Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1015 Walnut Street, Curtis Building, Suite 620, Philadelphia, PA, 19107, USA.
Department of Surgery, Nemours AI duPont Hospital for Children, Wilmington, DE, USA.
Pediatr Surg Int. 2021 Oct;37(10):1349-1354. doi: 10.1007/s00383-021-04942-x. Epub 2021 Jun 20.
Tumor biopsy is often essential for diagnosis and management of intraabdominal neoplasms found in children. Open surgical biopsy is the traditional approach used to obtain an adequate tissue sample to guide further therapy, but image-guided percutaneous core-needle biopsy is being used more often due to concerns about the morbidity of open biopsy. We used a national database to evaluate the morbidity associated with open intraabdominal tumor biopsy.
We identified all patients undergoing laparotomy with tumor biopsy in the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) database from 2012 to 2018 and measured the frequency of complications in the 30 days postoperatively. We tested associations between patient characteristics and outcomes to identify risk factors for complications.
We identified 454 patients undergoing laparotomy for biopsy of an intraabdominal neoplasm. Median postoperative hospital stay was 7 days (IQR 4-12) and operative time was 117 min (IQR 84-172). The overall complication rate was 12.1%, with post-operative infection (6%) and bleeding (4.2%) being the most common complications. Several patient characteristics were associated with bleeding, but the only significant association on multivariable analysis was underlying hematologic disorder.
Open abdominal surgery for pediatric intraabdominal tumor biopsy is accompanied by significant morbidity. Postoperative infection was the most common complication, which can delay initiation of further therapy, especially chemotherapy. These findings support the need to prospectively compare percutaneous image-guided core-needle biopsy to open biopsy as a way to minimize risk and optimize outcomes for this vulnerable population.
肿瘤活检对于儿童腹部肿瘤的诊断和治疗至关重要。传统的方法是通过开放式手术活检获得足够的组织样本以指导进一步治疗，但由于担心开放式活检的发病率，越来越多地采用影像引导下的经皮核心针活检。我们使用国家数据库评估与开放式腹部肿瘤活检相关的发病率。
我们从 2012 年至 2018 年在国家外科质量改进计划-儿科（NSQIP-P）数据库中确定了所有接受剖腹手术进行肿瘤活检的患者，并测量了术后 30 天内并发症的发生率。我们检验了患者特征与结果之间的关联，以确定并发症的危险因素。
我们共确定了 454 例行剖腹手术活检腹腔内肿瘤的患者。术后住院中位数为 7 天（IQR 4-12），手术时间为 117 分钟（IQR 84-172）。总体并发症发生率为 12.1%，术后感染（6%）和出血（4.2%）是最常见的并发症。一些患者特征与出血有关，但多变量分析中唯一显著相关的是潜在的血液系统疾病。
儿童腹部肿瘤开放式手术活检的发病率较高。术后感染是最常见的并发症，这可能会延迟进一步治疗的开始，特别是化疗。这些发现支持前瞻性比较经皮影像引导下的核心针活检与开放式活检，以降低风险并优化这一脆弱人群的治疗结果。
