BEYOND IMAGE DEFINED RISK FACTORS (idrfS): A Delphi survey Highlighting
definition of the Surgical Complexity Index (SCI) in Neuroblastoma
Abstract
BACKGROUND Preoperative evaluation of Image Defined Risk Factors (IDRFs)
in neuroblastoma (NB) is crucial for determining suitability for upfront
resection or tumor biopsy. IDRFs are linked with a higher potential
morbidity at operation and lessen the chance of complete tumor
resection. The IDRFs do not all carry the same weight in predicting
tumor complexity and surgical risk. In this study we aimed to assess and
categorize the degrees of surgical complexity (Surgical Complexity
Index, SCI) in NB resection. PROCEDURE A panel of 15 surgeons was
involved in an electronic Delphi consensus survey to identify and score
a set of shared items predictive and/or indicative of surgical
complexity, including the number of preoperative IDRFs. Risk categories
included - (a) Standard risk; (b) Moderate risk; (c) High risk; (d) Very
high risk. A shared agreement included the achievement of at least 75%
consensus focused on a single category or, alternatively, on the sum
between the prevailing category and an immediately closest one. RESULTS
After 3 Delphi rounds, agreement was established on 25/27 items
(92.6%). A severity score was established for each item ranging from 0
to 3 with an overall SCI range varying from a minimum score of zero to a
maximum score of 29 points for any given patient. CONCLUSIONS A
consensus on a SCI to stratify the risks related to tumor resection was
established by the panel experts. This index will now be deployed to
critically assign a better severity score to IDRFs involved in NB
surgery.