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BEYOND IMAGE DEFINED RISK FACTORS (idrfS): A Delphi survey Highlighting definition of the Surgical Complexity Index (SCI) in Neuroblastoma
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  • Stefano Avanzini,
  • Patrizia Dall'Igna,
  • Bjornland K,
  • Sarah Braungart,
  • Kate Cross,
  • Paula Flores,
  • Hany Gabra,
  • Gomez-Chacon J,
  • Sabine Irtan,
  • Pablo Lobos,
  • Amos Loh,
  • Matthyssens LE,
  • Martin Metzelder,
  • Stefano Parodi,
  • Pio L,
  • Cees van de Ven,
  • Joerg Fuchs,
  • Paul Losty,
  • Sabine Sarnacki
Stefano Avanzini
Istituto Giannina Gaslini

Corresponding Author:[email protected]

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Patrizia Dall'Igna
Azienda Ospedaliera Di Venere e Giovanni XXIII
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Bjornland K
Oslo Universitetssykehus
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Sarah Braungart
Leeds Teaching Hospitals NHS Trust
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Kate Cross
Great Ormond Street Hospital For Children NHS Trust Cardiothoracic Surgery Unit
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Paula Flores
Hospital Britanico de Buenos Aires
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Hany Gabra
Newcastle University
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Gomez-Chacon J
Hospital Universitari i Politecnic La Fe
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Sabine Irtan
Hopital Armand-Trousseau Chirurgie orthopedique
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Pablo Lobos
Hospital Italiano de Buenos Aires
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Amos Loh
KK Women's and Children's Hospital Medical Library
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Matthyssens LE
Universitair Ziekenhuis Gent Plastische Heelkunde
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Martin Metzelder
University of Vienna Polymer and Composites Engineering Group
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Stefano Parodi
Istituto Giannina Gaslini
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Pio L
Istituto Giannina Gaslini
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Cees van de Ven
Prinses Maxima Centrum voor Kinderoncologie
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Joerg Fuchs
Universitatsklinikum Tubingen Medizinbibliothek Tubingen
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Paul Losty
University of Liverpool School of Life Sciences
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Sabine Sarnacki
Hopital universitaire Necker-Enfants malades
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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.