Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection. Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement. Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study. Results: There were 16 patients with a mean age of 39.3 ± 22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncho-laryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality. Conclusion: In this cohort, 43.8% of the patients had intraoperative and or postoperative complications in terms of organ dysfunction or sepsis. 81.3% of the patients received intraoperative transfusion. Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated tools in children could be necessary for a better postoperative outcome in this surgical setting.
References
[1]
Hallett, A. and Traunecker, H. (2011) A Review and Update on Neuroblastoma. Paediatrics and Child Health, 22, 103-107. https://doi.org/10.1016/j.paed.2011.08.005
[2]
Colon, N.C. and Chung, D.H. (2011) Neuroblastoma. Advances in Pediatrics, 58, 297-311. https://doi.org/10.1016/j.yapd.2011.03.011
[3]
Gomez-Rios, M.A., Nuno, F.C. and Barreto-Calvo, P. (2017) Anesthetic Management of an Infant with Giant Abdominal Neuroblastoma. Brazilian Journal of Anesthesiology, 67, 210-213. https://doi.org/10.1016/j.bjane.2014.07.012
[4]
Louis, C.U. and Shohet, J.M. (2015) Neuroblastoma: Molecular Pathogenesis and Therapy. Annual Review of Medicine, 66, 49-63. https://doi.org/10.1146/annurev-med-011514-023121
[5]
Schengrund, C.L. (2020) Gangliosides and Neuroblastomas. International Journal of Molecular Sciences, 21, Article No. 5313. https://doi.org/10.3390/ijms21155313
[6]
Liu, T., Lv, Z., Xu, W., Liu, J. and Sheng, Q. (2020) Role of Image-Defined Risk Factors in Predicting Surgical Complications of Localized Neuroblastoma. Pediatric Surgery International, 36, 1167-1172. https://doi.org/10.1007/s00383-020-04731-y
[7]
Malek, M., Mollen, K.P., Kane, T.D., Shah, S.R. and Irwin, C. (2010) Thoracic Neuroblastoma: A Retrospective Review of Our Institutional Experience with Comparison of the Thoracoscopic and Open Approaches to Resection. Journal of Pediatric Surgery, 45, 1622-1626. https://doi.org/10.1016/j.jpedsurg.2010.03.018
[8]
Cheung, S.L.W. and Lerman, J. (1998) Mediastinal Masses and Anesthesia in Children. Anesthesiology Clinics of North America, 16, 893-910. https://doi.org/10.1016/S0889-8537(05)70068-7
[9]
Kumba, C. (2019) Pheochromocytoma, Paraganglioma, Neuroblastoma, Catecholamine Secreting Tumor Perioperative and Anesthetic Management in Children. International Journal of Pediatrics & Neonatal Care, 5, Article ID: IJPNC-156. https://doi.org/10.15344/2455-2364/2019/156
[10]
Stricker, P.A., Gurnaney, H.G. and Litman, R.S. (2010) Anesthetic Management of Children with an Anterior Mediastinal Mass. Journal of Clinical Anesthesia, 22, 159-163. https://doi.org/10.1016/j.jclinane.2009.10.004
[11]
Kumba, C., Cresci, F., Picard, C., Thiry, C., Albinni, S., et al. (2017) Transfusion and Morbi-Mortality Factors: An Observational Descriptive Retrospective Pediatric Cohort Study. Journal of Anesthesia & Critical Care: Open Access, 8, Article No. 00315. https://doi.org/10.15406/jaccoa.2017.08.00315
[12]
Tibby, S.M., Durward, A. and Murdoch, I.A. (2001) Are Transoesophageal Doppler Parameters a Reliable Guide to Paediatric Haemodynamic Status and Fluid Management? Intensive Care Medicine, 27, 201-205. https://doi.org/10.1007/s001340000795
[13]
Murdocc, I.A., Marsh, M.K., Tibby, S.M. and McLuckie, A. (1995) Continuous Haemodynamic Monitoring in Children: Use of Transoesophageal Doppler. Acta Paediatrica, 84, 761-764. https://doi.org/10.1111/j.1651-2227.1995.tb13751.x
[14]
Weber, T., Wagner, T., Neumann, K. and Deusch, E. (2015) Low Predictability of Three Different Noninvasive Methods to Determine Fluid Responsiveness in Critically Ill Children. Pediatric Critical Care Medicine, 16, e89-e94. https://doi.org/10.1097/PCC.0000000000000364
[15]
Gan, H., Cannesson, M., Chandler, J.R. and Ansermino, J.M. (2013) Predicting Fluid Responsiveness in Children: A Systematic Review. Anesthesia & Analgesia, 117, 1380-1392. https://doi.org/10.1213/ANE.0b013e3182a9557e
[16]
Pereira de Souza Neto, E., Grousson, S., Duflo, F., Ducreux, C., Joly, H., Convert, J.,, et al. (2011) Predicting Fluid Responsiveness in Mechanically Ventilated Children under General Anaesthesia Using Dynamic Parameters and Transthoracic Echocardiography. British Journal of Anaesthesia, 106, 856-864. https://doi.org/10.1093/bja/aer090
