Pelvic neuroblastoma: Low mortality and high morbidity

Background/Purpose: Cervical, thoracic, and pelvic neuroblastomas are regar ded as having a better outcome than abdominal primaries. The aim of the stu dy was to analyze the results of treatment of pelvic neuroblastomas in our institution. Methods: The authors reviewed the records of 284 patients with neuroblastom a treated in our hospital during the period 1983 through 1998 and identifie d 17 (6%) with pelvic tumors. The revised International Neuroblastoma Stagi ng System was used. Results: There were 6 patients with stage 1 disease, 8 with stage 2, 2 with stage 3, and 1 with stage 4 disease. Intraspinal extension of the tumor wa s present in 7 patients (41%). Except for one child with stage 4 disease, a ll patients underwent an attempt of tumor excision, and 6 had a complete re section. All 7 patients with intraspinal tumor survived. Permanent postoper ative neurological complications occurred in 6 patients (35%). These includ ed sciatic nerve palsy, urinary and fecal incontinence, neuropathic bladder , and leg weakness or nerve root injury L4-S1. Three of 17 patients died, b ut 1 fatality was unrelated to the tumor. The overall survival rate was 82% and was not influenced by the completeness of tumor resection. Conclusions: The survival of nonmetastatic pelvic neuroblastoma in our inst itution is good despite incomplete tumor resection. Intraspinal extension i s not a negative prognostic factor. Considering the high incidence of perma nent neurological damage after surgery and the generally favorable biologic al characteristics of these tumors, surgical treatment should not be overag gressive. Copyright (C) 2000 by W.B. Saunders Company.