Resectability and operative morbidity after chemotherapy in neuroblastoma patients with encasement of major visceral arteries.
OBJECTIVE
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%).


CONCLUSIONS
Encasement of major visceral arteries in patients with neuroblastoma who have received chemotherapy does not preclude gross total resection.
Department of Surgery, Pediatric Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Barrie S
BS
Rich
Maureen P
MP
McEvoy
Natasha E
NE
Kelly
Edwin
E
Oh
Sara J
SJ
Abramson
Anita P
AP
Price
Nai-Kong V
NK
Cheung
Michael P
MP
La Quaglia
D000008:Abdominal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001158:Arteries / Q000473:pathology / Q000601:surgery; D002445:Celiac Artery / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery; D020360:Neoadjuvant Therapy / Q000379:methods*; D009447:Neuroblastoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012077:Renal Artery / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply* / Q000473:pathology
D000970:Antineoplastic Agents