Clinical Comparison of Surgical Treatment and Complications in Pediatric Patients with Neuroblastoma at Stage 4

Abstract OBJECTIVE : To compare the surgical methods and complications in pediatric patients with neuroblastoma (NB) at International neuroblastoma staging system (INSS) stage 4 in the adrenal site. METHODS : Thirty-four patients, 21 males and 13 females, with NB at INSS stage 4 underwent radical surgery (RS) from May 2018 to May 2021, and were retrospectively included. Patients were divided into three groups, namely RS group (group A), tumor biopsy + chemotherapy + RS group (group B), and bone marrow biopsy + chemotherapy + RS group (group C) depending on the particular treatment protocol. The total survival rate, factors related to surgical resection, and surgical complications in each group were analyzed. Results : 5 cases were enrolled in group A, 9 cases in group B, and 20 cases in group C. The number of Encasement of Vessels (EVS) was higher in the (CR+MR) group compared to the IR group (P=0.039). The operative time was shorter when EVS was present (P=0.022). RS complications mainly included bleeding (73.5%), celiac leakage (70.6%) and intestinal obstruction (26.5%). A total of 29 cases (85.3%) were graded by CDC as grade II, 2 cases as grade IIIa, 1 case as grade IIIb, 1 case as grade IVa and 1 case as grade IVb.By comparing patients who developed grade II and grade III complications or higher, it was observed that neuron-specific enolase (NSE) (P<0.0001), primary EVS (P<0.0001), RS preoperative EVS (P<0.0001), Lactate dehydrogenase (LDH) (P=0.005), Ki67 (P=0.012), primary tumor maximum diameter (P=0.018), primary IDRFs (P=0.022), and preoperative IDRFs for RS (P=0.043) were statistically different. CONCLUSION : In this study, it is concluded that pre-operative biopsy in patients with NB at INSS stage 4 located in the adrenal glands allows for a clear diagnosis, and that subsequent RS does not increase the risk of surgical complications. Moreover, EVS is proved an important factor for surgical resection and surgical complications.