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DOI: 10.1055/s-0029-1220681
© Georg Thieme Verlag KG Stuttgart · New York
Surgical Complications in Abdominal Tumor Surgery in Children. Experiences at a Single Oncological Center
Publication History
received October 16, 2008
accepted after revision March 22, 2009
Publication Date:
15 May 2009 (online)

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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 4
Castel V, Tovar JA, Costa E. et al .
The role of surgery in stage IV neuroblastoma.
J Pediatr Surg.
2002;
37
1574-1578
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 12
Günther P, Waag KL, Tröger J. et al .
MR volumetric analysis of the course of nephroblastomatosis.
Pediatr Radiol.
2004;
34
660-664
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 19
Ritchey ML, Kelalis PP, Breslow N. et al .
Surgical complications after nephrectomy for Wilms' tumor.
Surg Gynecol Obstet.
1992;
175
507-514
MissingFormLabel
- 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
MissingFormLabel
- 21
Schenk JP, Günther P, Schrader C. et al .
Childhood kidney tumors – relevance of imaging.
Radiologe.
2005;
45
1112-1123
MissingFormLabel
- 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
MissingFormLabel
- 23
Schenk JP, Schrader C, Zieger B. et al .
Reference radiology in nephroblastoma: accuracy and relevance for preoperative chemotherapy.
Rofo.
2006;
178
38-45
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 28
Sindelar WF, Kinsella TJ.
Normal tissue tolerance to intraoperative radiotherapy.
Surg Oncol Clin N Am.
2003;
12
925-942
MissingFormLabel
- 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
MissingFormLabel
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