Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector94210.17816/psaic942Original Study ArticlesОригинальные исследованияResearch ArticleDiarrhea as a postoperative complication of surgically treated retroperitoneal neurogenic tumors in childrenПослеоперационная диарея как осложнение хирургического лечения детей с нейрогенными опухолями забрюшинной локализацииhttps://orcid.org/0000-0001-5150-14367229-4555TverdovIvan V.ТвердовИван Вадимович
Russian Federation

2nd year resident, Department of Oncology and Pediatric Surgery

Ординатор 2-го года, отделение онкологии и детской хирургии

twerdov.iwan@yandex.ruhttps://orcid.org/0000-0002-1387-209X7714-9343AkhaladzeDmitry G.АхаладзеДмитрий Гурамович
Russian Federation

MD, Cand. Sci.(Med.), Head of the Department of Thoracoabdominal Surgery, Department of oncology and pediatric surgery

Кандидат медицинских наук, руководитель отдела торакоабдоминальной хирургии, отделение онкологии и детской хирургии

d.g.akhaladze@gmail.comhttps://orcid.org/0000-0002-3704-87839878-5540KachanovDenis Y.КачановДенис Юрьевич
Russian Federation

Dr. Sci. (Med.), Head of the Department of Clinical Oncology, Deputy Director

Доктор медицинских наук, заведующий отделением клинической онкологии, заместитель директора

Denis.Kachanov@fccho-moscow.ruhttps://orcid.org/0000-0003-0404-6420MerkulovNikolay N.МеркуловНиколай Николаевич
Russian Federation

Physician, pediatric surgeon of the Department of Oncology and Pediatric Surgery

Врач, детский хирург отделения онкологии и детской хирургии

nikolay.merkulov@fccho-moscow.ruhttps://orcid.org/0000-0001-9424-1646UskovaNatalia G.УсковаНаталья Геннадьевна
Russian Federation

MD, Cand. Sci.(Med.), doctor

Кандидат медицинских наук, врач, детский хирург отделения онкологии и детской хирургии

nataliyauskova@gmail.comhttps://orcid.org/0000-0002-5691-2522RabaevGavriil S.РабаевГавриил Савельевич
Russian Federation

Doctor, pediatric surgeon

Врач, детский хирург отделения онкологии и детской хирургии

rabaevgesha@gmail.comhttps://orcid.org/0000-0002-4451-3233GrachevNikolay S.ГрачевНиколай Сергеевич
Russian Federation

Dr. Sci. (Med.), Deputy General Director

Доктор медицинских наук, заместитель генерального директора, отделение онкологии и детской хирургии

nick-grachev@yandex.ruDmitry Rogachev National Medical Research Center of Pediatric HematologyНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия РогачёваDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of HealthНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия Рогачёва070720211121211302203202113052021Copyright ©; 2021, Tverdov I.V., Akhaladze D.G., Kachanov D.Y., Merkulov N.N., Uskova N.G., Rabaev G.S., Grachev N.S.Copyright ©; 2021, Твердов И.В., Ахаладзе Д.Г., Качанов Д.Ю., Меркулов Н.Н., Ускова Н.Г., Рабаев Г.С., Грачев Н.С.2021Tverdov I.V., Akhaladze D.G., Kachanov D.Y., Merkulov N.N., Uskova N.G., Rabaev G.S., Grachev N.S.Твердов И.В., Ахаладзе Д.Г., Качанов Д.Ю., Меркулов Н.Н., Ускова Н.Г., Рабаев Г.С., Грачев Н.С.https://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/942

BACKGROUND: Diarrhea as a result of skeletonization of the superior mesenteric artery (SMA) and celiac trunk after retroperitoneal lymph node dissection is a common complication in adult patients with malignant neoplasms of the pancreas, colon, and retroperitoneal tumors. The reports mentioning this complication in the treatment of neurogenic tumors in children are scarce.

AIM: This study aims to improve the surgical treatment results of locally advanced retroperitoneal neuroblastomas by studying which factors influence the development of prolonged postoperative diarrhea.

MATERIALS AND METHODS: An analysis of the treatment results in patients with locally advanced neurogenic retroperitoneal neoplasms at the Dmitry Rogachev national medical research center of pediatric hematology, oncology, and immunology from 2018 to 2020 was conducted. All patients from this cohort underwent SMA and celiac trunk dissection.

RESULTS: During this period, surgeries with dissection of the SMA and celiac trunk were performed in 29 patients. In four (13%) cases, prolonged diarrhea was noted (median duration, 136.5 days with a frequency of up to 13 times a day). Assessment of the dependence of diarrhea frequency on complete dissection or preservation of the tumor component in the SMA and celiac trunk showed no significant differences.

CONCLUSIONS: The complete removal of a neurogenic tumor improves prognosis in patients with a locally advanced form of the disease, but it is associated with the risk of long-term intractable complications. This study does not confirm the opinion that preservation of the tumor component on the SMA prevents its denervation and postoperative diarrhea.

Введение. Диарея в результате скелетизации верхней брыжеечной артерии и чревного ствола при забрюшинной лимфаденэктомии — распространенное осложнение у взрослых пациентов, страдающих новообразованиями поджелудочной железы, ободочной кишки и внеорганными забрюшинными опухолями. Диарея может осложнять течение послеоперационного периода у детей с нейрогенными опухолями, однако информация о данном состоянии в литературе встречается редко.

Цель — улучшение результатов хирургического лечения при местнораспространенных нейробластомах забрюшинной локализации за счет изучения факторов, влияющих на развитие длительной послеоперационной диареи.

Материалы и методы. Проведен анализ результатов лечения пациентов с местнораспространенными нейрогенными опухолями забрюшинного пространства в НМИЦ ДГОИ им. Д. Рогачева с 2018 по 2020 гг. Всем пациентам из данной выборки в ходе хирургического вмешательства выполнялась скелетизация верхней брыжеечной артерии и чревного ствола.

Результаты. В исследование включены 29 пациентов. В 4 (13 %) случаях отмечено развитие длительной диареи (медиана длительности 136,5 суток с частотой до 13 раз в день). При оценке зависимости частоты диареи от полной скелетизации или сохранения компонента опухоли на верхней брыжеечной артерии и чревном стволе значимых различий не получено.

Выводы. Полное удаление нейрогенной опухоли, улучшающее прогноз пациента при местнораспространенной форме заболевания, связано с риском длительных некупируемых осложнений. В данном исследовании не удалось подтвердить тезис о превентивной роли сохранения мягкотканного компонента на верхней брыжеечной артерии с целью предотвращения послеоперационной диареи.

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