Neuroblastoma pp 363-374 | Cite as

Complications of the Surgical Management of Children with Neuroblastoma

  • Andrew M. DavidoffEmail author


Neuroblastoma is a heterogeneous cancer; tumors can spontaneously regress or mature or display an aggressive, malignant phenotype. Clinical factors, including age and stage at diagnosis, and biologic factors, including amplification of the MYCN proto-oncogene and tumor histopathology, predictive of outcome, have been identified. This has allowed for the risk-based adjustment of therapy intensity, lessening intensity for children with low-risk disease to avoid long-term therapy toxicity and increasing intensity for those with high-risk disease to increase the likelihood of cure. This risk of disease relapse should be considered when determining the extent and aggressiveness to which surgical removal of a primary tumor and locoregional disease, if present, should be attempted, given that there is a high incidence of complications associated with neuroblastoma resection, many of which are significant. This is due, in large part, to the fact that neuroblastoma often infiltrates organs and surrounds critical vessels and nerves. More recently, image-defined risk factors have been identified that are associated with a greater risk of complications and a lower rate of complete tumor resection. Understanding these image-defined risk factors can help surgeons in their preoperative planning and discussions with families about potential complications associated with neuroblastoma surgery. These complications associated with the surgical management of children with neuroblastoma are discussed in this chapter.


