Vascular Encasement Image Defined Risk Factors Predict Surgical Complications in Neuroblastoma

Background Specific Image Defined Risk Factors (IDRF) may be of more relevance to the pediatric surgical oncologist than simply the presence of any IDRF. The aim of this study was to correlate IDRF with surgical complications with reference to vascular encasement IDRF and the grade of complication. Methods We searched the New Zealand Children’s Cancer Registry for all cases of neuroblastoma treated at a single pediatric oncology center between January 2007 – February 2021 and reviewed the pre-treatment axial imaging for IDRF status. Surgical complications were scored by Clavien-Dindo grade and correlated with the number of IDRF and with the subset of vascular encasement IDRF. Results Of 101 patients, 77 were IDRF positive. In total, 74 underwent surgical resection and 32 (43.2%) had a surgical complication. Complications were related to the number of IDRF (OR 1.33, 95% CI 1.05 – 1.73, p = 0.02) and the subgroup of vascular encasement IDRF (OR 1.78, 95% CI 1.12 – 3.04, p = 0.01) but were not significantly correlated with the subgroup of non-vascular encasement IDRF. We report three cases of chyle leak associated with tumor encasing the origin of the celiac axis and/or the superior mesenteric artery. Conclusions The vascular encasement IDRF subgroup is potentially a more useful prognostic indicator of surgical complications than non-vascular IDRF. More studies are needed to correlate specific IDRF with specific surgical complications to aid operative decision making. Level of evidence Level III Highlights Image Defined Risk Factors (IDRF) in neuroblastoma correlate with survival, completeness of resection, and surgical complications. Complications correlate specifically with the subset of vascular encasement IDRF. Chylous ascites was a specific complication associated with encasement of the celiac and superior mesenteric vessels.