Renal atrophy following removal of a neuroblastoma

With the increased survival of neuroblastoma patients, there have been several reports of acute renal failure, atrophy, or disappearance of the unresected kidney after tumor resection in relation to the surgical procedures employed. Between February 1987 and February 1993, we experienced three cases of renal atrophy or disappearance folowing neuroblastoma removal that were unrelated to chemotherapy or irradiation. Two of them were caused by renal infarction due to disturbed renal blood flow during and after the surgery. Traction on the renal artery may cause renal artery spasm and endothelial damage, which may lead to stagnation of renal blood flow and finally to renal artery thrombosis. To prevent the occurrence of this complication, the renal artery should be handled gently to avoid traction, with no tape placed around it during excision of the tumor and para-aortic lymph nodes. The third case was caused by ureteric obstruction due to fibrosis around the silver clip placed at surgery. This complication may obviously be prevented by not using such clips.