SURGICAL TREATMENT OF CHILDREN WITH NEUROBLASTOMA OF COMPLEX ANATOMICAL LOCALIZATION

Autor: Sergey V. Sokolov, M. N. Sukhov, I. P. Lyvina, T. N. Komarova, I. A. Bryzzheva, M. V. Isaeva, E. V. Skorobogatova, N. I. Ponomareva, A. G. Narbutov, E. S. Andreev
Rok vydání: 2018
Předmět:
Zdroj: Russian Journal of Pediatric Surgery. 22:172-178
ISSN: 2412-0677
1560-9510
DOI: 10.18821/1560-9510-2018-22-4-172-178
Popis: Introduction. Neuroblastomas arise in the case of intimate association of the tumor with large vessels and internal organs. The early detailed stratification of cancer risk, as well as forecasting possible complications of surgery based on visual diagnostic methods, contribute to the improving the results in this category of patients. Material and methods. The study analyzes the results of the diagnosis and treatment of neuroblastoma of thoracoabdominal localization in 9 children aged from 9 to 55 months. All of them received the treatment according to the NB-2004 protocol. Before surgical intervention, the factors of the surgical risk were estimated from computed tomography with contrast, the number of factors averaged of 5. Results. The inclusion of the left renal artery and aorta into the tumor was revealed intraoperatively in 8 children, the involvement of the left renal vein, the right renal artery, the superior mesenteric artery was found in 7 patients, the right renal vein, the celiac trunk - in 6 cases, and the other large vessels - in a smaller number of cases. Damages of the right renal vein in 2 patients, left renal vein - in 2 children, aorta - in 1 child, inferior vena cava - in 2 observations and celiac trunk in 1 patient was sutured without subsequent complications. After injury and suturing of the inferior vena cava in a 1 patient, there was revealed a parietal thrombus without clinically significant hemodynamic disturbances. In 1 observation, postoperative thrombosis of the left renal artery caused the deterioration of the blood flow requiring nephrectomy. Damage to the pancreas in 1 child was accompanied by a long drainage and the formation of pancreatojejunostomy. The volume of the resection of the tumor amounted on average of 93%. The total number of complications in the early postoperative period accounted for 44%, out of which repeated surgical interventions were required in case of bleeding against the therapy of renal artery thrombosis in 1 patient and focal pancreatic necrosis in the 1 patient. The duration of postoperative follow-up was of 18 months. Overall survival is 100%, the event-free survival rate is of 78%. The continued growth of the tumor was registered in 2 patients in the high-risk group. Discussion. Neoadjuvant chemotherapy contributed to the enhancement of the radicalization of the surgical treatment, leading to a decrease in the size of the primary focus, metastases, and involvement of large vessels and internal organs in the tumor. The radical removal of neuroblastoma is acceptable in the absence of the invasive growth in the walls of large vessels and internal organs, otherwise, the resection should be performed for the purpose of cytoreduction and prevention of organ failure due to tumor compression.
Databáze: OpenAIRE
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