Evolution of robotic-assisted resection of pediatric neuroblastic tumors: a retrospective analysis.
In a retrospective cohort of 44 children undergoing robotic resection of neuroblastic tumors, complete resection was reported in all patients, conversion occurred in 22.7%, two early grade IIIb complications occurred, and higher IDRF score was associated with conversion.
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In a retrospective cohort of 44 children undergoing robotic resection of neuroblastic tumors, complete resection was reported in all patients, conversion occurred in 22.7%, two early grade IIIb complications occurred, and higher IDRF score was associated with conversion.
Research significance
The study provides preliminary clinical evidence that IDRF score is associated with conversion during robotic resection; it is reasonable—but not established—to hypothesize that prospective IDRF-based selection could improve surgical planning and reduce conversion or residual-tumor risk in appropriately selected children.
Source abstract
Due to rarity and variability in pediatric tumors presentation, robotic oncologic surgery remains a challenging field. This study analyses clinical features that can impact outcomes of robotic excision of neuroblastic tumors (pNBTs) in children. Retrospective cohort of children who underwent robotic resection of pNBTs between 2020 and 2025. Exclusion criteria: biopsy only, follow-up ≤ 6 months. Forty-four children included, 24 girls (54.5%), 68.1% neuroblastoma, 18.1% ganglioneuroblastoma intermixed, 13.6% ganglioneuroma. Abdominal tumors were described in 33 (75%). At surgery 61.3% had a IDRFpositive status. Median age was 36 months (IQR 17-63) with a median weight of 12 kg (IQR 9.6-22). Median operative time was 170 min (IQR 130-210). Ten (22.7%) conversions occurred, with a single urgent de-docking. No incomplete resection was recorded. Median hospitalization was 3 days (IQR 2-5). Two (4.5%) early post-operative complications: two incisional eventration (IIIb Clavien-Dindo). There was no statistical difference in conversion and complications rates between patients ≤ 10 kg (31.8%) and children > 10 kg. Risk factor analysis showed higher conversion rate in children with higher IDRF score (p = 0.032). Uneventful oncological follow-up. Robotic surgery seems a safe option for pNBTs resection in carefully selected children. This study suggests IDRF score might be helpful in selecting patients for robotic approach, to limit the chances of minimal residual tumor and/or conversion. The robotic approach should be performed by surgeons with extensive experience in robotic surgery and a strong expertise of oncological principles.