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Managing Intraoperative Complications and Consequences

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Pediatric Surgical Oncology
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Abstract

Major intraoperative complications are a known and dreaded possibility in pediatric surgical oncology. Several pediatric tumors encase major neurovascular structures in ways that create significant surgical risk. Other major complications may carry less immediate life-threatening

risk, but still threaten significant long-term morbidity. The relatively good long-term outcomes for pediatric solid tumors, coupled with the ability of children to tolerate major surgery with significant

pathophysiologic disruption, and the reluctance to “give up” on pediatric patients all contribute to efforts toward heroic surgical procedures with their associated major risks.

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References

  1. Lezama-Del Valle P, Krauel L, LaQuaglia MP. Error traps and culture of safety in pediatric surgical oncology. Semin Pediatr Surg. 2019;28(3):164–71.

    Article  PubMed  Google Scholar 

  2. Davidoff AM, Fernandez-Pineda I. Complications in the surgical management of children with malignant solid tumors. Semin Pediatr Surg. 2016;25(6):395–403.

    Article  PubMed  Google Scholar 

  3. Holmes K, Pötschger U, ADJ P, Sarnacki S, Cecchetto G, Gomez-Chacon J, Squire R, Freud E, Bysiek A, Matthyssens LE, Metzelder M, Monclair T, Stenman J, Rygl M, Rasmussen L, Joseph JM, Irtan S, Avanzini S, Godzinski J, Björnland K, Elliott M, Luksch R, Castel V, Ash S, Balwierz W, Laureys G, Ruud E, Papadakis V, Malis J, Owens C, Schroeder H, Beck-Popovic M, Trahair T, Forjaz de Lacerda A, Ambros PF, Gaze MN, McHugh K, Valteau-Couanet D, Ladenstein RL, International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOPEN). Influence of surgical excision on the survival of patients with stage 4 high-risk neuroblastoma: a report from the HR-NBL1/SIOPEN study. J Clin Oncol. 2020;38(25):2902–15.

    Article  PubMed  Google Scholar 

  4. von Allmen D, Davidoff AM, London WB, Van Ryn C, Haas-Kogan DA, Kreissman SG, Khanna G, Rosen N, Park JR, La Quaglia MP. Impact of extent of resection on local control and survival in patients from the COG A3973 study with high-risk neuroblastoma. J Clin Oncol. 2017;35(2):208–16.

    Article  Google Scholar 

  5. Schnater JM, Aronson DC, Plaschkes J, Perilongo G, Brown J, Otte JB, Brugieres L, Czauderna P, MacKinlay G, Vos A. Surgical view of the treatment of patients with hepatoblastoma: results from the first prospective trial of the International Society of Pediatric Oncology Liver Tumor Study Group. Cancer. 2002;94(4):1111–20.

    Article  PubMed  Google Scholar 

  6. Zsiros J, Brugieres L, Brock P, Roebuck D, Maibach R, Zimmermann A, Childs M, Pariente D, Laithier V, Otte JB, Branchereau S, Aronson D, Rangaswami A, Ronghe M, Casanova M, Sullivan M, Morland B, Czauderna P, Perilongo G, International Childhood Liver Tumours Strategy Group (SIOPEL). Dose-dense cisplatin-based chemotherapy and surgery for children with high-risk hepatoblastoma (SIOPEL-4): a prospective, single-arm, feasibility study. Lancet Oncol. 2013;14(9):834–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Brisse HJ, MB MC, Granata C, Krug KB, Wootton-Gorges SL, Kanegawa K, Giammarile F, Schmidt M, Shulkin BL, Matthay KK, Lewington VJ, Sarnacki S, Hero B, Kaneko M, London WB, Pearson AD, Cohn SL, Monclair T, International Neuroblastoma Risk Group Project. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project. Radiology. 2011;261(1):243–57.

    Article  PubMed  Google Scholar 

  8. Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, Kaneko M, London WB, Matthay KK, Nuchtern JG, von Schweinitz D, Simon T, Cohn SL, Pearson AD, INRG Task Force. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol. 2009;27(2):298–303.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Phelps HM, Ndolo JM, Van Arendonk KJ, Chen H, Dietrich HL, Watson KD, Hilmes MA, Chung DH, Lovvorn HN 3rd. Association between image-defined risk factors and neuroblastoma outcomes. J Pediatr Surg. 2019;54(6):1184–91.

    Article  PubMed  PubMed Central  Google Scholar 

  10. van Dijk IW, Oldenburger F, Cardous-Ubbink MC, Geenen MM, Heinen RC, de Kraker J, van Leeuwen FE, van der Pal HJ, Caron HN, Koning CC, Kremer LC. Evaluation of late adverse events in long-term wilms’ tumor survivors. Int J Radiat Oncol Biol Phys. 2010;78(2):370–8.

    Article  PubMed  Google Scholar 

  11. Pondrom M, Pariente D, Mallon B, Taque S, Branchereau S, Chardot C, Laithier V, Tabone MD, Lejeune J, Faure-Conter C, Saumet L, Vérité C, Aerts I, Brugières L, Fresneau B. Tumor rupture in hepatoblastoma: a high risk factor? Pediatr Blood Cancer. 2020;67(9):e28549.

