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Eur J Pediatr Surg 2009; 19(5): 297-303
DOI: 10.1055/s-0029-1220681
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Complications in Abdominal Tumor Surgery in Children. Experiences at a Single Oncological Center

P. Günther 1 , J. Tröger 2 , S. Holland-Cunz 1 , W. Behnisch 3 , U. Hinz 4 , P. Romero 1 , J.-P. Schenk 2
  • 1Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
  • 2Department of Pediatric Radiology, University of Heidelberg, Heidelberg, Germany
  • 3Department of Pediatric Oncology, University of Heidelberg, Hematology and Immunology, Heidelberg, Germany
  • 4Unit for Documentation and Statistics of the Department of Surgery, University of Heidelberg, Heidelberg, Germany
Further Information

Publication History

received October 16, 2008

accepted after revision March 22, 2009

Publication Date:
15 May 2009 (online)

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Abstract

Introduction: Surgical complications after tumor operations are frequent in children, with rates of up to 30% cited in the literature. Various approaches to reduce these complication rates have been attempted, with preoperative chemotherapy holding pride of place. One approach to minimize surgical complications is better preoperative preparation. In a retrospective analysis, we evaluated the complications associated with tumor surgery.

Material and Methods: We retrospectively analyzed patient data from 1991 to 2007. The distribution of the various tumors, the type of surgery, and complications were evaluated. For neuroblastomas a differentiated analysis of complications was performed, which included staging and radiologically defined surgical risk factors (SRFs). Patients were divided into two groups: A and B. Intensified surgical planning with 3D visualization was used in patients of group B.

Results: A total of 145 operations for abdominal tumors were performed in 123 patients. The three most common diseases were neuroblastoma (36%), nephroblastoma (26%), and ovarian tumor (19%). In 68% of patients complete resection and in 19% of cases partial resection of the tumor was carried out; open biopsy was performed in 13%. A total of 15 (10.3%) complications developed: the incidence of complications for group A was 11.8% and 7.7% for group B (p=0.5). For nephroblastoma these figures were 27.9% and 21.2% (p=1.0). In the group of patients with neuroblastoma, six complications developed in patients from group A (21.4%) and one in a group B patient (4.2%) (p=0.107). 54% of neuroblastomas were completely and 33% partially resected; these figures and the distribution of SRFs were similar in the two groups. A significant increase in the risk of complications could be seen with an increase in SRFs (p=0.0267) and with disease stages 2 and 3 (p=0.016). Tumor reduction surgery was also associated with an increase in complications (p=0.086).

Conclusions: In summary, tumor surgery is associated with considerable risks in children. Therefore it is very important to look for new approaches that could potentially minimize these risks. As the causes of surgical complications are multifactorial, we are of the opinion that intensified surgical planning can contribute to reducing risks. Particularly neuroblastoma surgery could profit from an increased use of 3D visualization and improved preoperative planning.

Key words

surgical complication - abdominal tumor - child - three-dimensional - surgical planning

