A prospective cohort study using the INSRF to identify risk factors for postoperative complications in pediatric...

The International Neuroblastoma Surgical Report Form (INSRF) was developed to standardize intraoperative assessment and documentation in patients with neuroblastoma (NB). This study aimed to identify independent risk factors and develop a model to predict postoperative complications using INSRF and clinical data.

A single-center analysis was conducted using prospectively collected data from NB patients undergoing resection between 2021 and 2024. Intraoperative variables and complications were recorded via the INSRF. Postoperative complications were graded using the Clavien-Dindo classification and the Comprehensive Complication Index (CCI).

Among the 205 children who underwent tumor resection, 87 (42.4%) experienced intraoperative complications and 136 (66.3%) developed postoperative complications. Renal ischemia (20.5%), intraoperative hypertension (18.5%), and vascular injury (13.2%) were the most common intraoperative events observed. Vascular injury was significantly associated with tumor encasement of the major vessels (P<0.001, AUC = 0.834), whereas renal ischemia was independently predicted by superior mesenteric artery (SMA) encasement (P = 0.01) and renal invasion (P = 0.049). Postoperative complications included hepatic dysfunction (48.8%), lymphatic leakage (20.0%), diarrhea (19.0%), renal atrophy (18.1%), and infections (13.7%). Independent predictors of severe complications (Clavien-Dindo grade ≥ IIIa or CCI>32) included renal vein and inferior vena cava (IVC) encasement, hepatic and diaphragmatic invasion, and major vascular injury. Furthermore, pancreatic fistulas, lymphatic leakage, diarrhea, and postoperative infection are associated with extended postoperative hospitalization.

Using prospectively collected INSRF data, we identified tumor vascular encasement and organ invasion as key independent risk factors for surgical complications in NB. These findings underscore the importance of standardized preoperative risk assessments and tailored surgical strategies to improve perioperative safety. Integrating complication profiling into surgical planning may facilitate early intervention, reduce morbidity, and enhance patient recovery. Future efforts will focus on refining INSRF-based predictive models to optimize outcomes and guide precision surgical care in pediatric NB.