Background
To evaluate the morbidity and mortality after surgical excision in Dutch neuroblastoma patients.
Methods
A retrospective review was performed of all 187 neuroblastoma patients presented at two pediatric oncology centers (EMC and Radboud UMC) between 1998 and 2014. Morbidity and mortality caused by surgical intervention was documented.
Results
Surgical excision was performed in 146 patients (78.1%): Stage I (18/20), Stage II (16/20), Stage III (23/26), Stage IV (77/99), Stage IVs (3/11).
Peroperative complications occurred in 66 patients (45.2%), varying from minor vessel injury to removal of organs or structures, the majority involving stage IV patients (n=38).
Unplanned removal of organs or structures occurred in 38 patients (26%). In nine children this involved total nephrectomy (6.1%).
Postoperatively, 53 children (36.3%) experienced Clavien-Dindo grade 1 or grade 2 complications, including renal ischemia in 6 children, leading to complete renal atrophia in 2 patients.
Clavien-Dindo grade 3, 4 or 5 complications occurred in 12 children. Secondary surgery was necessary in four patients: subtotal colectomy for intestinal ischemia, surgical drainage of chylo-abdomen, nephrectomy for renal atrophia and surgical reduction of intestinal intussusception. Longterm ICU admission was necessary for one child who endured severe sepsis after aspiration due to tracheal tube dislocation after surgery.
Longterm complications involved, among others, scoliosis, Horners’ syndrome and mechanic bowel obstruction (n=6 ), leading to surgical reintervention in three children.
Peroperative mortality occurred in one patient; a 2-year old child with stage IV disease. Laceration of a liver vein caused an air embolus due to low intrathoracal pressure, leading to irreversible cardiac arrest. No postoperative mortality was reported.
Conclusion
Surgical excision for Neuroblastoma is associated with significant complications and peroperative mortality, especially in Stage IV patients.