    Article  CAS  PubMed  Google Scholar 

  12. Cox S, Büyükünal C, Millar AJW. Surgery for the complex Wilms tumour. Pediatr Surg Int. 2020;36(2):113–27.

    Article  PubMed  Google Scholar 

  13. Baniel J, Sella A. Complications of retroperitoneal lymph node dissection in testicular cancer: primary and post-chemotherapy. Semin Surg Oncol. 1999;17(4):263–7.

    Article  CAS  PubMed  Google Scholar 

  14. Ohlmann CH, Saar M, Pierchalla LC, Zangana M, Bonaventura A, Stöckle M, Siemer S, Heinzelbecker J. Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours. Sci Rep. 2021;11(1):10700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Grimaldi C, Bertocchini A, Crocoli A, de Ville de Goyet J, Castellano A, Serra A, Spada M, Inserra A. Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature. J Pediatr Surg. 2019;54(3):557–61.

    Article  PubMed  Google Scholar 

  16. Boglino C, Martins AG, Ciprandi G, Sousinha M, Inserra A. Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication. Med Pediatr Oncol. 1999;32(5):349–52.

    Article  CAS  PubMed  Google Scholar 

  17. Nordin AB, Fallon SC, Jea A, Kim ES. The use of spinal angiography in the management of posterior mediastinal tumors: case series and review of the literature. J Pediatr Surg. 2013;48(9):1871–7.

    Article  PubMed  Google Scholar 

  18. Shamberger RC, Smith EI, Joshi V, Rao PV, Hayes FA, Bowman LC, Castle-berry RP. The risk of nephrectomy during local control in abdominal neuroblastoma. J Pediatr Surg. 1998;33:161–4.

    Article  CAS  PubMed  Google Scholar 

  19. Fusaro F, Cecchetto G, Boglino C, Inserra A, Zanon GF, Giusti F, Dall’Igna P. Measures to prevent renal impairment after resection of retroperitoneal neuroblastoma. Pediatr Surg Int. 2002;18(5–6):388–91.

    CAS  PubMed  Google Scholar 

  20. Sosnowska-Sienkiewicz P, Januszkiewicz-Lewandowska D, Łosin M, Gowin E, Czauderna P, Mańkowski P. Arterial constriction after resection of neuroblastic tumors in children: two-center retrospective study. J Pediatr Surg. 2021;56(9):1661–7.

    Article  PubMed  Google Scholar 

  21. Fanelli MCA, Guilhen JCS, Duarte AAB, de Souza FKM, Cypriano MDS, Caran EMM, Lederman HM, de Seixas Alves MT, SCV A. Management of pediatric tumors with vascular extension. Front Pediatr. 2022;4(9):753232.

    Article  Google Scholar 

  22. De Corti F, Avanzini S, Cecchetto G, Buffa P, Guida E, Zanon GF, Jasonni V. The surgical approach for cervicothoracic masses in children. J Pediatr Surg. 2012;47:1662–8.

    Article  PubMed  Google Scholar 

  23. El Madi A, Irtan S, Sauvat F, Zérah M, Schleiermacher G, Galmiche-Roland L, Minard-Colin V, Brisse H, Sarnacki S. Long-term results of the transmanubrial osteomuscular-sparing approach for pediatric tumors. Pediatr Blood Cancer. 2017;64:e26527

    Google Scholar 

  24. Chui CH, Thirugnanam A. Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children. Pediatr Surg Int. 2020;36:891–5.

    Article  PubMed  Google Scholar 

  25. Pio L, Blanc T, de Saint DT, Irtan S, Valteau-Couanet D, Michon J, Brisse H, Galmiche-Rolland L, Joyeux L, Odent T, Harte C, Glorion C, Zerah M, Sarnacki S. Multidisciplinary surgical strategy for dumbbell neuroblastoma: a single-center experience of 32 cases. Pediatr Blood Cancer. 2019;66(Suppl 3):e27670.

    PubMed  Google Scholar 

  26. Kupferman ME, de la Garza GO, Santillan AA, Williams MD, Varghese BT, Huh W, Roberts D, Weber RS. Outcomes of pediatric patients with malignancies of the major salivary glands. Ann Surg Oncol. 2010;17(12):3301–7.

    Article  PubMed  Google Scholar 

  27. Billmire D, Vinocur C, Rescorla F, Colombani P, Cushing B, Hawkins E, London WB, Giller R, Lauer S. Malignant mediastinal germ cell tumors: an intergroup study. J Pediatr Surg. 2001;36(1):18–24.

    Article  CAS  PubMed  Google Scholar 

  28. Olson SL, Ingram ME, Graffy PM, Murphy PM, Tian Y, Samis JH, Josefson JL, Rastatter JC, Raval MV. Effect of surgeon volume on pediatric thyroid surgery outcomes: a systematic review. J Pediatr Surg. 2021;S0022-3468(21):00834-4.

