Laparoscopic resection of adrenal neuroblastoma without image-defined risk factors: a prospective study on 21 consecutive pediatric patients.
BACKGROUND
Over the last 20 years MIS has progressively gained popularity in children with cancer. We therefore aimed at evaluating the safety of Minimally Invasive Surgery (MIS) resection in a series of children affected by adrenal neuroblastoma (NB) presenting without Image-Defined Risk Factors (IDRFs).


METHODS
An Institutional protocol for MIS resection of adrenal NB in pediatric patients without IDRFs has been applied since 2008. Absence of IDRFs represented the main indication for MIS in NB, regardless of tumor size. All pediatric patients who underwent MIS for NB between January 2008 and May 2013 were included. Specific technical considerations, demographic data, and outcome have been recorded.


RESULTS
Twenty-one patients underwent MIS resection for IDRFs-negative adrenal NB. Nine of these patients experienced preoperative downgrading of IDRFs after chemotherapy. Radiological median diameter of the mass was 30 mm (range 10-83 mm). Median operative time was 90 min. Median hospital stay was 4 days. All patients were treated successfully, without serious intraoperative complications. One mild intraoperative hemorrhage occurred and was treated without the need for conversion to open surgery nor blood transfusion was required. No postoperative complications, including port-site or peritoneal metastases were experienced.


CONCLUSIONS
This study demonstrated the safety and effectiveness of MIS for the resection of adrenal NB without IDRFs in children. Pediatric surgeons dedicated to oncology should be aware of this alternative approach to open resection.
Pediatric Surgery Department, G. Gaslini Children's Hospital and DINOGMI University of Genoa, Largo G. Gaslini 5, 16147, Genoa, Italy, girolamomattioli@ospedale-gaslini.ge.it.
Girolamo
G
Mattioli
Stefano
S
Avanzini
Alessio
A
Pini Prato
Luca
L
Pio
Claudio
C
Granata
Alberto
A
Garaventa
Massimo
M
Conte
Carla
C
Manzitti
Giovanni
G
Montobbio
Piero
P
Buffa
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009447:Neuroblastoma / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors