Renal preservation in high-risk retroperitoneal neuroblastoma: Impact on survival and local progression

Qinghua Ren; Shen Yang; Saishuo Chang; Wei Yang; Haiyan Cheng; Xiaofeng Chang; Zhiyun Zhu; Tong Yu; Jun Feng; Jianyu Han; Jianing Mou; Hong Qin; Huanmin Wang

doi:10.1016/j.ejso.2023.107303

Renal preservation in high-risk retroperitoneal neuroblastoma: Impact on survival and local progression

Eur J Surg Oncol. 2024 Jan;50(1):107303. doi: 10.1016/j.ejso.2023.107303. Epub 2023 Nov 29.

Authors

Qinghua Ren¹, Shen Yang¹, Saishuo Chang¹, Wei Yang¹, Haiyan Cheng¹, Xiaofeng Chang¹, Zhiyun Zhu¹, Tong Yu², Jun Feng¹, Jianyu Han¹, Jianing Mou¹, Hong Qin³, Huanmin Wang⁴

Affiliations

¹ Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
² Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
³ Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China. Electronic address: qinhong999999@163.com.
⁴ Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China; MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China. Electronic address: wanghuanmin@bch.com.cn.

PMID: 38056023
DOI: 10.1016/j.ejso.2023.107303

Abstract

Background: Retroperitoneal neuroblastomas predominantly encroach upon critical structures, complicating surgical intervention and yielding elevated rates of surgery-associated complications. The kidney and renal vasculature represent the organs most susceptible to retroperitoneal neuroblastoma infiltration. Prior investigations have revealed high nephrectomy incidence and a paucity of renal-preserving surgical approaches.

Methods: A retrospective analysis was undertaken, examining patients with retroperitoneal neuroblastoma who underwent surgical procedures from January 2018 to December 2019 at Beijing Children's Hospital.

Results: The study encompassed 225 patients, presenting a median age of 37 months. Concomitant nephrectomy and tumor excision were performed in 11 (4.9%) patients, while 214 (95.1%) patients successfully preserved their kidneys during surgery. Among the patients who retained their kidneys, 8 (3.5%) experienced renal atrophy postoperatively. Predominant rationales for simultaneous nephrectomy included tumor invasion into the renal hilum (n = 9), markedly diminished function of the affected kidney (n = 2), and ureteral infiltration (n = 1). Subsequent to a median follow-up duration of 43 months, the outcomes demonstrated no considerable divergence in overall survival (OS) and event-free survival (EFS) between the nephrectomy and renal-preserving cohorts among high-risk (HR) neuroblastoma patients. Among the eight HR children who underwent nephrectomy, four experienced local recurrence. The nephrectomy cohort exhibited a significantly elevated cumulative incidence of local progression (CILP) relative to the renal-preserving group.

Conclusion: In high-risk retroperitoneal neuroblastoma patients, nephrectomy does not enhance CILP, EFS, or OS. The guiding surgical tenet involves preserving the kidney while striving for gross total resection of the primary neoplasm, barring instances of severe deterioration of the affected renal function.

Keywords: Children; Kidney-sparing; Nephrectomy; Neuroblastoma; Prognosis.

MeSH terms

Child
Child, Preschool
Humans
Kidney / pathology
Kidney Neoplasms* / pathology
Nephrectomy / methods
Neuroblastoma* / surgery
Retroperitoneal Space
Retrospective Studies