Complications of the Surgical Management of Children with Neuroblastoma
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.
KeywordsPediatric cancer Surgery Complications Neuroblastoma Image-defined risk factors
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