title: Feasibility and safety of thoracoabdominal approach in children for resection of upper abdominal neuroblastoma.
abstract: BACKGROUND
  A thoracoabdominal incision provides excellent exposure in the upper abdominal region. We present our experience with the use of this approach in children for resection of upper abdominal neuroblastoma.
  
  
  METHODS
  Fifty-one of the 106 consecutive patients with abdominal neuroblastoma who underwent tumor resection using the thoracoabdominal approach between June 2006 and May 2011 were selected from the prospective database for this interim analysis.
  
  
  RESULTS
  The median age was 3.1 years (range, 10 months-14 years), with 8 younger than 18 months and 22 younger than 4 years. Gross total resection was achieved in 44 patients. There were no major vascular injuries or perioperative mortality. Forty-two patients could be extubated immediate postoperatively, whereas 9 were extubated within 24 hours. Good pain relief was achieved in all patients, and prolonged analgesia was not required in any patient. There were no pulmonary complications, and wound infection occurred in 2 patients. The 2-year local control was 92%. The 2-year survival for stages 1 and 2 is 100%, 71.6% for stage 3, and 40.4% for stage 4.
  
  
  CONCLUSIONS
  The thoracoabdominal incision for difficult upper abdominal neuroblastoma is tolerated well in pediatric patients with no added morbidity. The enhanced exposure facilitates resection and improves local control.
authors.affiliation: Department of Pediatric Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Bombay 400012, India. sajidshafique@rediffmail.com
authors.forename: Sajid S
authors.initials: SS
authors.lastname: Qureshi
authors.forename: Vijaya P
authors.initials: VP
authors.lastname: Patil
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009447:Neuroblastoma / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome