A Decade of Enhanced Recovery After Surgery (ERAS) After Resection of Abdominal Neuroblastoma.

PURPOSE: To investigate the impact of Enhanced Recovery After Surgery (ERAS) protocols in children undergoing surgical resection for abdominal neuroblastoma.

METHODS

Medical records from children who underwent surgical resection of abdominal neuroblastoma at a single institution from January 2014 to November 2024 and treated using ERAS principles were reviewed for this retrospective study. Surgical characteristics and outcomes are reported.

RESULTS

Among 115 eligible children, the median age was 2.8 [1.4, 4.9] years. Most (71.3%) had stage M disease and received neoadjuvant chemotherapy (76.5%). Intraoperative opiates (0.4 [0.2, 0.6] morphine milli-equivalents (MME)/kg) and fluids (15.1 [10.7, 19.1] mL/kg/h) were minimized. Intraoperative complications occurred in 16 patients (13.9%). Nasogastric tubes were used in 8 (7%) with a median duration of 1 [1, 2] day. Epidural catheters were used in 12 (10.4%), ketorolac in 98 (85.2%), and acetaminophen in 99 (86.1%). Postoperative opiates were minimized (0.14 [0.03, 0.49] MME mg/kg/day). Postoperative complications occurred in 11 (9.6%). Time to regular diet was 1 [0, 2] day, return of bowel function 2 [1, 2] days, and ambulation 1 [1, 2] day. Length of stay was 3 [2, 4] days. Readmissions unrelated to chemotherapy occurred in 3 (2.6%) patients.

CONCLUSIONS

ERAS protocols appear to be safe and have the potential to enhance recovery after resection of abdominal neuroblastoma.