Laparoscopic surgery for neuroblastoma identified by mass screening

Most neuroblastoma identified by mass screening are clearly different from the clinically diagnosed tumors with respect to biology, epidemiology, and outcome. Because the neuroblastomas detected by mass screening have favorable biological features (97% survival rate at 5 years), aggressive surgery may not be appropriate for such tumors. Laparoscopic adrenalectomy was performed on a 9-month-old boy and two 8-month-old girls who had suitable lesions. The tumors were small (< 20 mm in diameter). With the patients under general anesthesia, five trocars were placed in the abdomen. The abdominal wall traction method was used in addition to pneumoperitoneum. Intraabdominal pressure was maintained at below 4 mm Hg. The adrenal tumors were well encapsulated and completely excised, placed into a plastic bag, and removed through one of the 10-mm trocar sites. No lymphadenopathy was observed. The postoperative course was uneventful. The tumors were of favorable Shimada histology and had no N-myc gene amplification. The patients have survived, with no evidence of recurrence or metastasis, through the follow-up period of 17 to 22 months.