Minimally invasive surgery reduces intraoperative blood loss and accelerates postoperative recovery without compromising the completeness of tumor resection in children with neuroblastoma: a prospective cohort study

Liu Yinghao; Qin Lan; Zeng Miao; Zhang Mingying; Xu Hongxiang; Li Xiaoyu; Kong Xiangru; Zhao Zhenzhen; Li Yonggang; Deng Xiaobin; Zhang Jun

doi:10.16016/j.2097-0927.202603056

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Minimally invasive surgery reduces intraoperative blood loss and accelerates postoperative recovery without compromising the completeness of tumor resection in children with neuroblastoma: a prospective cohort study

Monographic Reports | 更新时间：2026-09-16

- Minimally invasive surgery reduces intraoperative blood loss and accelerates postoperative recovery without compromising the completeness of tumor resection in children with neuroblastoma: a prospective cohort study
- Journal of Army Medical University Vol. 48, Issue 17, Pages: 2397-2407(2026)
- 作者机构：
  
  1.重庆医科大学附属儿童医院，肿瘤外科，重庆
  2.重庆医科大学附属儿童医院，儿童少年健康与疾病国家临床医学研究中心，儿童发育疾病研究教育部重点实验室，重庆
  3.重庆医科大学附属儿童医院，儿童感染与免疫罕见病重庆市重点实验室，重庆
  4.重庆医科大学附属儿童医院，胸心外科，重庆
- 作者简介：
  
  Zhang Jun，E-mail：junzhang@hospital.cqmu.edu.cn
- 基金信息：
  
  the Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health Commission(2021MSXM298)
- DOI：10.16016/j.2097-0927.202603056
  CLC： R181.32;R730.56;R739.4
- Received：11 March 2026，
  
  Revised：2026-06-08，
  
  Accepted：14 June 2026，
  
  Published：15 September 2026
- 稿件说明：
移动端阅览
刘颖豪，秦岚，曾秒，等.微创手术可减少儿童神经母细胞瘤术中出血、加速术后恢复且未降低肿瘤切除完整性：一项前瞻性队列研究［J］.陆军军医大学学报，2026，48（17）：2397-2407.DOI：,10.16016/j.2097-0927.202603056.

Liu Y H，Qin L，Zeng M，,et al.Minimally invasive surgery reduces intraoperative blood loss and accelerates postoperative recovery without compromising the completeness of tumor resection in children with neuroblastoma： a prospective cohort study［J］.J Army Med Univ，2026，48（17）：2397-2407.DOI：,10.16016/j.2097-0927.202603056.
刘颖豪，秦岚，曾秒，等.微创手术可减少儿童神经母细胞瘤术中出血、加速术后恢复且未降低肿瘤切除完整性：一项前瞻性队列研究［J］.陆军军医大学学报，2026，48（17）：2397-2407.DOI：,10.16016/j.2097-0927.202603056. DOI：

Liu Y H，Qin L，Zeng M，,et al.Minimally invasive surgery reduces intraoperative blood loss and accelerates postoperative recovery without compromising the completeness of tumor resection in children with neuroblastoma： a prospective cohort study［J］.J Army Med Univ，2026，48（17）：2397-2407.DOI：,10.16016/j.2097-0927.202603056. DOI：

摘要

目的

神经母细胞瘤（neuroblastoma，NB）是儿童常见颅外恶性肿瘤，手术切除是其综合治疗的重要组成部分。微创手术（minimally invasive surgery，MIS）虽可减少围术期创伤，但其在儿童NB中的肿瘤切除完整性、围术期获益及远期肿瘤学安全性仍需进一步评价。本研究旨在比较MIS与开放手术（open surgery，OPEN）治疗儿童胸腹部NB的临床疗效及预后差异，为儿童NB手术方式选择提供依据。

方法

采用前瞻性队列研究设计，纳入2015年1月至2023年6月于重庆医科大学附属儿童医院肿瘤外科及胸心外科收治并接受手术治疗的胸腹部NB患儿289例。对于肿瘤体积较大或明显侵犯、包绕周围重要血管及脏器者优先选择OPEN，其余患儿按随机原则分配至MIS组或OPEN组。采用倾向性评分匹配方法，以1∶1比例按年龄、肿瘤最大径、肿瘤部位、术前国际神经母细胞瘤危险分组分期系统分期、病理类型及

MYCN

基因扩增状态等变量进行匹配。比较2组患儿的肿瘤部位、影像学定义危险因子（image-defined risk factors，IDRFs）类型、围术期指标、原发灶肿瘤全切率（gross total resection，GTR）、术中中转OPEN情况、术后并发症及无事件生存结局。生存分析采用Kaplan-Meier法，并采用60个月限制平均无事件生存（event-free survival，EFS）时间作为补充分析指标。

结果

倾向性评分匹配后共纳入70例患儿，其中MIS组35例，OPEN组35例。2组肿瘤部位分布一致，均为腹部27例、胸部8例。围术期结果显示，MIS组术中出血量少于OPEN组［5.0（5.0，15.0）

