Clinical outcomes in children with adrenal neuroblastoma undergoing open versus laparoscopic adrenalectomy.
BACKGROUND
Laparoscopic resection of adrenal neuroblastoma has become a common alternative to open surgery. Prior reports have largely focused on short-term operative complications. This study compares long-term oncologic outcomes in children undergoing laparoscopic or open adrenalectomy for neuroblastoma.


METHODS
Seventy-nine patients at a single center met inclusion criteria for having adrenal neuroblastoma and undergoing operative resection. Patients were assigned to high or low/intermediate (L/I) risk groups based upon Children's Oncology Group (COG) trial enrollment. Criteria for laparoscopic resection were absence of vascular encasement and size ≤ 5 cm in greatest dimension. Comparison between open versus laparoscopic groups was performed by Wilcoxon ranked-sum and Fisher's exact test. Multivariate Cox proportional hazard models analyzed the primary outcomes of mortality and recurrence.


RESULTS
In the L/I risk category (N=30) there was one non-neuroblastoma related death in the open cohort. Six of 7 patients in the High risk Group who underwent laparoscopic resection had favorable outcomes. Only higher tumor stage (Hazard Ratio 8.455, P=0.01) and earlier tumor recurrence were associated with increased mortality (Hazards Ratio 0.932, P=0.0002). Among patients who met selection criteria for laparoscopic surgery there was no difference in mortality or recurrence rates between High risk and L/I risk.


CONCLUSIONS
Laparoscopic resection of adrenal neuroblastoma is feasible and can be performed with equivalent recurrence and mortality rates in L/I risk patients and selected High risk patients. These data suggest that laparoscopic resection of adrenal neuroblastoma should be considered in patients who meet selection criteria, irrespective of risk group categorization.
MassGeneral Hospital for Children, Boston, MA, USA. ckelleher3@partners.org
Cassandra M
CM
Kelleher
Lauren
L
Smithson
Louis L
LL
Nguyen
Giovanni
G
Casadiego
Ahmed
A
Nasr
Meredith S
MS
Irwin
Justin T
JT
Gerstle
D000310:Adrenal Gland Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000706:statistics & numerical data; D002675:Child, Preschool; D018572:Disease-Free Survival; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009447:Neuroblastoma / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D047368:Tumor Burden
Adrenal tumor; Laparoscopy; Neuroblastoma