Surgical Complications and Mortality

In high-risk patients, neuroblastomas tend to involve and/or encase major vascular and neural structures in their sites of origin or surrounding nodal echelons. Major surgical complications following neuroblastoma resection are listed by organ system in Table 11.4.3; most serious among them are massive hemorrhage, major vascular injury, and respiratory failure requiring mechanical ventilation after major surgery. Cervical and upper mediastinal resections are often associated with a permanent post-operative Horner's syndrome. Excision of epidural tumors or those heavily involving spinal foramina can result in paralysis (Shimada et al. 1995). Nephrectomy or renal infarction may occur with removal of retroperitoneal neuroblastomas (Sham-berger et al. 1998) (Table 11.4.4).An increased frequency of complications, including foot drop, can occur after removal of pelvic tumors despite their overall good prognosis (Cruccetti et al. 2000). Operative death is quite rare despite massive resections. In high-risk neu-roblastoma, complications following resection of the primary tumor are reduced by giving neoadjuvant chemotherapy (Shamberger et al. 1991) that reduces tumor volume (La Quaglia 2001; Medary et al. 1996). Typically with dose-intensive induction, surgery for high-risk neuroblastoma can be done after the administration of three to five cycles of chemotherapy.

Table 11.4.3 Surgical complications

System

Complications

Vascular

Arterial or venous laceration:

primary repair Arterial laceration: graft Renovascular hypertension Lymphatic ascites

Genitourinary

Nephrectomy

Renal infarction (arterial or venous occlusion or thrombosis) Ureteral transection or fibrosis Neurogenic bladder Bladder perforation Urinary tract infection

Gastrointestinal

Intussusception Chronic diarrhea Gastric atony Motility disorders

Nervous

Spinal cord injury with paralysis

Horner's syndrome

Recurrent nerve injury

Brachial or lumbosacral plexus injury

Sensory loss

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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