EMBR-05. THE TENTATIVE APPLICATION OF EN BLOC CONCEPT IN THE PEDIATRIC BRAIN TUMOR: EXPERIENCE FROM A LARGE PEDIATRIC CENTER IN CHINA

Abstract

Abstract Background The less allowable blood loss and tolerance of intraoperative blood loss of children lead to the high rate of massive blood transfusion in the treatment of brain tumor. The surgical concepts of en bloc resection may contribute to the improvement of brain tumor resection. Objective To investigate the effects of en bloc concept on short outcomes of pediatric brain tumors and factors associated with the application of en bloc concept. Methods According to the surgical concept involved, the patients were divided into three subgroups-complete en bloc concept, partial en bloc concept and piecemeal concept. The matching-comparison (piecemeal group and en bloc group formed from the first two subgroups) was conducted based on age, tumor location, lesion volume, and pathological diagnosis to investigate effect of the en bloc concept on the short-term outcomes. Then the patient data after January 2018, when the en bloc concept was routinely integrated into brain tumor surgery in our medical center, were reviewed and analyzed to find out the predictors associated with the application of en bloc concept. Results In the en bloc group, the perioperative outcomes, including hospital stay (p=0.001), PICU stay (p=0.003), total blood loss(p=0.015), transfusion rate(p=0.005) and complication rate(p=0.039), were all significantly improved. The multinomial logistic regression analysis showed that tumor volume and imaging features, like bottom vessel, encasing nerve or pass-by vessel, finger-like attachment, ratio of “limited line” and ratio of “clear line” remained independent factors for the application of en bloc concept in our medical center. Conclusion This study supports the application of complete or partial en bloc concept in the pediatric brain tumor surgery referring to the preoperative imaging features, and compared with piecemeal concept, en bloc concept can improve the short outcomes without significant increases in neurological complication. Large series and Additional supportive evidence are still warranted.