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Backgrounds <p>Thoracic neuroblastic tumors pose surgical challenges due to proximity to vital structures. Image-defined risk factors (IDRFs) aid in assessing surgical risks. This study evaluates their impact on surgical decisions, resection extent, and complications.</p> Methods <p>Forty-one children undergoing surgery for thoracic neuroblastic tumors (2007–2020) were analyzed. Group A (<i>n</i> = 22) underwent neoadjuvant chemotherapy followed by surgery; Group B (<i>n</i> = 19) underwent upfront surgery. IDRFs (infiltrative, vascular, neurological, or extensive) were identified via imaging. Tumor volumes were calculated using ellipsoid approximation. Resections were classified as complete or incomplete, and complications graded by the Clavien-Dindo system and Comprehensive Complication Index.</p> Results <p>At diagnosis, 70% had IDRFs; median IDRF count was 4 in Group A vs. 0 in Group B (<i>p</i> &lt; 0.001). Chemotherapy significantly reduced tumor volume and IDRF count (from 4 to 2, <i>p</i> &lt; 0.001). Complete resection was achieved in 38 patients. Surgical complications occurred in 29.3% of patients. Neurological IDRFs were significantly associated with complications on univariate analysis and showed a strong, though not statistically significant, association in multivariable analysis. Two IDRF-negative patients developed Horner syndrome, both with upper mediastinal tumors, suggesting that upper mediastinal localization warrants careful surgical consideration.</p> Conclusion <p>IDRFs are essential for planning thoracic neuroblastic tumor surgery. Neoadjuvant chemotherapy reduces tumor burden and IDRFs count, potentially lowering surgical risk. Upper mediastinal localization may require particular attention during surgical planning, even in the absence of classical IDRFs.</p>

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Impact of image-defined risk factors on surgical outcomes in thoracic neuroblastic tumors

  • 期刊论文

  • 发表日期：

    2026年4月19日

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  • Burak Ardicli,
  • Idil Rana User,
  • Arbay Ozden Ciftci,
  • Ibrahim Karnak,
  • Berna Oguz,
  • Mithat Haliloglu,
  • Mustafa Tezer Kutluk,
  • Diclehan Orhan,
  • Saniye Ekinci

摘要

Backgrounds

Thoracic neuroblastic tumors pose surgical challenges due to proximity to vital structures. Image-defined risk factors (IDRFs) aid in assessing surgical risks. This study evaluates their impact on surgical decisions, resection extent, and complications.

Methods

Forty-one children undergoing surgery for thoracic neuroblastic tumors (2007–2020) were analyzed. Group A (n = 22) underwent neoadjuvant chemotherapy followed by surgery; Group B (n = 19) underwent upfront surgery. IDRFs (infiltrative, vascular, neurological, or extensive) were identified via imaging. Tumor volumes were calculated using ellipsoid approximation. Resections were classified as complete or incomplete, and complications graded by the Clavien-Dindo system and Comprehensive Complication Index.

Results

At diagnosis, 70% had IDRFs; median IDRF count was 4 in Group A vs. 0 in Group B (p < 0.001). Chemotherapy significantly reduced tumor volume and IDRF count (from 4 to 2, p < 0.001). Complete resection was achieved in 38 patients. Surgical complications occurred in 29.3% of patients. Neurological IDRFs were significantly associated with complications on univariate analysis and showed a strong, though not statistically significant, association in multivariable analysis. Two IDRF-negative patients developed Horner syndrome, both with upper mediastinal tumors, suggesting that upper mediastinal localization warrants careful surgical consideration.

Conclusion

IDRFs are essential for planning thoracic neuroblastic tumor surgery. Neoadjuvant chemotherapy reduces tumor burden and IDRFs count, potentially lowering surgical risk. Upper mediastinal localization may require particular attention during surgical planning, even in the absence of classical IDRFs.