SURGICAL-TREATMENT OF NEUROBLASTOMAS IN INFANTS UNDER 12 MONTHS OF AGE

Background: Surgical treatment of neuroblastomas, both those detected by screening and those detected clinically, in infants less than 12 mo nths of age, is controversial, because some tumors in this age group p otentially have the ability to regress spontaneously. Methods: From Ja nuary 1985 to March 1997, the authors treated 50 infants (under 1 year of age) with neuroblastoma: 23 boys and 27 girls. Forty-one cases wer e detected preclinically by screening when the patients were 6 to 11 m onths of age (median, 7 months), and nine patients were discovered to have clinical manifestations at the age of 1 to 10 months (median, 4 m onths). Results:The tumor was INSS stage 3 or 4 in 10 patients (24%) w ith screening-detected tumor and in five (56%) with clinically detecte d tumor, although the difference was not statistically significant. Fo ur screening-positive patients had multifocal primary tumors, and thre e of them were synchronous bilateral adrenal neuroblastomas. There was no statistically significant difference between the screening-detecte d tumors and the clinically detected tumors in biological characterist ics such as Shimada's histology, DNA ploidy, and N-myc amplification. Complete resection of the primary lesion was accomplished by either pr imary surgery or second look (delayed primary) surgery in 46 patients (92%), and the resection was incomplete in the remaining four. In pati ents with bilateral adrenal tumors, the larger one was primarily resec ted, and the smaller contralateral tumor was enucleated or resected by partial adrenalectomy. Surgical complications included postoperative adhesive ileus (n = 2), Horner's syndrome (n = 2), renal atrophy (n = 1), renal failure (n = ?), phrenic nerve injury(n = 1), chylous ascite s(n = 1), chylothorax (n = 1) and intussusception (n = 1). One patient died of respiratory failure caused by a complication, but 49 patients (98%) were alive at the time of evaluation. Conclusion: When consider ing surgical treatment of infants with biologically favorable neurobla stoma, the risk involved in treatment should be weighed against the ri sk inherent in a tumor capable of spontaneous regression, and aggressi ve surgery is unacceptable. Copyright (C) 1998 by W.B. Saunders Compan y.