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Laparoscopic adrenalectomy in children for neuroblastoma: report of case series
Fábio de Barros1, Rodrigo Luiz Pinto Romão, Maria Lúcia de Pinho-Apezzato
1Pediatric Surgery, Pediatric Liver Transplantation and Pediatric Onco-Hematology Divisions, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Background:
Neuroblastoma is one of the most common solid tumors in the pediatric population and the adrenal gland is the main abdominal site of this tumor. The laparoscopic approach has become the standard of care for most benign adrenal tumors in adults, but the role of laparoscopic adrenalectomy in children for malignant tumor is still a point of controversy. However, there is a growing experience with laparoscopic neuroblastoma resection of small lesions and the use of minimally invasive techniques for the initial management of infiltrative neuroblastoma in the last years. The aim of this study is to describe our initial experience with laparoscopic adrenalectomy for neuroblastoma in children, based on surgical outcomes.
Methods:
A retrospective review of 7 laparoscopic adrenalectomies performed in a single institution between October 2008 and October 2009. We focused our analysis on early surgical outcomes.
Results:
The mean tumoral size was 2.8±0.9 cm, the average surgical time was 138.6±65.5 minutes, and the mean hospital stay was 2.9±1.6 days. One stage IV patient was submitted to conversion due to bleeding and needed blood transfusion. There were no late complications or deaths and the mean follow-up time was 18.8±6.1 months.
Conclusions:
The laparoscopic approach for adrenal neuroblastoma resection is feasible in children with good outcomes, but should be reserved to patients with small, well-circumscribed adrenal lesions, without invasive or infiltrative disease.