Potential Complications of Neuroblastoma Surgery
Surgery is a cornerstone of treatment for neuroblastoma, a cancer that most often affects young children. The primary goal of an operation is to physically remove the tumor. However, this is a complex task, and the decision to operate is made carefully by a multidisciplinary team of experts, including surgeons, oncologists, and radiologists.
Using advanced imaging like CT and MRI scans, the team maps the tumor’s exact location and its relationship to vital structures. For large or challenging tumors, chemotherapy may be given before surgery (neoadjuvant therapy) to shrink the tumor, making it safer to remove. Despite this careful planning, all surgery carries risks, and families should be aware of the potential complications associated with neuroblastoma resection.
Intraoperative Complications: Risks During Surgery
The most immediate risks are those that occur in the operating room as the surgeon works to remove the tumor. The nature of neuroblastoma, particularly its tendency to grow around critical body parts, creates significant challenges.
Major Bleeding (Hemorrhage)
Neuroblastoma tumors frequently develop near the body's largest blood vessels, such as the aorta and vena cava. These tumors can wrap around, or encase, these vessels, making it extremely difficult to separate them. Any attempt to dissect the tumor away from a major artery or vein carries a risk of causing a tear, which can lead to life-threatening bleeding. Surgical teams are always prepared for this possibility but preventing it is a top priority.
Damage to Adjacent Organs
A neuroblastoma is not always a self-contained mass; it can be invasive, growing into or becoming firmly stuck to nearby organs. For example, a tumor originating in the adrenal gland may adhere to the top of the kidney or the spleen. In these situations, separating the tumor without causing damage can be impossible. Surgeons must weigh the benefit of removing all cancer against the risk of injuring an organ, which could lead to long-term problems like reduced kidney function.
Incomplete Tumor Resection
The goal of surgery is to remove 100% of the visible tumor. However, achieving this is not always possible or safe. If a tumor is wrapped around essential nerves or blood vessels, aggressively removing every last piece could cause permanent paralysis or catastrophic bleeding. In these cases, the surgeon may make the difficult but necessary decision to leave a small amount of residual tumor behind. This is done to protect the child from severe, life-altering harm, with the understanding that the remaining cancer cells will be targeted by other treatments like chemotherapy or radiation.
Postoperative Neurologic Complications
Because neuroblastomas often arise from nerve tissue and grow near the spinal cord and other major nerves, neurologic complications are a significant concern. These issues can arise from the surgery itself and may become apparent in the days and weeks following the procedure.
Direct Nerve Injury
During the operation, surgeons must meticulously work to peel the tumor away from delicate nerves. Nerves controlling arm and hand movement (brachial plexus), diaphragm function (phrenic nerve), or voice and swallowing (vagus nerve) can be at risk. Despite the use of nerve-monitoring technology and extreme care, these nerves can be stretched, bruised, or cut. This can result in:
- Temporary or permanent weakness or paralysis in a limb.
- Difficulty breathing if the phrenic nerve is affected.
- Hoarseness or swallowing problems.
Spinal Cord Complications
Some neuroblastomas grow from the chest or abdomen directly into the spinal canal, a condition known as intraspinal extension. These tumors can compress the spinal cord, and surgery to remove this portion is exceptionally delicate. An injury to the spinal cord during surgery is a serious risk and could lead to lasting consequences, including:
- Loss of motor control or sensation below the level of the injury.
- Problems with bladder and bowel function.
Anesthesia-Related Complications
Anesthesia is essential for keeping a child safe and pain-free during surgery, but the methods used to manage pain can carry their own specific neurologic risks.
Risks from Epidural Analgesia
For major chest or abdominal surgeries, an epidural catheter is often placed to deliver pain medication near the spinal cord. While highly effective, this procedure has a small but serious risk of complications. These can include bleeding that creates pressure on spinal nerves, infection, or an accidental puncture of the spinal cord's protective layer. Though rare, these events can cause nerve damage, leading to weakness or sensation changes.
Local Anesthetic Systemic Toxicity (LAST)
Regional nerve blocks, where an anesthetic is injected to numb a specific part of the body, are another common pain management tool. If the medication is accidentally injected into a blood vessel or too much is absorbed, it can cause a rare but serious condition called LAST. Early signs are neurologic and include dizziness, ringing in the ears, and numbness around the mouth, which can progress to seizures if not treated immediately.
Other Potential Postoperative Issues
Beyond the immediate and neurologic risks, children recovering from neuroblastoma surgery can face other common postoperative complications.
Surgical Site Infection
As with any major surgery, there is a risk of infection at the incision site on the skin. There is also a risk of a deeper infection developing inside the chest or abdominal cavity where the tumor was removed. These infections are typically treated with antibiotics but can sometimes require additional procedures to resolve.
Bowel Complications
For abdominal surgeries, the bowels can be slow to "wake up" afterward, a temporary condition known as postoperative ileus. This can cause abdominal bloating and vomiting and may require the child to be fed intravenously until normal bowel function returns. Over the long term, scar tissue (adhesions) can form inside the abdomen, which can sometimes lead to future bowel obstructions.
Chyle Leak
If the surgery takes place in the chest or upper abdomen, a major lymphatic vessel called the thoracic duct can be injured. This can cause a chyle leak, where lymphatic fluid accumulates in the chest or abdomen. This complication often requires placing a drainage tube and putting the child on a special low-fat diet to allow the duct to heal.
