A Decade of Enhanced Recovery After Surgery (ERAS) After Resection of Abdominal Neuroblastoma

Purpose: To investigate the impact of Enhanced Recovery After Surgery (ERAS) protocols in children undergoing surgical resection for abdominal neuroblastoma. Methods: Medical records from children who underwent surgical resection of abdominal neuroblastoma at a single institution from January 2014 to November 2024 and treated using ERAS principles were reviewed for this retrospective study. Surgical characteristics and outcomes are reported. Results: Among 115 eligible children, the median age was 2.8 [1.4, 4.9] years. Most (71.3%) had stage M disease and received neoadjuvant chemotherapy (76.5%). Intraoperative opiates (0.4 [0.2, 0.6] morphine milli-equivalents (MME)/kg) and fluids (15.1 [10.7, 19.1] mL/kg/h) were minimized. Intraoperative complications occurred in 16 patients (13.9%). Nasogastric tubes were used in 8 (7%) with a median duration of 1 [1, 2] day. Epidural catheters were used in 12 (10.4%), ketorolac in 98 (85.2%), and acetaminophen in 99 (86.1%). Postoperative opiates were minimized (0.14 [0.03, 0.49] MME mg/kg/day). Postoperative complications occurred in 11 (9.6%). Time to regular diet was 1 [0, 2] day, return of bowel function 2 [1, 2] days, and ambulation 1 [1, 2] day. Length of stay was 3 [2, 4] days. Readmissions unrelated to chemotherapy occurred in 3 (2.6%) patients. Conclusions: ERAS protocols appear to be safe and have the potential to enhance recovery after resection of abdominal neuroblastoma.