20.0（7.5，37.5）mL，

=0.006］；MIS组手术时间长于OPEN组［122.0（85.5，162.5）和88.0（71.0，110.0）min，

=0.008］；MIS组术后恢复进食时间短于OPEN组［1.0（1.0，1.0）

2.0（1.0，3.0）d，

0.001］。MIS组原发灶肉眼全切除率为94.3%，OPEN组为100.0%，差异无统计学意义。2组患儿术后1年EFS率均为100.0%；MIS组和OPEN组5年EFS率分别为93.1%和97.1%，差异无统计学意义。Kaplan-Meier分析显示，2组EFS差异无统计学意义（Log-rank

=0.536）。Cox回归分析显示，2组EFS结局差异无统计学意义（

=2.10，95%

：0.19~23.18，

=0.545）。MIS组和OPEN组60个月限制平均EFS时

间分别为58.16月和58.71月，差异无统计学意义。2组患儿的IDRFs类型包括肿瘤侵犯同侧肾蒂、压迫同侧主支气管、包绕重要血管，以及肿瘤同时累及胸腔、颈部或腹腔。

结论

经合理筛选后，MIS切除儿童胸腹部NB原发灶安全可行，可减少术中出血并促进术后恢复，且未明显降低肿瘤切除完整性。MIS适应证应结合风险分层、IDRFs类型、肿瘤大小、肿瘤部位及术者经验综合判断。

Abstract

Objective

Neuroblastoma (NB) is a common extracranial solid malignancy in children

and surgical resection is an important component of multimodal treatment. Although minimally invasive surgery (MIS) may reduce perioperative trauma

its effects on resection completeness

perioperative outcomes

and long-term oncological safety in pediatric NB require further evaluation. This study aims to compare the clinical efficacy and prognosis of MIS and open surgery (OPEN) for thoracoabdominal NB in children

and to provide evidence for surgical decision-making.

Methods

A prospective cohort study was conducted on 289 children with thoracoabdominal NB who underwent surgical resection in Department of Surgical Oncology and Department of Thoracic and Cardiovascular Surgery at Children’s Hospital of Chongqing Medical University between January 2015 and June 2023. OPEN was preferentially selected for patients with large tumors or tumors with obvious invasion or encasement of major vessels or adjacent organs; the remaining patients were randomly allocated to the MIS group or OPEN group. Propensity score matching (PSM) was performed at a 1∶1 ratio based on age

maximum tumor diameter

tumor location

preoperative International Neuroblastoma Risk Group Staging System (INRGSS) stage

histopathological type and

MYCN

amplification status. The 2 groups were compared with respect to tumor location

image-defined risk factors (IDRFs) type

perioperative parameters

gross total resection (GTR) rate of the primary tumor

intraoperative conversion to OPEN

postoperative complications

and event-free survival (EFS) outcomes. Survival analysis was performed using the Kaplan-Meier method

and 60-month restricted mean EFS time was used as a supplementary endpoint.

Results

After PSM

70 patients were included

with 35 patients in the MIS group and 35 in the OPEN group. The distribution of tumor locations was comparable between the 2 groups

with 27 abdominal and 8 thoracic cases in each. Perioperative outcomes showed that compared with the OPEN group

the MIS group had less intraoperative blood loss [5.0 (5.0

15.0)

20.0 (7.5

37.5) mL

=0.006

]

longer operative time [122.0 (85.5

162.5)

88.0 (71.0

110.0) min

=0.008

]

and shorter time to postoperative oral intake [1.0(1.0

1.0)

2.0 (1.0

3.0) d

0.001

]

. The GTR rate of the primary tumor was 94.3% in the MIS group and 100.0% in the OPEN group

with no statistically significant difference. The 1-year EFS rate was 100.0% in both groups

and the 5-year EFS rates were 93.1% in the MIS group and 97.1% in the OPEN group. Kaplan-Meier analysis showed no significant difference in EFS between the 2 groups (Log-rank

=0.536).Cox regression analysis also showed no statistically significant difference in EFS outcomes between groups (

=2.10

95%

: 0.19 to 23.18

=0.545). The 60-month restricted mean EFS time was 58.16 months in the MIS group and 58.71 months in the OPEN group

with no statistically significant difference. IDRFs types in both groups included involvement of the ipsilateral renal pedicle

compression of the ipsilateral main bronchus

encasement of major vessels

and simultaneous tumor involvement of the thoracic cavity and the cervical or abdominal region.

Conclusion

With appropriate patient selection

MIS for resection of the primary tumor is safe and feasible for children with thoracoabdominal NB. MIS may reduce intraoperative blood loss and facilitate postoperative recovery without substantially compromising resection completeness. The indications for MIS should be determined comprehensively according to risk stratification

IDRFs types

tumor size

tumor location

and surgeon experience.

关键词

Keywords

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