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Retroperitoneal localized neuroblastoma in children: a comparison of enhanced recovery after surgery versus traditional care

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Abstract

Purpose

To investigate the clinical value of enhanced recovery after surgery (ERAS) protocols for children with neuroblastoma (NB).

Methods

This retrospective review was conducted by using the electronic medical records of 48 children with retroperitoneal localized NB who underwent tumor resection (surgery for treatment, not diagnosis) between October 2016 and September 2021. The ERAS protocols for NB excision were implemented in 28 children (ERAS group), while 20 children received traditional care (TRAD group). The same group of pediatric surgeons performed all the tumor resections. Intraoperative fluid infusion, the extent of NB resection, time of early ambulation and time of first flatus, time to total enteral nutrition (TEN) after surgery, abdominal drainages, nasogastric tubes and urinary catheters used and duration, the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table on a postoperative day 1 (POD1), 3, 5, length of stay after surgery (LOS), hospitalization expense, postoperative complications, parental satisfaction rate and readmission rate of surgical wards within 30 days after operation were analyzed.

Results

The median postoperative period of early mobilization, first flatus, TEN, LOS and total cost during hospitalization were 1.0 days, 2.0 days, 5.5 days, 9.0 days and 33,397.3 yuan in the ERAS group and 3.0 days, 3.0 days, 7.0 days, 11.0 days and 38,120.3 Yuan in the TRAD group, respectively (all p < 0.05). Median intraoperative fluid volume was 5.0 mL/kg/h compared to 8.0 mL/kg/h and the magnitude of decrease in FLACC scores from POD1 to POD5 was greater in the ERAS group (all p < 0.05). Abdominal drainages, urinary catheters and nasogastric tubes were removed earlier in the ERAS group (p < 0.05). The satisfaction of parents in the ERAS group was slightly higher, but the difference was not statistically significant (P = 0.762). There were no marked differences between the two groups in aspects of the extent of NB resection, operation-related complications and 30-day readmissions (all P = 1.000).

Conclusions

Application of ERAS protocols in localized retroperitoneal NBs resection in children is feasible and safe. However, applying ERAS protocols in the surgical resection of solid tumors in children still requires much more research, especially randomized prospective research.

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Data availability

All data are transparent and will be provided by the corresponding authors upon reasonable request.

References

  1. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78(5):606–617

    Article  CAS  PubMed  Google Scholar 

  2. Pokorny H, Resinger C, Fischer I, Lorenz V, Noske H, Podar S et al (2017) Fast early recovery after transabdominal preperitoneal repair in athletes with sportsman’s groin: a prospective clinical cohort study. J Laparoendosc Adv Surg Tech A 27(3):272–276

    Article  PubMed  Google Scholar 

  3. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J et al (2014) Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 118(5):1052–1061

    Article  PubMed  Google Scholar 

  4. Tang J, Humes DJ, Gemmil E, Welch NT, Parsons SL, Catton JA (2013) Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages. Ann R Coll Surg Engl 95(5):323–328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. He F, Lin X, Xie F, Huang Y, Yuan R (2015) The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Translat Oncol : Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex 17(9):694–701

    Article  CAS  Google Scholar 

  6. Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M et al (2013) Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 37(2):240–258

    Article  PubMed  Google Scholar 

  7. Melnyk M, Casey RG, Black P, Koupparis AJ (2011) Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J 5(5):342–348

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lundberg KI, Treis D, Johnsen JI (2022) Neuroblastoma heterogeneity, plasticity, and emerging therapies. Curr Oncol Rep 24(8):1053–1062

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Whittle SB, Smith V, Doherty E, Zhao S, McCarty S, Zage PE (2017) Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther 17(4):369–386

    Article  CAS  PubMed  Google Scholar 

  10. Matthay KK, Maris JM, Schleiermacher G, Nakagawara A, Mackall CL, Diller L et al (2016) Neuroblastoma. Nat Rev Dis Prim 2:16078

    Article  PubMed  Google Scholar 

  11. Luksch R, Castellani MR, Collini P, De Bernardi B, Conte M, Gambini C et al (2016) Neuroblastoma (Peripheral neuroblastic tumours). Crit Rev Oncol Hematol 107:163–181

    Article  PubMed  Google Scholar 

  12. Brisse HJ, McCarville MB, Granata C, Krug KB, Wootton-Gorges SL, Kanegawa K et al (2011) Guidelines for imaging and staging of neuroblastic tumors: consensus report from the international neuroblastoma risk group project. Radiology 261(1):243–257

    Article  PubMed  Google Scholar 

  13. Simon T, Hero B, Benz-Bohm G, von Schweinitz D, Berthold F (2008) Review of image defined risk factors in localized neuroblastoma patients: results of the GPOH NB97 trial. Pediatr Blood Cancer 50(5):965–969

    Article  PubMed  Google Scholar 

  14. Croteau N, Nuchtern J, LaQuaglia MP (2021) Management of neuroblastoma in pediatric patients. Surg Oncol Clin N Am 30(2):291–304

    Article  PubMed  Google Scholar 

  15. Ripollés-Melchor J, Abad-Motos A, Zorrilla-Vaca A (2022) Enhanced recovery after surgery (ERAS) in surgical oncology. Curr Oncol Rep 24(9):1177–1187

    Article  PubMed  Google Scholar 

  16. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. (2017) 126(3): 376–93

  17. Buettner M, Schummer W, Huettemann E, Schenke S, van Hout N, Sakka SG (2008) Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport. Br J Anaesth 101(2):194–199