Pediatric cancer Surgery Complications Neuroblastoma Image-defined risk factors 


  1. 1.
    Bhakta N, Liu Q, Ness KK, Baassiri M, Eissa H, Yeo F, Chemaitilly W, Ehrhardt MJ, Bass J, Bishop MW, et al. The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE). Lancet. 2017;390(10112):2569–82.CrossRefGoogle Scholar
  2. 2.
    Kuroda T, Saeki M, Honna T, Kumagai M, Masaki H. Late complications after surgery in patients with neuroblastoma. J Pediatr Surg. 2006;41(12):2037–40.CrossRefGoogle Scholar
  3. 3.
    Ziegler MM. Pediatric surgical oncology. Curr Opin Pediatr. 1990;2(3):579–84.CrossRefGoogle Scholar
  4. 4.
    von Allmen D, Davidoff AM, London WB, Ryn CV, Haas-Kogan DA, Kreissman SG, Khanna G, Rosen N, Park JR, Quaglia MPL. 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.CrossRefGoogle Scholar
  5. 5.
    Canete A, Jovani C, Lopez A, Costa E, Segarra V, Fernandez JM, Verdeguer A, Velazquez J, Castel V. Surgical treatment for neuroblastoma: complications during 15 years’ experience. J Pediatr Surg. 1998;33(10):1526–30.CrossRefGoogle Scholar
  6. 6.
    Azizkhan RG, Shaw A, Chandler JG. Surgical complications of neuroblastoma resection. Surgery. 1985;97(5):514–7.PubMedGoogle Scholar
  7. 7.
    Losty P, Quinn F, Breatnach F, O’Meara A, Fitzgerald RJ. Neuroblastoma—a surgical perspective. Eur J Surg Oncol. 1993;19(1):33–6.PubMedGoogle Scholar
  8. 8.
    Kiely EM. Radical surgery for abdominal neuroblastoma. Semin Surg Oncol. 1993;9(6):489–92.CrossRefGoogle Scholar
  9. 9.
    Rich BS, McEvoy MP, Kelly NE, Oh E, Abramson SJ, Price AP, Cheung NK, La Quaglia MP. Resectability and operative morbidity after chemotherapy in neuroblastoma patients with encasement of major visceral arteries. J Pediatr Surg. 2011;46(1):103–7.CrossRefGoogle Scholar
  10. 10.
    Cantos MF, Gerstle JT, Irwin MS, Pappo A, Farley S, Cheang T, Kim PC. Surgical challenges associated with intensive treatment protocols for high-risk neuroblastoma. J Pediatr Surg. 2006;41(5):960–5.CrossRefGoogle Scholar
  11. 11.
    Davidoff AM. Neuroblastoma. Semin Pediatr Surg. 2012;21(1):2–14.CrossRefGoogle Scholar
  12. 12.
    Schmidt ML, Lukens JN, Seeger RC, Brodeur GM, Shimada H, Gerbing RB, Stram DO, Perez C, Haase GM, Matthay KK. Biologic factors determine prognosis in infants with stage IV neuroblastoma: a prospective Children’s Cancer Group study. J Clin Oncol. 2000;18(6):1260–8.CrossRefGoogle Scholar
  13. 13.
    Cecchetto G, Mosseri V, De Bernardi B, Helardot P, Monclair T, Costa E, Horcher E, Neuenschwander S, Toma P, Rizzo A, et al. Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group. J Clin Oncol. 2005;23(33):8483–9.CrossRefGoogle Scholar
  14. 14.
    Jackson JR, Tran HC, Stein JE, Shimada H, Patel AM, Marachelian A, Kim ES. The clinical management and outcomes of cervical neuroblastic tumors. J Surg Res. 2016;204(1):109–13.CrossRefGoogle Scholar
  15. 15.
    Qureshi SS, Kembhavi S, Ramadwar M, Chinnaswamy G, Laskar S, Talole S, Desai S, Khanna N, Vora T, Kurkure P. Outcome and morbidity of surgical resection of primary cervical and cervicothoracic neuroblastoma in children: a comparative analysis. Pediatr Surg Int. 2014;30(3):267–73.CrossRefGoogle Scholar
  16. 16.
    Paran TS, Corbally MT, Gross-Rom E, Rutigliano DN, Kayton ML, La Quaglia MP. Experience with aortic grafting during excision of large abdominal neuroblastomas in children. J Pediatr Surg. 2008;43(2):335–40.CrossRefGoogle Scholar
  17. 17.
    Katzenstein HM, Kent PM, London WB, Cohn SL. Treatment and outcome of 83 children with intraspinal neuroblastoma: the Pediatric Oncology Group experience. J Clin Oncol. 2001;19(4):1047–55.CrossRefGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar
  19. 19.
    Kiely EM. The surgical challenge of neuroblastoma. J Pediatr Surg. 1994;29(2):128–33.CrossRefGoogle Scholar
  20. 20.
    Lim II, Goldman DA, Farber BA, Murphy JM, Abramson SJ, Basu E, Roberts S, LaQuaglia MP, Price AP. Image-defined risk factors for nephrectomy in patients undergoing neuroblastoma resection. J Pediatr Surg. 2016;51(6):975–80.CrossRefGoogle Scholar
  21. 21.
    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.PubMedGoogle Scholar
  22. 22.
    Dickson PV, Sims TL, Streck CJ, McCarville MB, Santana VM, McGregor LM, Furman WL, Davidoff AM. Avoiding misdiagnosing neuroblastoma as Wilms tumor. J Pediatr Surg. 2008;43(6):1159–63.CrossRefGoogle Scholar
  23. 23.
    Qureshi SS, Rent EG, Bhagat M, Dsouza P, Kembhavi S, Vora T, Prasad M, Chinnaswamy G, Ramadwar M, Laskar S, et al. Chyle leak following surgery for abdominal neuroblastoma. J Pediatr Surg. 2016;51(9):1557–60.CrossRefGoogle Scholar
  24. 24.
    Liu Y, Pan C, Tang JY, Chen J, Zhou M, Ye QD. What is the result: chylous leakage following extensive radical surgery of neuroblastoma. World J Pediatr. 2012;8(2):151–5.CrossRefGoogle Scholar
  25. 25.
    Rees H, Markley MA, Kiely EM, Pierro A, Pritchard J. Diarrhea after resection of advanced abdominal neuroblastoma: a common management problem. Surgery. 1998;123(5):568–72.CrossRefGoogle Scholar
  26. 26.
    Ein SH, Ferguson JM. Intussusception—the forgotten postoperative obstruction. Arch Dis Child. 1982;57(10):788–90.CrossRefGoogle Scholar
  27. 27.
    Holcomb GW 3rd, Ross AJ 3rd, O’Neill JA Jr. Postoperative intussusception: increasing frequency or increasing awareness? South Med J. 1991;84(11):1334–9.CrossRefGoogle Scholar
  28. 28.
    Pumberger W, Pomberger G, Wiesbauer P. Postoperative intussusception: an overlooked complication in pediatric surgical oncology. Med Pediatr Oncol. 2002;38(3):208–10.CrossRefGoogle Scholar
  29. 29.
    Kaste SC, Wilimas J, Rao BN. Postoperative small-bowel intussusception in children with cancer. Pediatr Radiol. 1995;25(1):21–3.CrossRefGoogle Scholar
  30. 30.
    VanHouwelingen LT, Seims AD, Ortega-Laureano L, Coleman JL, McCarville MB, Davidoff AM, Fernandez-Pineda I. Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review. Pediatr Radiol. 2017;48(2):204–9.CrossRefGoogle Scholar
  31. 31.
    Yang G, Wang X, Jiang W, Ma J, Zhao J, Liu W. Postoperative intussusceptions in children and infants: a systematic review. Pediatr Surg Int. 2013;29(12):1273–9.CrossRefGoogle Scholar
  32. 32.
    Madenci AL, Fisher S, Diller LR, Goldsby RE, Leisenring WM, Oeffinger KC, Robison LL, Sklar CA, Stovall M, Weathers RE, et al. Intestinal obstruction in survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2015;33(26):2893–900.CrossRefGoogle Scholar
  33. 33.
    Barrena S, Miguel M, de la Torre CA, Ramirez M, Diaz M, Martinez L, Perez-Grueso FS, Lassaletta L, Tovar JA. Late surgery for spinal deformities in children previously treated for neural tumors. Eur J Pediatr Surg. 2011;21(1):54–7.CrossRefGoogle Scholar
  34. 34.
    Paulino AC, Fowler BZ. Risk factors for scoliosis in children with neuroblastoma. Int J Radiat Oncol Biol Phys. 2005;61(3):865–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of SurgerySt. Jude Children’s Research HospitalMemphisUSA

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