Feasibility and safety of thoracoabdominal approach in children for resection of upper abdominal neuroblastoma

BackgroundA thoracoabdominal incision provides excellent exposure in the upper abdominal region. We present our experience with the use of this approach in children for resection of upper abdominal neuroblastoma.MethodsFifty-one of the 106 consecutive patients with abdominal neuroblastoma who underwent tumor resection using the thoracoabdominal approach between June 2006 and May 2011 were selected from the prospective database for this interim analysis.ResultsThe median age was 3.1 years (range, 10 months-14 years), with 8 younger than 18 months and 22 younger than 4 years. Gross total resection was achieved in 44 patients. There were no major vascular injuries or perioperative mortality. Forty-two patients could be extubated immediate postoperatively, whereas 9 were extubated within 24 hours. Good pain relief was achieved in all patients, and prolonged analgesia was not required in any patient. There were no pulmonary complications, and wound infection occurred in 2 patients. The 2-year local control was 92%. The 2-year survival for stages 1 and 2 is 100%, 71.6% for stage 3, and 40.4% for stage 4.ConclusionThe thoracoabdominal incision for difficult upper abdominal neuroblastoma is tolerated well in pediatric patients with no added morbidity. The enhanced exposure facilitates resection and improves local control.