Resectability and operative morbidity after chemotherapy in neuroblastoma patients with encasement of major visceral arteries
| Autor: | Anita P. Price, Barrie S. Rich, Maureen P. McEvoy, Sara J. Abramson, Nai-Kong V. Cheung, Natasha E. Kelly, Edwin Oh, Michael P. La Quaglia |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Antineoplastic Agents Neuroblastoma Renal Artery Celiac Artery Mesenteric Artery Superior medicine.artery medicine Humans Superior mesenteric artery Significant risk Stage (cooking) Child Chemotherapy business.industry Arteries General Medicine SMA medicine.disease Combined Modality Therapy Neoadjuvant Therapy Surgery Survival Rate Viscera Treatment Outcome Chemotherapy Adjuvant Abdominal Neoplasms Child Preschool Pediatrics Perinatology and Child Health Renal vessels Female Radiology business Operative morbidity |
| Zdroj: | Journal of Pediatric Surgery. 46:103-107 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2010.09.075 |
| Popis: | Background/purpose Image-defined vessel encasement is a significant risk factor for surgical complications and incomplete resection for intermediate-risk tumors. We sought to examine the impact of vessel encasement on complications or resectability in intermediate-risk or high-risk patients after neoadjuvant chemotherapy. Methods We retrospectively reviewed 207 consecutive patients with circumferential encasement of the renal vessels, celiac axis, and/or superior mesenteric artery (SMA) who underwent resection between 1991 and 2009. Specifically, we evaluated resection rates, complications, and outcome. Results Median age at diagnosis was 3.0 years, and 79% of patients had stage 4 disease. Of known MYCN status, 23.4% had MYCN amplification. Vessel encasement included renal vessels, celiac axis, or SMA alone in 107, 7, and 4 patients, respectively. Both the renal vessels and celiac axis were encased in 5 patients, renal vessels and SMA in 7 patients, and celiac axis and SMA in 14 patients. Sixty-three patients had all 3 vessels encased. The gross total resection (GTR) rate was 94%. No operative or postoperative deaths occurred. The overall complication rate was 34.8% (n = 72). Overall 5-year survival (± SEM) was 67.4% (± 7.4%). Conclusion Encasement of major visceral arteries in patients with neuroblastoma who have received chemotherapy does not preclude gross total resection. |
| Databáze: | OpenAIRE |
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