    Article  CAS  PubMed  Google Scholar 

  18. Slater R, Cornelissen L, Fabrizi L, Patten D, Yoxen J, Worley A et al (2010) Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet (London, England) 376(9748):1225–1232

    Article  CAS  PubMed  Google Scholar 

  19. Crellin DJ, Harrison D, Santamaria N, Babl FE (2015) Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain 156(11):2132–2151

    Article  PubMed  Google Scholar 

  20. Reismann M, Dingemann J, Wolters M, Laupichler B, Suempelmann R, Ure BM (2009) Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children. Langenbecks Arch Surg 394(3):529–533

    Article  PubMed  Google Scholar 

  21. Kiely EM (1994) The surgical challenge of neuroblastoma. J Pediatr Surg 29(2):128–133

    Article  CAS  PubMed  Google Scholar 

  22. Kiely E (2007) A technique for excision of abdominal and pelvic neuroblastomas. Ann R Coll Surg Engl 89(4):342–348

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wells SJ, Austin M, Gottumukkala V, Kruse B, Mayon L, Kapoor R et al (2021) Development of an enhanced recovery program in pediatric, adolescent, and young adult surgical oncology patients. Children (Basel, Switzerland). https://doi.org/10.3390/children8121154

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A (2017) Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs 26(9–10):1172–1188

    Article  PubMed  Google Scholar 

  25. Short HL, Taylor N, Thakore M, Piper K, Baxter K, Heiss KF et al (2018) A survey of pediatric surgeons’ practices with enhanced recovery after children’s surgery. J Pediatr Surg 53(3):418–430

    Article  PubMed  Google Scholar 

  26. Warmann SW, Seitz G, Fuchs J (2012) Surgical complications in pediatric surgical oncology. Pediatr Blood Cancer 59(2):398–404

    Article  PubMed  Google Scholar 

  27. Jawahar K, Scarisbrick AA (2009) Parental perceptions in pediatric cardiac fast-track surgery. AORN J 89(4):725–731

    Article  PubMed  Google Scholar 

  28. Bayne CE, Cardona-Grau D (2018) Featuring: prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. J Pediatr Urol 14(2):192–193

    Article  PubMed  Google Scholar 

  29. Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR et al (2005) Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 95(5):634–642

    Article  CAS  PubMed  Google Scholar 

  30. Parikh RP, Sharma K, Guffey R, Myckatyn TM (2016) Preoperative paravertebral block improves postoperative pain control and reduces hospital length of stay in patients undergoing autologous breast reconstruction after mastectomy for breast cancer. Ann Surg Oncol 23(13):4262–4269

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brustia R, Monsel A, Skurzak S, Schiffer E, Carrier FM, Patrono D et al (2022) Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (ERAS) recommendations. Transplantation 106(3):552–561

    Article  PubMed  Google Scholar 

  32. Ali Abdelhamid Y, Chapman MJ, Deane AM (2016) Peri-operative nutrition. Anaesthesia 71(Suppl 1):9–18

    Article  PubMed  Google Scholar 

  33. Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M et al (2014) Consensus guidelines for enhanced recovery after gastrectomy: enhanced recovery after surgery (ERAS®) society recommendations. Br J Surg 101(10):1209–1229

    Article  CAS  PubMed  Google Scholar 

  34. Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007(3):cd004929

    PubMed  PubMed Central  Google Scholar 

  35. Batchelor TJP, Ljungqvist O (2019) A surgical perspective of ERAS guidelines in thoracic surgery. Curr Opin Anaesthesiol 32(1):17–22

    Article  PubMed  Google Scholar 

  36. Vukovic N, Dinic L (2018) Enhanced recovery after surgery protocols in major urologic surgery. Front Med 5:93

    Article  Google Scholar 

  37. Shen C, Che G (2020) No drains in thoracic surgery with ERAS program. J Cardiothorac Surg 15(1):112

    Article  PubMed  PubMed Central  Google Scholar 

  38. Takeda Y, Mise Y, Kishi Y, Sugo H, Kyoden Y, Hasegawa K et al (2022) Enteral versus parental nutrition after pancreaticoduodenectomy under enhanced recovery after surgery protocol: study protocol for a multicenter, open-label randomized controlled trial (ENE-PAN trial). Trials 23(1):917

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152(3):292–298

    Article  PubMed  Google Scholar 

  40. Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg (Chicago, Ill : 1960) 146(5):571–577

    Article  Google Scholar 

  41. Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ et al (2013) Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg 100(8):1015–1024

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding source supported our work.

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Author notes

  1. Kai Zhu, Jingjing He, and Tiantuo Chen contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China

    Kai Zhu

  2. Department of Pediatric Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China

    Kai Zhu, Tiantuo Chen, Xiyang Yu, Xiaorui He & Yilin Su

  3. Reproductive Medicine Center, Anhui Province Maternity and Child Health Hospital, Hefei, 230001, Anhui, China

    Jingjing He

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  1. Kai Zhu
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Contributions

KZ and YS conceived the project. KZ, JH and YS designed protocols and wrote the manuscript. KZ, TC and XY performed the medical record statistics. KZ, JH and XH interpreted the data. All authors read and approved the final manuscript. YS authorized the final version to be published.

Corresponding author

Correspondence to Yilin Su.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards. The Ethics Boards of the First Affiliated Hospital of USTC approved this study and written informed consent to participate in this research was provided by the participants’ legal guardians.

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Zhu, K., He, J., Chen, T. et al. Retroperitoneal localized neuroblastoma in children: a comparison of enhanced recovery after surgery versus traditional care. Pediatr Surg Int 39, 208 (2023). https://doi.org/10.1007/s00383-023-05493-z

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