Pediatric surgery international · 2025
When neuroblastoma steals a kidney: understanding autonephrectomy risks.
СтатьяНазвание и аннотация: Перевод в очереди
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Badami Khushbu, Suthar Sweta, Krishnamurthy Shalini Shree, Radhakrishnan Venkatraman, Raja Anand
Аннотация
PURPOSE: This study aims to evaluate and analyze the incidence of autonephrectomy in operated cases of intra-abdominal neuroblastoma with renal vessel encasement. We also assessed factors contributing to autonephrectomy.
METHODS: This retrospective study analyzed 93 pediatric neuroblastoma patients treated at a single tertiary center in India from January 2015 to December 2023. We included patients with intraabdominal neuroblastoma who underwent surgery, focusing mainly on tumors with renal vascular encasement, defined as tumor abutment exceeding 180 degrees of the vessel wall circumference. Preoperative imaging and intraoperative findings were used to determine the extent of renal vessel involvement. Subsequent kidney status was assessed through postoperative scans.
RESULTS: There were a total of 93 patients across all subsites. After applying the inclusion and exclusion criteria, 39 patients were included in the study. Among these 39 patients, 14 patients (35.9%) had renal vessel encasement as per predefined criteria, two patients required intraoperative nephrectomy for complete resection due to dense adhesions with renal artery and renal parenchymal infiltration. Eight patients (of 12, 66.7%) had intact ipsilateral renal function despite extensive dissection and handling of renal vessels during surgery. Four patients (of 12, 33.3%) experienced autonephrectomy at a median time of 3.25 months from the surgery. Patients were followed up until they were either lost to follow-up or expired due to the disease or other causes. The median follow-up duration of the study was 13 months.
CONCLUSION: Autonephrectomy, though not widely described or reported, is not an uncommon occurrence. Attention to detail and meticulous dissection around the renal vessels may help reduce the risk of inadvertent damage to these critical structures. These measures may enhance patient safety and surgical outcomes.
METHODS: This retrospective study analyzed 93 pediatric neuroblastoma patients treated at a single tertiary center in India from January 2015 to December 2023. We included patients with intraabdominal neuroblastoma who underwent surgery, focusing mainly on tumors with renal vascular encasement, defined as tumor abutment exceeding 180 degrees of the vessel wall circumference. Preoperative imaging and intraoperative findings were used to determine the extent of renal vessel involvement. Subsequent kidney status was assessed through postoperative scans.
RESULTS: There were a total of 93 patients across all subsites. After applying the inclusion and exclusion criteria, 39 patients were included in the study. Among these 39 patients, 14 patients (35.9%) had renal vessel encasement as per predefined criteria, two patients required intraoperative nephrectomy for complete resection due to dense adhesions with renal artery and renal parenchymal infiltration. Eight patients (of 12, 66.7%) had intact ipsilateral renal function despite extensive dissection and handling of renal vessels during surgery. Four patients (of 12, 33.3%) experienced autonephrectomy at a median time of 3.25 months from the surgery. Patients were followed up until they were either lost to follow-up or expired due to the disease or other causes. The median follow-up duration of the study was 13 months.
CONCLUSION: Autonephrectomy, though not widely described or reported, is not an uncommon occurrence. Attention to detail and meticulous dissection around the renal vessels may help reduce the risk of inadvertent damage to these critical structures. These measures may enhance patient safety and surgical outcomes.