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Laparoscopic Resection of Abdominal Neuroblastoma

¹ Department of Paediatric Surgery, Hôpital Mère-Enfant, Nantes, France
² Department of Paediatric Surgery, Hôpital Robert Debré, Paris, France
³ Department of Paediatric Surgery, Hôpital de la Timone, Marseille, France
⁴ Department of Paediatric Surgery, CHU de Strasbourg, Strasbourg, France
⁵ Department of Paediatric Surgery, CHU de Saint Etienne, Saint Etienne, France
⁶ Department of Paediatric Oncology and Haematology, Hôpital Mère-Enfant, Nantes, France
⁷ Department of Paediatric Surgery, Hôpital Lenval, Nice, France
⁸ Department of Paediatric Surgery, CHU de Caen, Caen, France
⁹ Paediatric Surgery, Hôpital Debrousse, Lyon, France
¹⁰ Department of Paediatric Surgery, Hôpital des Enfants Malades, Paris, France
¹¹ Department of Paediatric Oncology, Institut Curie, PARIS, France

Correspondence: Address correspondence and reprint requests to: Marc-David Leclair; E-mail: marcdavid.leclair{at}chu-nantes.fr

Background: Since indications for laparoscopic adrenalectomy have progressively expanded to pediatric surgery, preliminary reports have studied the laparoscopic approach for abdominal neuroblastoma (NB). We aimed to report on the indications and the results of laparoscopic resection in a large series of abdominal NBs.

Methods: A retrospective multicenter study included 45 children with abdominal NBs (28 localized, 11 stage 4, 6 stage 4s) and laparoscopic resection of their abdominal primary tumor. Primary site of the tumor was the adrenal gland in 41 cases and retroperitoneal space in 4. The median age at surgery was 12 months (1–122); median tumor size was 37 mm (12–70). Resection was performed through transperitoneal laparoscopy (n = 38) or retroperitoneoscopy (n = 7).

Results: Complete macroscopic resection was achieved in 43 of 45 children (96%). The median duration of pneumoperitoneum was 70 min (30–160), and the length of hospital stay was 3 days (2–9). Four procedures (9%) were converted to open surgery, and tumor rupture occurred in three cases. Of the 28 children with localized disease, there was a 96% overall survival (OS) rate after a median follow-up of 28 months (4–94). There was one local relapse in this subgroup, with subsequent complete remission. For the entire 45-children cohort, four children died and three presented a recurrence resulting in OS, disease-free survival, and event-free survival rates of 84% ± 8.1, 84% ± 8.2, and 77% ± 9.1 respectively.

Conclusion: Laparoscopic resection of abdominal primary allows effective local control of the disease in a wide range of clinical situations of neuroblastoma, with an acceptable morbidity.

Key Words: Laparoscopy • Neuroblastoma • Retroperitoneoscopy