[Surgical approach of retroperitoneal neuroblastoma in infancy (author's transl)]

Rarely retroperitoneal neuroblastoma is a well localized, encapsulated tumor, like it my appear somewhere else, as in the pelvic floor or mediastinum. Even with the same histological findings they are different from de point of view of invasion. Therefore the surgical approach should be different in each case. This is our main conclusion after de study performed in 48 cases operated upon in the last 8 years. We have tried three kinds of operations. 1. The so called curative, total resections. Performing a surgical ablation of the tumor and the organs macroscopically involved, either prior or after radiotherapy or quimiotherapy. At any risk, even of life in the early postoperative period. This kind of surgery has been undertaken in 34 cases with an early mortality of 9. The main aim of this technique is to divide the tumor in two across the supraaortic line well below the renal vessels and up to the diaphragm. In 18 cases the homolateral kidney was resected with the suprarrenal gland. Spleen and pancreas in 5 cases, colon in 4, and the inferior vena cava in 3. The survivors over 2 years are 19 cases. 2. Paliative resection, taking out the main tumor only, has been achieved in 4 cases, with the highest mortality because postoperative hemorrhage. We believed is a dangerous procedure. None of these children survived more than one year. 3. Biopsy and surgical macroscopic diagnosis of invasion plus placing clips at their margin has been carried out in 12 occasions. This had naturally the best early postoperative but not in the long run, none survived more than 2 years. A second look up with resection was undertaken in 3 cases with mortality of one. Most surgeons are puzzled when dealing with retroperitoneal neuroblastoma and some how disappointed before undertaking a long, difficult and highly risk operation, but in many instances still is about the only hope they may have.