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TÜRKÇE
Oral Presentation - 119
Image Defined Risk Factor(s) and outcomes for abdominal neuroblastoma – a surgical perspective from a Thailand national cancer centre
Bhavita Thamsopitt 1, Thitiporn Junhasavasdikul 2, Suwadee Eng-Chaun 2, Paul D. Losty 3, Pornsri Thanachatchairattana 1
1 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2 Division of Pediatric Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
Purpose
To identify specific IDRFs relationship to surgical outcomes, complications, and survival in patients with abdominal neuroblastoma (ANB)
Method
A retrospective study was conducted on patients (<15 years) with ANB stage L2 or higher, treated over two decades. All underwent surgery at a single centre in Thailand.
Results
Fifty patients were included - 94% classified as high-risk disease. Tumours encasing the celiac axis (CA) or superior mesenteric artery (SMA) were identified as a significant preoperative IDRF that related to incomplete surgery (33.3% vs 8.6%, p = 0.04). Complications were significantly associated with tumors encasing the abdominal aorta or IVC (58% vs 27%, p < 0.03) and in those infiltrating adjacent organs (42% vs 7%, p < 0.04). Visceral organ injuries were correlated to vascular and infiltrating related IDRFs ie. tumour encasing mesenteric root (r = 0.31, p = 0.03) and infiltrating the porta hepatis or hepatoduodenal ligament (r = 0.33, p =0.02). Tumours invading the CA or SMA carried less risk (%) of vascular injury (r =- 0.28, p =0.04). Only tumour encasement of the SMA at the mesenteric root was associated with disease progression (r = 0.35, p = 0.01). Incomplete resection linked to higher risk (%) of disease progression accounted for two of three patients experiencing local recurrence(s). Two and five-year survival rates were 80.6% and 52.1%, respectively.
Conclusion
Vascular IDRFs especially mesenteric root encasement were associated with visceral organ injury and disease progression. Tumours invading the CA or SMA carried less risk (%) of vascular injury. Surgical awareness of these ‘risks’ may help prevent vascular injury. However, balancing the goal(s) of minimizing complications with the need for complete tumor resection is critical, as incomplete surgery may lead to disease progression and recurrence. Survival outcomes of this study are comparable to the Southeast Asia region.