Primary thoracoscopic gross total resection of neuroblastoma

Thoracic neuroblastomas are generally less aggressive and have a better prognosis than those arising below the diaphragm. Our purpose was to study the safety and efficacy of thoracoscopic resection and to evaluate tumor data and patient outcomes.

We reviewed the records of patients who underwent primary thoracoscopic resection of neuroblastoma (NB) between 1998 and 2002. Data included demographics, symptoms, size, location, operative time, complications, hospital stay, histology, biologic markers, adjuvant therapy, and outcome.

Five patients (age range, 9 to 44 months) underwent thoracoscopic resection of NB. Three of the patients had neurological symptoms. Tumor size ranged from 2.1 to 6.0 cm. Two tumors were apical, three supradiaphragmatic. Primary thoracoscopic gross total resection was achieved in all 5 cases, all of which were stage 1. Operative time ranged from 64 to 175 minutes. The only complications were two cases of small tumor spillage. Hospital stay was 1 to 4 days. Histology ranged from ganglioneuroma to differentiating NB, with a favorable classification in 4 of 5 cases. None of the tumors were N-Myc amplified. Chemotherapy or radiation therapy was not indicated for any patient. All are alive with no evidence of disease at 14 to 55 months' follow-up.

Primary gross total resection of mediastinal NB can be achieved safely and effectively by a thoracoscopic approach. In our series, most tumors had favorable histology and biology, and all appear to be potentially treatable by primary thoracoscopic resection alone.