Irtan Sabine, Brisse Hervé J, Minard-Colin Véronique, Schleiermacher Gudrun, Canale Sandra, Sarnacki Sabine
Department of Pediatric Surgery, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France.
Department of Radiology, Curie Institute, Paris, France.
Pediatr Blood Cancer. 2015 Feb;62(2):257-261. doi: 10.1002/pbc.25248. Epub 2014 Oct 4.
Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs).
Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n = 20), retroperitoneoscopic (n = 1) or laparoscopic approaches (n = 18). The tumor locations were paravertebral (n = 18; thoracic n = 15, lumbar n = 3), perivascular (n = 5; abdominal n = 2; thoracic n = 3), adrenal (n = 13), pleural (n = 2) and pelvic (n = 1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35 mm for thoracic tumors (range: 7-85 mm) and 34 mm for abdominal tumors (range: 10-75 mm). Mean follow-up was 25 months (range: 5-116 months).
Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%.
In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized. Pediatr Blood Cancer 2015;62:257-261. © 2014 Wiley Periodicals, Inc.
微创手术（MIS）仍未被广泛接受作为切除神经母细胞瘤的手术方法。我们旨在根据肿瘤位置和影像定义的风险因素（IDRFs）评估MIS在这种儿童肿瘤治疗中的适应证和局限性。
2006年至2012年期间，39例患者接受了用于神经母细胞瘤的MIS手术，采用胸腔镜手术（n = 20）、后腹腔镜手术（n = 1）或腹腔镜手术（n = 18）。肿瘤位置为椎旁（n = 18；胸段n = 15，腰段n = 3）、血管周围（n = 5；腹段n = 2；胸段n = 3）、肾上腺（n = 13）、胸膜（n = 2）和盆腔（n = 1）。2例患者接受复发病灶治疗。根据国际神经母细胞瘤风险组（INRG）分期系统，20例患者不存在IDRFs，19例患者存在IDRFs。10例患者术前接受了化疗。胸段肿瘤的平均最大直径为35 mm（范围：7 - 85 mm），腹段肿瘤的平均最大直径为34 mm（范围：10 - 75 mm）。平均随访时间为25个月（范围：5 - 116个月）。
6例胸段肿瘤和1例肾上腺肿瘤的切除在宏观上不完全（R2）。3例胸段L2肿瘤需要中转开腹。术后并发症包括3例L2椎旁胸段肿瘤患者发生乳糜胸，1例颈胸段肿瘤患者发生霍纳综合征，1例L2腹段肿瘤患者发生肾萎缩。肾上腺和腹段椎旁肿瘤患者未发生围手术期或术后并发症。总生存率为98%。
在经过精心挑选的病例中，MIS能够安全、有效地切除儿童神经母细胞瘤。如果器官或血管控制或切除质量受到威胁，则应考虑采用开放手术方法。《儿科血液与癌症》2015年；62:257 - 261。©2014威利期刊公司。
