Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP).

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP).
Retrospective multicenter survey of patients with Neuroblastoma and hypertension from the Italian Registry of Neuroblastoma who underwent surgical resection between 2006 and 2014.
Hypertension (HT) defined as BP higher than 99th percentile + 5mm Hg. Of 1126 patients with NB, only 25 patients had HT (2.2%). Of 25 patients with HT and NB, 21 patients underwent surgical resection and were included in the analysis
Median age 15 months, Stage 1 (24%), Stage 2 (43%), Stage 4 (34%), MYCN amplification neg. in 95%, VMA/HVA – 57% normal. 89% of normal BP patients had elevated VMA/HVA versus 43% of HT patients. Norepinephrine only analyzed in 3 high BP patients – all elevated. Renal pedicle involvement – 38%. Renal size – normal in all patients. No evidence of cardiac HT-related complications on preop echo analysis. 86% received an antihypertensive treatment (various agents). Intraoperative HT peaks treated predominantly with alpha1 blockers (5 patients). 6 patients had persistent HTN despite complete tumor resection in 4.
Small number of patients, No analysis of renal artery stenosis, renal flow etc. so while no evidence of renal parenchymal size change, incomplete analysis. Heterogenous treatment of HT preoperatively means no definite therapeutic protocol can be recommended.
Given limited number of patients, this retrospective review doesn't add markedly to the literature, however, the incidence of postresection HT and the risk factors for same (renal pedicle involvement) might be helpful for prognostication.