title: Minimally invasive surgery of neuroblastic tumors in children: Indications depend on anatomical location and image-defined risk factors.
abstract: Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs).
  
  
  
  Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n = 20), retroperitoneoscopic (n = 1) or laparoscopic approaches (n = 18). The tumor locations were paravertebral (n = 18; thoracic n = 15, lumbar n = 3), perivascular (n = 5; abdominal n = 2; thoracic n = 3), adrenal (n = 13), pleural (n = 2) and pelvic (n = 1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35 mm for thoracic tumors (range: 7-85 mm) and 34 mm for abdominal tumors (range: 10-75 mm). Mean follow-up was 25 months (range: 5-116 months).
  
  
  
  Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%.
  
  
  
  In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized. Pediatr Blood Cancer 2015;62:257-261. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatric Surgery, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Department of Radiology, Curie Institute, Paris, France.
authors.forename: Hervé J
authors.initials: HJ
authors.lastname: Brisse
authors.affiliation: Department of Pediatrics, Gustave Roussy Institute, Villejuif, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Minard-Colin
authors.affiliation: Department of Pediatrics, Curie Institute, Paris, France.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schleiermacher
authors.affiliation: Department of Radiology, Gustave Roussy Institute, Villejuif, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Canale
authors.affiliation: Department of Pediatric Surgery, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009447:Neuroblastoma / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
keywords: IDRF; laparoscopy; minimally invasive surgery; neuroblastoma; thoracoscopy