    Google Scholar 

  29. Ritter A, Ganly I, Wong RJ, Randolph GW, Shpitzer T, Bachar G, Mizrachi A. Intraoperative nerve monitoring is used routinely by a significant majority of head and neck surgeons in thyroid surgery and impacts on extent of surgery-Survey of the American Head and Neck Society. Head Neck. 2020;42(8):1757–64.

    Article  PubMed  Google Scholar 

  30. Chiaravalli S, Guzzo M, Bisogno G, De Pasquale MD, Migliorati R, De Leonardis F, Collini P, Casanova M, Cecchetto G, Ferrari A. Salivary gland carcinomas in children and adolescents: the Italian TREP project experience. Pediatr Blood Cancer. 2014;61(11):1961–8.

    Article  PubMed  Google Scholar 

  31. Gow KW, Barnhart DC, Hamilton TE, Kandel JJ, Chen MK, Ferrer FA, Price MR, Mullen EA, Geller JI, Gratias EJ, Rosen N, Khanna G, Naranjo A, Ritchey ML, Grundy PE, Dome JS, Ehrlich PF. Primary nephrectomy and intraoperative tumor spill: report from the Children’s Oncology Group (COG) renal tumors committee. J Pediatr Surg. 2013;48(1):34–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ehrlich PF, Hamilton TE, Gow K, Barnhart D, Ferrer F, Kandel J, Glick R, Dasgupta R, Naranjo A, He Y, Perlman EJ, Kalapurakal JA, Khanna G, Dome JS, Geller J, Mullen E. Surgical protocol violations in children with renal tumors provides an opportunity to improve pediatric cancer care: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2016;63(11):1905–10.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Pater L, Melchior P, Rübe C, Cooper BT, McAleer MF, Kalapurakal JA, Paulino AC. Wilms tumor. Pediatr Blood Cancer. 2021;68(Suppl 2):e28257.

    PubMed  Google Scholar 

  34. van Waas M, Neggers SJ, Raat H, van Rij CM, Pieters R, van den Heuvel-Eibrink MM. Abdominal radiotherapy: a major determinant of metabolic syndrome in nephroblastoma and neuroblastoma survivors. PLoS One. 2012;7(12):e52237.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ritchey ML, Kelalis PP, Etzioni R, Breslow N, Shochat S, Haase GM. Small bowel obstruction after nephrectomy for Wilms’ tumor A report of the National Wilms’ Tumor Study-3. Ann Surg. 1993;218(5):654–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Panagopoulos D, Antoniades E, Karydakis P, Giakoumettis D, Themistocleous M. Postoperative tetraplegia to a child after cerebellar pilocytic astrocytoma excision at prone position: case report and literature review. Am J Case Rep. 2020;12(21):e920213.

    Google Scholar 

  37. Wills J, Schwend RM, Paterson A, Albin MS. Intraoperative visible bubbling of air may be the first sign of venous air embolism during posterior surgery for scoliosis. Spine (Phila Pa 1976). 2005;30(20):E629–35.

    Article  PubMed  Google Scholar 

  38. Cairo SB, Lautz TB, Schaefer BA, Yu G, Naseem HU, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgicalpatients: defining indications for prophylaxis. J Pediatr Surg. 2018;53(10):1996–2002.

    Article  PubMed  Google Scholar 

  39. Huang YL, Yang MC, Huang CH, Wang CC, Wu ET, Huang SC, Jou ST, Chen JS, Ko WJ. Rescue of cardiopulmonary collapse in anterior mediastinal tumor: case presentation and review of literature. Pediatr Emerg Care. 2010;26(4):296–8.

    Article  PubMed  Google Scholar 

  40. Becker K, Furch C, Schmid I, von Schweinitz D, Häberle B. Impact of postoperative complications on overall survival of patients with hepatoblastoma. Pediatr Blood Cancer. 2015;62(1):24–8.

    Article  PubMed  Google Scholar 

  41. Yanchar NL, Bass J. Poor outcome of gastrointestinal perforations associated with childhood abdominal non-Hodgkin’s lymphoma. J Pediatr Surg. 1999;34(7):1169–74.

    Article  CAS  PubMed  Google Scholar 

  42. Routh JC, Tollefson MK, Ashley RA, Husmann DA. Iatrogenic ureteral injury: can adult repair techniques be used on children? J Pediatr Urol. 2009;5(1):53–5.

    Article  PubMed  Google Scholar 

  43. Patil N, Javali T. Application of the “Yang-Monti principle” in children with iatrogenic ureteral injuries. J Pediatr Urol. 2021;17(4):543.e1–7.

    Article  PubMed  Google Scholar 

  44. Rutigliano DN, Georges A, Wolden SL, Kayton ML, Meyers P, La Quaglia MP. Ureteral reconstruction for retroperitoneal tumors in children. J Pediatr Surg. 2007;42(2):355–8.

    Article  PubMed  Google Scholar 

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Correspondence to Luca Pio or Timothy B. Lautz .

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Pio, L., Lautz, T.B. (2023). Managing Intraoperative Complications and Consequences. In: Lakhoo, K., Abdelhafeez, A.H., Abib, S. (eds) Pediatric Surgical Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-71113-9_79-1

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  • DOI: https://doi.org/10.1007/978-3-030-71113-9_79-1

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