Technical aspects of laparoscopic removal of neurogenic tumors of abdominal localization in children

Progress in a modern pediatric oncological surgery, including neuroblastoma surgery, is characterized by increased role of the minimally-invasive approach. Authors represent standardized technical aspects of abdominal neuroblastoma laparoscopic resection. The purpose of this research was to systematize the technical aspects of laparoscopic resection for pediatric abdominal neuroblastoma, also in cases with Image-Defined Risk Factors (IDRF). Methods used: pre- and intraoperative data of 181 patients (85 (47%) males/96 (53%) females) of the median age of 14 [5-51] (1-209) months old with abdominal neuroblastoma who had received laparoscopic tumor resection at the National Scientific and Practical Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev (Moscow, Russia) in Jan. 2018-Jan. 2024 were analyzed. Technical features of laparoscopic surgery procedure, also in cases with IDRF have been systematized as follows: patient position on the operating table, trocars placement, visualization of surgical field, dissection plan. Results: maximal tumor length was 3,6 [2,6-5] (0,7-12,6) cm, maximal tumor volume was 16,8 [4-40] (0,5-557) ml. IDRF were identified in 53 (29%) cases, wherein two and more IDRFs were in 19 (10%) patients. The surgical intervention duration was 100 [70-140] (35-725) minutes, intraoperative blood loss was 5 [5-18] (5-3600) ml, intraoperative transfusion was 0 [0-0] (0-890) ml. Intraoperative complications were observed in 6 (3%) patients, conversion was required in 7 (4%) cases. Complete tumor resection (98% to 100%) was achieved in 163 (90%) cases. Conclusion: the accumulated experience of minimally invasive surgery for neuroblastoma indicates the demand for reviewing of the current indications for these surgical procedures as well as a precise investigation of the effect of each IDRF on the difficulty and risk of surgery. In this Article Authors have described standardized technical features of abdominal neuroblastoma laparoscopic resection. These technical features are used in prospective clinical trial whilst the purpose of this research was to design the difficulty scoring system for such surgery (ClinicalTrials.gov ID NCT06296732).