Evolution of robotic-assisted resection of pediatric neuroblastic tumors: a retrospective analysis

Due to rarity and variability in pediatric tumors presentation, robotic oncologic surgery remains a challenging field. This study analyses clinical features that can impact outcomes of robotic excision of neuroblastic tumors (pNBTs) in children. Retrospective cohort of children who underwent robotic resection of pNBTs between 2020 and 2025. Exclusion criteria: biopsy only, follow-up ≤ 6 months. Forty-four children included, 24 girls (54.5%), 68.1% neuroblastoma, 18.1% ganglioneuroblastoma intermixed, 13.6% ganglioneuroma. Abdominal tumors were described in 33 (75%). At surgery 61.3% had a IDRFpositive status. Median age was 36 months (IQR 17-63) with a median weight of 12 kg (IQR 9.6-22). Median operative time was 170 min (IQR 130-210). Ten (22.7%) conversions occurred, with a single urgent de-docking. No incomplete resection was recorded. Median hospitalization was 3 days (IQR 2-5). Two (4.5%) early post-operative complications: two incisional eventration (IIIb Clavien-Dindo). There was no statistical difference in conversion and complications rates between patients ≤ 10 kg (31.8%) and children > 10 kg. Risk factor analysis showed higher conversion rate in children with higher IDRF score (p = 0.032). Uneventful oncological follow-up. Robotic surgery seems a safe option for pNBTs resection in carefully selected children. This study suggests IDRF score might be helpful in selecting patients for robotic approach, to limit the chances of minimal residual tumor and/or conversion. The robotic approach should be performed by surgeons with extensive experience in robotic surgery and a strong expertise of oncological principles.