Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
Department of Pediatric Hematology and Oncology, University Children's Hospital of Tuebingen, Tübingen, Germany.
J Cancer Res Clin Oncol. 2023 Apr;149(4):1485-1493. doi: 10.1007/s00432-022-04027-9. Epub 2022 May 6.
Surgery of complex neuroblastic tumors often requires additional procedures, especially in the situation of tumor extension within thorax and impossibility of securing the aorta above the tumor. These situations prompt the opening of the thoracic cavity. The concern regarding increased operative trauma and morbidity associated with this approach make surgeons reluctant regarding this technique. The aim of this study was to evaluate the efficacy of two-cavities approach based on our experience in a reference pediatric onco-surgical center.
Between 2003 and 2021, we operated on 232 neuroblastic tumors. 31/232 patients with complex, advanced-stage neuroblastic tumors underwent tumor resection through a two-cavities approach. A retrospective review of patient's records was performed.
The median age at operation was 48 months (5-180). 23/31 patients presented image-defined risk factors (IDRF). The approach most commonly used was the transverse laparotomy with incision of the diaphragm (n = 14), followed by the thoraco-abdominal incision (n = 10). Gross total resection (GTR) was achieved in 24 patients, a near-GTR in 4 cases, and an incomplete resection in 3 cases. Median duration of surgery was 288 min (99-900) and median duration of mechanical ventilation was 22 h (0-336). Postoperative complications occurred in 10 patients, 6/10 required surgical reintervention. The 5-year overall survival (OS) was 90% and the 5-year event-free survival (EFS) was 50%.
The two-cavities approach for resection of abdominal neuroblastoma in children is a safe technique with no added morbidity.
复杂神经母细胞瘤的手术往往需要附加手术，特别是在肿瘤向胸腔内延伸且无法在肿瘤上方安全固定主动脉的情况下。在这些情况下，需要打开胸腔。由于这种方法会增加手术创伤和发病率，因此外科医生对这种技术持保留态度。本研究旨在评估基于我们在参考儿科肿瘤外科中心的经验的双腔方法的疗效。
2003 年至 2021 年，我们共对 232 例神经母细胞瘤进行了手术。31/232 例复杂、晚期神经母细胞瘤患者通过双腔方法进行肿瘤切除。对患者病历进行回顾性分析。
手术时的中位年龄为 48 个月（5-180）。23/31 例患者存在影像学定义的危险因素（IDRF）。最常用的方法是横切口加横膈膜切开术（n=14），其次是胸腹联合切口（n=10）。24 例患者实现了大体全切除（GTR），4 例接近 GTR，3 例不完全切除。手术中位时间为 288 分钟（99-900），机械通气中位时间为 22 小时（0-336）。10 例患者发生术后并发症，其中 6 例需要再次手术干预。5 年总生存率（OS）为 90%，5 年无事件生存率（EFS）为 50%。
对于儿童腹部神经母细胞瘤切除术，双腔方法是一种安全的技术，不会增加发病率。