References

  • 1 Adkins ES, Sawin R, Gerbing RB. et al . Efficacy of complete resection for high-risk neuroblastoma: a Children's Cancer Group study.  J Pediatr Surg. 2004;  39 931-936
    Google Scholar
  • 2 Cantos MF, Gerstle JT, Irwin MS. et al . Surgical challenges associated with intensive treatment protocols for high-risk neuroblastoma.  J Pediatr Surg. 2006;  41 960-965
    Google Scholar
  • 3 Cañete A, Jovani C, Lopez A. et al . Surgical treatment for neuroblastoma: complications during 15 years' experience.  J Pediatr Surg. 1998;  33 1526-1530
    Google Scholar
  • 4 Castel V, Tovar JA, Costa E. et al . The role of surgery in stage IV neuroblastoma.  J Pediatr Surg. 2002;  37 1574-1578
    Google Scholar
  • 5 Cecchetto G, Mosseri V, De Bernardi B. et al . Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group.  J Clin Oncol. 2005;  23 8483-8489
    Google Scholar
  • 6 Coll DM, Herts BR, Davros WJ. et al . Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy.  Radiographics. 2000;  20 431-438
    Google Scholar
  • 7 Endo I, Shimada H, Sugita M. et al . Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma.  Surgery. 2007;  142 666-675
    Google Scholar
  • 8 Frericks BB, Caldarone FC, Nashan B. et al . 3D CT modelling of hepatic vessel architecture and volume calculation in living donated liver transplantation.  Eur Radiol. 2004;  14 326-333
    Google Scholar
  • 9 Fuchs J, Warmann SW, Szavay P. et al . Three-dimensional visualization and virtual simulation of resections in pediatric solid tumors.  J Pediatr Surg. 2005;  40 364-370
    Google Scholar
  • 10 Fusaro F, Cecchetto G, Boglino C. et al . Measures to prevent renal impairment after resection of retroperitoneal neuroblastoma.  Pediatr Surg Int. 2002;  18 388-391
    Google Scholar
  • 11 Grenacher L, Thorn M, Knaebel HP. et al . The role of 3-D imaging and computer-based postprocessing for surgery of the liver and pancreas.  Rofo. 2005;  177 1219-1226
    Google Scholar
  • 12 Günther P, Waag KL, Tröger J. et al . MR volumetric analysis of the course of nephroblastomatosis.  Pediatr Radiol. 2004;  34 660-664
    Google Scholar
  • 13 Günther P, Schenk JP, Wunsch R. et al . Abdominal tumors in children: 3D visualization and surgical planning.  Eur J Pediatr Surg. 2004;  14 316-321
    Google Scholar
  • 14 Günther P, Ley S, Tröger J. et al . 3D perfusion mapping and virtual surgical planning in the treatment of pediatric embryonal abdominal tumors.  Eur J Pediatr Surg. 2008;  18 7-12
    Google Scholar
  • 15 Günther P, Göppl M, Tröger J. et al . Surgical planning for solid abdominal tumors in childhood. Analysis of the need and acceptance of computer-assisted 3D-visualization.  Monatsschr Kinderheilkunde. 2008;  156 569-573
    Google Scholar
  • 16 Lamade W, Glombitza G, Fischer L. et al . The impact of 3-dimensional reconstructions on operation planning in liver surgery.  Arch Surg. 2000;  135 1256-1261
    Google Scholar
  • 17 Lamade W, Vetter M, Hassenpflug P. et al . Navigation and image-guided HBP surgery: a review and preview.  J Hepatobiliary Pancreat Surg. 2002;  9 592-599
    Google Scholar
  • 18 Ritchey ML, Shamberger RC, Haase G. et al . Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group.  J Am Coll Surg. 2001;  192 63-68
    Google Scholar
  • 19 Ritchey ML, Kelalis PP, Breslow N. et al . Surgical complications after nephrectomy for Wilms' tumor.  Surg Gynecol Obstet. 1992;  175 507-514
    Google Scholar
  • 20 Schenk JP, Waag KL, Graf N. et al . 3D-visualization by MRI for surgical planning of Wilms tumors.  Fortschr Röntgenstr. 2004;  176 1447-1452
    Google Scholar
  • 21 Schenk JP, Günther P, Schrader C. et al . Childhood kidney tumors – relevance of imaging.  Radiologe. 2005;  45 1112-1123
    Google Scholar
  • 22 Schenk JP, Graf N, Günther P. et al . Role of MRI in the management of patients with nephroblastoma.  Eur Radiol. 2008;  18 683-691
    Google Scholar
  • 23 Schenk JP, Schrader C, Zieger B. et al . Reference radiology in nephroblastoma: accuracy and relevance for preoperative chemotherapy.  Rofo. 2006;  178 38-45
    Google Scholar
  • 24 Seseke F, Rebmann S, Zöller G. et al . Risk factors for perioperative complications in renal surgery for Wilms' tumor.  Aktuelle Urol. 2007;  38 46-51
    Google Scholar
  • 25 Shamberger RC, Smith EI, Joshi VV. et al . The risk of nephrectomy during local control in abdominal neuroblastoma.  J Pediatr Surg. 1998;  33 161-164
    Google Scholar
  • 26 Shamberger RC, Allarde-Segundo A, Kozakewich HP. et al . Surgical management of stage III and IV neuroblastoma: resection before or after chemotherapy?.  J Pediatr Surg. 1991;  26 1113-1117
    Google Scholar
  • 27 Simon T, Hero B, Benz-Bohm G. et al . Review of image defined risk factors in localized neuroblastoma patients: Results of the GPOH NB97 trial.  Pediatr Blood Cancer. 2008;  50 965-969
    Google Scholar
  • 28 Sindelar WF, Kinsella TJ. Normal tissue tolerance to intraoperative radiotherapy.  Surg Oncol Clin N Am. 2003;  12 925-942
    Google Scholar
  • 29 Schweinitz vD von, Hero B, Berthold F. The impact of surgical radicality on outcome in childhood neuroblastoma.  Eur J Pediatr Surg. 2002;  12 402-409
    Google Scholar

Correspondence

Dr. P. Günther

Division of Pediatric Surgery

University of Heidelberg

Im Neuenheimer Feld 110

69120 Heidelberg

Germany

Phone: +49/6221/56 62 82

Fax: +49/6221/56 51 05

Email: patrick.guenther@med.uni-heidelberg.de

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