen with an increase in SRFs (p=0.0267) and with disease stages 2 and 3 (p=0.016). Tumor reduction surgery was also associated with an increase in complications (p=0.086).
In summary, tumor surgery is associated with considerable risks in children. Therefore it is very important to look for new approaches that could potentially minimize these risks. As the causes of surgical complications are multifactorial, we are of the opinion that intensified surgical planning can contribute to reducing risks. Particularly neuroblastoma surgery could profit from an increased use of 3D visualization and improved preoperative planning.
儿童肿瘤手术后的手术并发症很常见，文献报道发生率高达30%。人们尝试了各种方法来降低这些并发症的发生率，术前化疗占据首要地位。一种将手术并发症降至最低的方法是更好的术前准备。在一项回顾性分析中，我们评估了与肿瘤手术相关的并发症。
我们回顾性分析了1991年至2007年的患者数据。评估了各种肿瘤的分布、手术类型和并发症。对于神经母细胞瘤，对并发症进行了详细分析，包括分期和放射学定义的手术风险因素（SRF）。患者分为两组：A组和B组。B组患者采用强化的三维可视化手术规划。
123例患者共进行了145例腹部肿瘤手术。三种最常见的疾病是神经母细胞瘤（36%）、肾母细胞瘤（26%）和卵巢肿瘤（19%）。68%的患者进行了肿瘤完全切除，19%的病例进行了部分切除；13%的患者进行了开放性活检。共发生15例（10.3%）并发症：A组并发症发生率为11.8%，B组为7.7%（p = 0.5）。肾母细胞瘤的这些数字分别为27.9%和21.2%（p = 1.0）。在神经母细胞瘤患者组中，A组有6例并发症发生（21.4%），B组有1例（4.2%）（p = 0.107）。54%的神经母细胞瘤被完全切除，33%被部分切除；两组的这些数字以及SRF的分布相似。随着SRF的增加（p = 0.0267）以及疾病分期为2期和3期（p = 0.016），并发症风险显著增加。肿瘤减瘤手术也与并发症增加相关（p = 0.086）。
总之，儿童肿瘤手术存在相当大的风险。因此，寻找可能将这些风险降至最低的新方法非常重要。由于手术并发症的原因是多因素的，我们认为强化手术规划有助于降低风险。特别是神经母细胞瘤手术可能会从更多地使用三维可视化和改进术前规划中受益。
