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Management of thoracoabdominal neuroblastoma: a 13-year experience
  1. Chan Hon Chui1 and
  2. Anselm Lee2
  1. 1Surgery Centre for Children, Singapore, Singapore
  2. 2Children's Haematology and Cancer Centre, Singapore, Singapore
  1. Correspondence to Dr Chan Hon Chui; chchui{at}surgeryforchildren.com

Abstract

Background Thoracoabdominal neuroblastoma is a unique surgical challenge. We reviewed our experience focusing on disease patterns and corresponding surgical approaches.

Methods Among 310 patients in our neuroblastoma database, 30 (9.7%) had thoracoabdominal neuroblastoma. Patients’ clinical charts were reviewed and analyzed. Two disease patterns were identified: solitary thoracoabdominal tumor (group A, n=15) and multifocal tumors in thorax and abdomen (group B, n=15). Operative approaches were categorized based on routes of surgical access.

Results Thirty patients with average age of 4.1 (range 0.8–12.8) years were studied. All received preoperative chemotherapy. Among 15 group A patients, four were stage 3 intermediate risk (IR) and 11 were stage 4 high risk (HR). Surgical approaches included single-incision thoracoabdominal approach (n=10), laparotomy-cum-transdiaphragmatic approach (n=3), and laparotomy-cum-thoracotomy approach (n=2). One patient had 10% residual disease and the rest achieved gross total resection. Postoperative complications included chylous ascites (n=3), intestinal obstruction (n=3), pneumonia (n=1), spinal cord infarction (n=1) scoliosis (n=2) and thoracoabdominal nerves palsy (n=3). Among 15 group B patients, all were stage 4 with five IR and 10 HR. Thoracic components were found in the posterior mediastinum (n=7), superior mediastinum (n=4), middle mediastinum (n=1), parietal pleura (n=3) and lungs (n=3). Surgical approaches included multi-incision laparotomy-cum-thoracotomy (n=14) and laparotomy-cum-transdiaphragmatic approach (n=1). Gross total resection was achieved in all surgeries. Postoperative complications included chylous ascites (n=3). Overall, all nine IR patients survived without evidence of disease and 9 (42.8%) HR patients died of disease. There was no perioperative mortality.

Conclusion Surgical resection of thoracoabdominal neuroblastoma is feasible and safe. Despite its complexity, thoracoabdominal neuroblastoma has comparable treatment outcomes when compared with single-compartmental disease.

  • neuroblastoma
  • thoracoabdominal
  • surgery

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Footnotes

  • Contributors CHC planned the study and conducted the research. The manuscript was written by CHC with significant help from AL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work. All data relevant to the study are included in the article or uploaded as supplementary information.

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