The results of concentration of care: Surgical outcomes of neuroblastoma in the Netherlands |
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| Affiliation: | 1. Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25 3584, CS, Utrecht, the Netherlands;2. Pediatric Surgical Center Amsterdam, Amsterdam University Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands;3. Mathematical Institute, Leiden University, Niels Bohrweg 1, 2333, CA, Leiden, the Netherlands;4. Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands;5. Department of Pediatric Surgery, Sophia Children''s Hospital, Erasmus Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands;6. Division Imaging & Cancer, Academic Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands;7. Department of Pediatric Surgery, Beatrix Children''s Hospital, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands;8. Department of Pediatric Surgery, Wilhelmina Children''s Hospital, Lundlaan 6, 3584, EA, Utrecht, the Netherlands;9. Department of Pediatric Surgery, Amalia Children''s Hospital, Radboud Medical Center, Geert Grooteplein Zuid 32, 6525, GA, Nijmegen, the Netherlands |
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| Abstract: | Introduction.In the Netherlands pediatric oncological care for solid tumours is concentrated in one centre since November 2014. One of the most frequently diagnosed solid non-brain tumours in children is the neuroblastoma. Results of surgical treatment of neuroblastoma since the start of this centralization are presented and compared to a historic cohort.Methods.The new national cohort of neuroblastoma (n = 111) consists of all consecutive patients treated between January 1st, 2015 and April 1st, 2021. The historic neuroblastoma cohort consists of all operated neuroblastoma patients in the Netherlands between 1998 and 2014 (n = 244). Intra-operative complications and surgical outcome were registered. Post-operative complications were divided in short (<30 days after surgery) and long term (>30 days). The severity of complications was graded using the Clavien Dindo Classification (CDC) system.Results.Intraoperative outcomes showed significant differences in favour of the new cohort with less blood loss (p < 0.001), fewer vascular complications (p < 0.001) and shorter duration of surgery (p < 0.001). Short term complications were comparable in numbers, but significantly more patients had CDC grade 3/4/5 complications in the historic cohort (p = 0.005). Long term complications did not differ.Estimated overall survival showed a better survival in the new cohort (log rank 0.022).Conclusion.Centralization of care for neuroblastoma patients has led to a significant improvement of both intraoperative outcomes and short term complications. |
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| Keywords: | Pediatric oncology Neuroblastoma Concentration of care Surgery Complications |
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