Laparoscopic adrenalectomy for neuroblastoma in children: a report of 6 cases

Neuroblastoma, a neoplasm of the sympathetic nervous system, is the most common solid extracranial tumor of childhood. Complete tumor resection has been shown to improve outcomes in both low- and high-risk neuroblastoma. The efficacy of laparoscopic adrenalectomy (LA) for metastatic lesions, benign tumors, and small neuroblastomas (<20 mm in diameter) is well established. However, the role of LA for large neuroblastomas is unclear. The authors describe the technical aspects of LA in 6 children with adrenal neuroblastomas greater than 2 cm and summarize their outcomes. All 6 patients underwent successful LA with removal of their tumors and surrounding lymph nodes. The specimens were placed in a laparoscopic specimen retrieval bag and morsulated in situ. The pathologic specimens were adequate for biologic factor analysis and histology. Mean operative time for all cases was 146 minutes. The average size of the adrenal tumors resected was 3.3 x 3.7 x 3.3 cm, and there were no intraoperative or perioperative deaths. All children, except the fifth patient who stayed for chemotherapy, were discharged home within 48 hours after surgery and are well. Our preliminary data suggest LA is a safe treatment option for neuroblastoma tumors greater than 2 cm in the select children.