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Diarrhea after resection of advanced abdominal neuroblastoma: a common management problem
H Rees1, M A Markley, E M Kiely
1Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust, London, U.K.
Insights
Postoperative diarrhea is a common complication in children after advanced abdominal neuroblastoma resection. Many survivors experience persistent diarrhea, requiring long-term management for this significant issue.
Area of Science:
- Pediatric Oncology
- Surgical Gastroenterology
- Neuroblastoma Research
Background:
- Advanced abdominal neuroblastoma resection can lead to persistent postoperative diarrhea in children.
- The clinical significance of this complication was previously underestimated.
Purpose of the Study:
- To evaluate the incidence, severity, and management strategies for chronic diarrhea following neuroblastoma resection.
- To identify factors associated with the development of postoperative diarrhea.
Main Methods:
- Retrospective review of case notes for children with stage III or IV abdominal/pelvic neuroblastoma (1985-1996).
- Diarrhea severity was classified: mild (<3 loose stools/day), moderate (3-5), and severe (>5 or urgency/incontinence/nocturnal).
Main Results:
- 23% of 77 resected patients developed postoperative diarrhea (11 mild, 7 moderate, 5 severe).
- Dissection near superior mesenteric and celiac arteries correlated with higher diarrhea incidence.
- Loperamide treatment in 15 children reduced but did not eliminate symptoms; 8 of 11 survivors had persistent loose stools.
Conclusions:
- Diarrhea is a frequent complication after advanced abdominal neuroblastoma resection, likely due to autonomic nerve disruption during tumor removal.
- Many children need long-term treatment for intestinal issues, with some experiencing severe, persistent diarrhea.
- Improved medical management strategies are necessary for this neuroblastoma complication.
Background:
After resection of advanced abdominal neuroblastoma, children may have persistent postoperative diarrhea. Until recently, the magnitude of this problem had not been appreciated.
Methods:
To assess the incidence, severity, and management of chronic postoperative diarrhea in these patients, we reviewed the case notes of all children with stage III or IV abdominal and pelvic neuroblastoma who underwent tumor resection in our hospital between January 1985 and September 1996. We classified the severity of diarrhea as follows: mild, less than 3 loose stools per day; moderate, 3 to 5 loose stools per day; and severe, more than 5 loose stools per day and/or urgency, incontinence, or nocturnal diarrhea.
Results:
Seventy-seven children underwent resection during this period, and 23 (30%) had postoperative diarrhea, classified as mild in 11 patients, moderate in 7, and severe in 5. Dissection around the superior mesenteric and celiac arteries was associated with a significantly higher incidence of diarrhea. Fifteen children (65%) received treatment with loperamide, which reduced but did not abolish symptoms. Twelve children subsequently died of progressive neuroblastoma. Of the 11 surviving children (mean duration of follow-up, 8.4 years), 8 have persistent loose stools.
Conclusions:
Diarrhea, probably resulting from disruption of the autonomic nerve supply to the gut during clearance of tumor from the major vessels of the retroperitoneum, is common after resection of advanced abdominal neuroblastoma. Many children require long-term treatment to slow intestinal peristalsis, and a few have severe and unremitting diarrhea. More effective medical management of this complication is needed.