PILOT VERSION OF SCORING SYSTEM FOR LAPAROSCOPIC SURGERY OF ABDOMINAL NEUROBLASTOMA IN CHILDREN

Abstract

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or

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儿童腹部神经母细胞瘤腹腔镜手术评分系统的试点版本

本研究的目的是考虑IDRF、肿瘤大小等影响手术结果的标准，制定儿童腹部定位神经源性肿瘤腹腔镜手术干预的风险、难度和复杂性评估量表。材料与方法:2018年1月- 4月，124例0 ~ 18岁(中位年龄20.5[5-50.5]个月)行腹腔镜下腹腔定位神经源性肿瘤手术的患者(男孩68例(55%)/女孩56例(45%))。2022例纳入单中心回顾性队列研究。分析了手术干预复杂性的24项标准与手术结果的参数评价(手术干预时间;术中出血量;术中输血;术中并发症和通路转换)。定量变量采用Spearman等级相关系数，定性变量采用eta系数。采用聚类分析方法根据难度等级来分配分数。采用高复杂程度敏感性和特异性的ROC曲线分析来检验复杂程度。结果:手术干预的中位时间为105 [75];150] min，术中出血量- 5 [5];15例(12%)需要输血，输血中位数为0 [0];4例(3%)出现术中并发症。4例(3%)患者进行了转换。选取10项复杂性标准:IDRF F1、F2、F3、F4、F5、肿瘤中心位置、中线外延伸、既往开放手术、肿瘤与下腔静脉接触、肿瘤体积(ml)/高度(m)比>或者</= 28。已经开发了一个具有三个难度等级的试点难度量表。高度复杂性(6分或以上)的敏感性为60% (95% CI 23.1-88.2%)，特异性为98.3% (95% CI 94.1-99.5%)。结论:不同的IDRFs对腹腔镜手术的复杂性和风险有不同的影响。与肿瘤的绝对大小相比，肿瘤大小与生长的比值是判断复杂性更重要的标准。复杂性的其他标准也起着重要的作用，例如以前的开放手术和肿瘤定位。作者不推荐该量表用于临床，因为本研究获得的结果将为进一步的前瞻性研究奠定基础，旨在制定更准确的腹部定位神经源性肿瘤腹腔镜手术复杂性量表。

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