Background: Thoracic neuroblastomas are generally less aggressive and have a better prognosis
than those arising below the diaphragm. Our purpose was to study the safety and efficacy of thoracoscopic
resection and to evaluate tumor data and patient outcomes.
Patients and Methods: We reviewed the records of patients who underwent primary thoracoscopic
resection of neuroblastoma (NB) between 1998 and 2002. Data included demographics, symptoms,
size, location, operative time, complications, hospital stay, histology, biologic markers, adjuvant therapy,
and outcome.
Results: Five patients (age range, 9 to 44 months) underwent thoracoscopic resection of NB. Three
of the patients had neurological symptoms. Tumor size ranged from 2.1 to 6.0 cm. Two tumors were
apical, three supradiaphragmatic. Primary thoracoscopic gross total resection was achieved in all 5
cases, all of which were stage 1. Operative time ranged from 64 to 175 minutes. The only complications
were two cases of small tumor spillage. Hospital stay was 1 to 4 days. Histology ranged from
ganglioneuroma to differentiating NB, with a favorable classification in 4 of 5 cases. None of the tumors
were N-Myc amplified. Chemotherapy or radiation therapy was not indicated for any patient.
All are alive with no evidence of disease at 14 to 55 months’ follow-up.
Conclusion: Primary gross total resection of mediastinal NB can be achieved safely and effectively
by a thoracoscopic approach. In our series, most tumors had favorable histology and biology, and
all appear to be potentially treatable by primary thoracoscopic resection alone.
