Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

Luca Pio, Stefano Avanzini, Girolamo Mattioli, Giuseppe Martucciello, Angela Rita Sementa, Massimo Conte, Annarita Gigliotti, Claudio Granata, Ernesto Leva, Anna Maria Fagnani, Umberto Caccioppoli, Nino Tedesco, Jurgen Schleef, Elisa Tirtei, Fortunato Siracusa, Paolo D'Angelo, Pierluigi Lelli Chiesa, Lucia Miglionico, Bruno Noccioli, Elisa SeveriClaudio Carlini, Francesco Vaccarella, Francesco Camoglio, Simone Cesaro, Alessandra Narciso, Giovanna Riccipetitoni, Giovanni Cecchetto, Alessandro Inserra

Research output: Contribution to journalArticle

Abstract

Background: Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. Methods: A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. Results: From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36. months (range 4-96. months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. Conclusion: Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. Level of evidence: IV.

Original languageEnglish
Pages (from-to)1633-1636
JournalJournal of Pediatric Surgery
Volume52
Issue number10
DOIs
Publication statusPublished - 2017

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Keywords

  • Hypertension
  • IDRFs
  • Neuroblastoma
  • Pediatric surgical oncology
  • Risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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