Abstract
Neuroblastoma is a malignant tumour affecting 10.5/1 million children annually. It
arises from sympathetic nervous system precursor cells and is most frequently found
in the adrenal gland and abdominal paravertebral ganglia. Diarrhoea as a presenting
symptom of neuroblastoma is uncommon and usually linked to vasoactive intestinal peptide
(VIP) tumour secretion. Even more rarely, postoperative diarrhoea may follow neuroblastoma
tumour resection. Published studies generally associate postoperative diarrhoea with
subadventitial tumour resection. These findings are however based on a handful of
reports. This systematic review therefore aims to analyse the true incidence of postoperative
diarrhoea and its morbid correlation with the extent/type of surgical resection. Pubmed/Embase
databases were searched according to PRISMA guidelines. Final analysis consisted of
16 studies: N = 779 patients. Postoperative diarrhoea was significantly more common
in all patients who underwent subadventitial resection compared to non subadventitial
resection, p < 0.001 (OR 25.9, 95% CI 9.3–72.4). 5-year survival rates were equivalent
in both groups. Preoperative diarrhoea was rarely reported in studies and always strongly
linked to elevated VIP secretion. In the majority of neuroblastoma patients, preoperative
diarrhoea ameliorated after gross tumour resection with elevated VIP normalized. The
operative technique of subadventitial neuroblastoma resection portends significant
risk(s) of post operative diarrhoea not seen in those patients undergoing other classical
methods of tumour resection with 5-year survival rates strikingly similar. These findings
affirm that subadventitial tumour resection should be avoided when undertaking surgery
for neuroblastoma to minimize the risk(s) of persistent postoperative diarrhoea.
Keywords
Abbreviations:
VIP (vasoactive intestinal peptide)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 10, 2023
Accepted:
April 27,
2023
Received in revised form:
February 25,
2023
Received:
December 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
