Pio Luca, Zaghloul Tarek, Abdelhafeez Abdelhafeez Hafeez
Department of Surgery, MS 133, St. Jude Children's Research Hospital, Memphis, TN, USA.
Learning Planet Institute, Université de Paris, Paris, France.
J Minim Access Surg. 2024 Jul 1;20(3):353-355. doi: 10.4103/jmas.jmas_134_23. Epub 2023 Oct 18.
Neuroblastoma (NB) is the most frequent paediatric extracranial solid tumour. The surgical management of these tumours in newborns changed recently, performing resections in cases with tumour size increase after birth. Minimally invasive procedures were mostly reported in cases without pre-operative image-defined risk factors (IDRFs), defined by vascular and organ involvement. Thoracoscopic resection represents a minority of the overall surgical procedures for neuroblastic tumour management, as the posterior mediastinum is one of the least frequent locations of NB. A thoracoscopic resection was performed on a 22-month-old child with a NB encasing the aorta and a 6-month-old child with the encasement of the left subclavian and vertebral artery. A step-by-step minimally invasive procedure was described, highlighting anatomical landmarks and dissection techniques. The described technique was performed in 130 min. Thoracoscopic resection provided a macroscopic resection without surgical complications and patient was discharged on the 3 rd post-operative day. The study shows a feasible and safe thoracoscopic approach for paediatric thoracic NB with IDRFs.
神经母细胞瘤（NB）是最常见的小儿颅外实体瘤。新生儿这些肿瘤的手术治疗最近有所改变，对于出生后肿瘤大小增加的病例进行切除术。微创手术大多报道于无术前影像定义风险因素（IDRFs）的病例，IDRFs由血管和器官受累情况定义。胸腔镜切除术在神经母细胞瘤治疗的整体手术中占少数，因为后纵隔是NB最少见的部位之一。对一名22个月大患有包绕主动脉的NB患儿和一名6个月大患有包绕左锁骨下动脉和椎动脉的NB患儿进行了胸腔镜切除术。描述了一种逐步的微创手术方法，突出了解剖标志和解剖技术。所描述的技术在130分钟内完成。胸腔镜切除术实现了宏观切除且无手术并发症，患者在术后第3天出院。该研究表明胸腔镜方法对于有IDRFs的小儿胸段NB是可行且安全的。
