Abstract
Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children. There is significant variability in the management of neuroblastoma, partially due to the heterogeneity of the clinical and biological behavior, and partially secondary to the different approaches between treating institutions. Anesthesia takes an integral part in the multidisciplinary care of patients with NB, from diagnosis to surgery and pain control. This paper aims to review and discuss the critical steps of the perioperative and operative management of children undergoing surgery for neuroblastoma. Anesthesia and analgesia largely depend on tumor location, surgical approach, and extension of the surgical dissection. Attention should be paid to the physio-pathological changes on cardiovascular, gastrointestinal, and immune systems induced by the tumor or by chemotherapy. At the time of surgery meticulous patient preparation needs to be carried out to optimize intraoperative monitoring and minimize the risk of complications. The cross-sectional role of anesthesia in cancer care requires effective communication between all members of the multidisciplinary team.
Highlights
Neuroblastoma is the most common extracranial, solid, malignancy of childhood, accounting for 5 to 8% incidence and 15% mortality among pediatric malignancies [1]
Gastrointestinal toxicity is common among children undergoing chemotherapy for neuroblastoma, especially for those affected by high-risk tumors
Renal and hepatic toxicity can result from carboplatin and cyclophosphamide administration, respectively; chemotherapy-related impairment needs to be evaluated in the pre-operative work-up as it could affect the metabolism of some anesthetic agents
Summary
Neuroblastoma is the most common extracranial, solid, malignancy of childhood, accounting for 5 to 8% incidence and 15% mortality among pediatric malignancies [1]. Neuroblastoma is an embryonal tumor of the sympathetic nervous system and a heterogeneous disease, characterized by variable clinical and biological behavior It can originate anywhere along the sympathetic chain such as a cervical, thoracic, retroperitoneal, or pelvic mass, affecting newborns, infants, or children; it can manifest as a small asymptomatic mass or as a large tumor with a major vascular encasement, spinal or bone marrow involvement. Prognosis ranges from spontaneous regression without treatment to aggressive, disseminated disease, refractory to multi-modal therapy including chemotherapy, surgery, and radiation. The result of this variability is a complex system of staging and pre-treatment risk stratification that tailors the intensity of treatment according to the patient’s stage, age and to the disease histology and biology [2]. The aim of this paper is to review and discuss the critical points of the perioperative and operative management of neuroblastoma in infants and children
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