[17]
Kumba, C. (2020) Goal Directed Fluid and Hemodynamic Therapy and Postoperative Outcomes in Children: Value of Transthoracic Echocardiographic Aortic Blood Flow Peak Velocity Variation: A Multi-Centre Randomized Controlled Trial Protocol. Advances in Pediatric Research, 7, Article No. 35. https://doi.org/10.35248/2385-4529.20.7.35
[18]
Kumba, C., Willems, A., Querciagrossa, S., Harte, C., Blanc, T., De Cock, A., et al. (2019) A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome. Journal of Emergency and Critical Care Medicine, 5, 1-9. https://doi.org/10.13188/2469-4045.1000020
[19]
El Kenz, H. and Van der Linden, P. (2014) Transfusion-Related Acute Lung Injury. European Journal of Anaesthesiology, 31, 345-350. https://doi.org/10.1097/eja.0000000000000015
[20]
Mulder, H.D., Augustijn, Q.J., Van Woensel, J.B., Bos, A.P., Juffermans, N.P. and Wöstenvan Asperen, R.M. (2015) Incidence, Risk Factors, and Outcome of Transfusion-Related Acute Lung Injury in Critically Ill Children: A Retrospective Study. Journal of Critical Care, 30, 55-59. https://doi.org/10.1016/j.jcrc.2014.10.005
[21]
Muszynski, J.A., Spinella, P.C., Cholette, J.M., Acker, J.P., Hall, M.W., Juffermans, N.P., et al. (2016) Transfusion-Related Immunomodulation: Review of the Literature and Implications for Pediatric Critical Illness. Transfusion, 57, 195-206. https://doi.org/10.1111/trf.13855
[22]
Kumba, C., Querciagrossa, S., Harte, C., Willems, A., De Cock, A., et al. (2019) A Systematic Review and Meta-Analysis of Goal Directed Intra-Operative Transfusion Protocols Guided by Viscoelastic Methods and Perioperative Outcomes in Children. International Journal of Recent Scientific Research, 10, 31466-31471.
[23]
Kumba, C. (2022) Liver Transplantation in Children and Impact of Intraoperative Goal-Directed Therapies on Postoperative Outcome. SOJ Pedia Clin Neonato., 2, 1-7. https://doi.org/10.21203/rs.3.rs-744584/v1
[24]
Kumba, C. and Miladi, L. (2021) Scoliosis in Children: Impact of Goal-Directed Therapies on Intraoperative and Postoperative Outcomes. Open Journal of Orthopedics, 11, 315-326. https://doi.org/10.4236/ojo.2021.1110030
[25]
Kumba, C. (2021) Patient Blood Management in Craniosynostosis Surgery. Open Journal of Modern Neurosurgery, 11, 211-222. https://doi.org/10.4236/ojmn.2021.114025
[26]
Kumba, C., Gaume, M., Barbarian, A. and Péjin, Z. (2021) Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies in Children and In-Hospital Postoperative Outcomes. Open Journal of Orthopedics, 11, 327-334. https://doi.org/10.4236/ojo.2021.1111031
[27]
Kumba, C. (2021) Postoperative Complications after Major Abdominal Surgery in Preterm Infants: A Single Institute Record. Open Journal of Pediatrics, 11, 413-420. https://doi.org/10.4236/ojped.2021.113039
[28]
Kumba, C., et al. (2021) Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery. Acta Scientific Paediatrics, 4, 11-23. https://doi.org/10.31080/ASPE.2021.04.0432
[29]
Kumba, C. (2021) Children Aged between 1 and 3 Years in Noncardiac Surgery and Postoperative Outcome. EC Paediatrics, 10, 67-74.
[30]
Kumba, C. (2021) Postoperative Outcome in Children Aged between 3 and 6 Years in Abdominal Surgery, Neurosurgery and Orthopedics. Pediatric Anesthesia and Critical Care Journal, 9, 43-47. https://doi.org/10.14587/paccj.2021.7
[31]
Kumba, C. (2021) Postoperative Outcome in Children aged between 6 and 10 Years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery. Open Journal of Pediatrics, 11, 636-645. https://doi.org/10.4236/ojped.2021.114059
[32]
Kumba, C. (2021) Major Abdominal Surgery, Neurosurgery, Orthopedic Surgery in Children Aged between 10 and 18 Years and Postoperative Outcome. SOJ Pediatrics and Clinical Neonatology, 1, Article No. 000509. https://doi.org/10.53902/SOJPCN.2021.01.000509
[33]
Chong, M., Wang, Y., Berbenetz, N. and McConachie, I. (2018) Does Doal-Directed Haemody-Namic and Fluid Therapy Improve Peri-Operative Outcomes? A Systematic Review and Meta-Analysis. European Journal of Anaesthesiology, 35, 469-483. https://doi.org/10.1097/EJA.0000000000000778
[34]
Kumba, C. (2020) Physiology Principles Underlying Goal Directed Therapies in Children. Research in Pediatrics & Neonatology, 4, Article No. RPN.000591. https://doi.org/10.31031/RPN.2020.04.000591
[35]
Kumba, C. (2020) Rationale of Goal Directed Therapies in Children. Advances in Pediatric Research, 7, Article No. 42.
