Abstract
The role of surgery varies greatly according to the clinical condition of the patients with neuroblastoma. A surgical resection is the mainstay of treatment for a localized tumor. However, in the era of intense chemotherapy associated with hematopoietic stem cell plant rescue, surgical resections are recommended without sacrificing the kidney or major vessels. Tumor biology further defines the necessity of supportive chemotherapy or radiation after surgical resection. The presence of diverse terminology concerning the range of resection may impose some confusion in the understanding of the previous papers. Therefore, the definition of a surgical resection was initially stated. In high-risk patients, the advantages of surgery for a patient’s survival seem to be limited. This article reviews the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma. The results of surgical resections are summarized according to the International Neuroblastoma Staging System. Finally, the long-term results regarding the strategy-related survival of the patients in the Niigata tumor board are briefly introduced.
Similar content being viewed by others
References
Fritsch P, Kerbl R, Lackner H, Urban C. “Wait and see” strategy in localized neuroblastoma in infants: an option not only for cases detected by mass screening. Pediatr Blood Cancer 2004;43:679–682.
Brodeur GM, Seeger RC, Barrett A, Castleberry RP, D’Angio G, De Bernardi B, et al. International criteria for diagnosis, staging, and response to treatment in patients with neuroblastoma. J Clin Oncol 1998;6:1874–1881.
Cecchetto G, Mosseri V, De Bernardi B, Helardot P, Monclair T, Costa E, et al. Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group. J Clin Oncol 2005;23:8483–8489.
Simon T, Hero B, Benz-Bohm G, von Schweinitz D, Berthold F. Review of image defined risk factors in localized neuroblastoma patients: Results of the GPOH NB97 trial. Pediatr Blood Cancer 2008;50:965–969.
McGregor LM, Rao BN, Davidoff AM, Billups CA, Hongeng S, Santana VM, et al. The impact of early resection of primary neuroblastoma on the survival of children older than 1 year of age with stage 4 disease: the St. Jude Children’s Research Hospital Experience. Cancer 2005;104:2837–2846.
Castel V, Tovar JA, Costa E, Cuadros J, Ruiz A, Rollan V, et al. The role of surgery in stage IV neuroblastoma. J Pediatr Surg 2002;37:1574–1578.
Gutierrez JC, Fischer AC, Sola JE, Perez EA, Koniaris LG. Markedly improving survival of neuroblastoma: a 30-year analysis of 1,646 patients. Pediatr Surg Int 2007;23:637–646.
Davidoff AM, Corey BL, Hoffer FA, Santana VM, Furman WL, Shochat SJ. Radiographic assessment of resectability of locoregional disease in children with high-risk neuroblastoma during neoadjuvant chemotherapy. Pediatr Blood Cancer 2005;44:158–162.
La Quanglia MP, Kushner BH, Su W, Heller G, Kramer K, Abramson S, et al. The impact of gross total resection on local control and survival in high-risk neuroblastoma. J Pediatr Surg 2004;39:412–417.
von Allmen D, Grupp S, Diller L, Marcus K, Ecklund K, Meyer J, et al. Aggressive surgical therapy and radiotherapy for patients with high-risk neuroblastoma treated with rapid sequence tandem transplant. J Pediatr Surg 2005;40:936–941.
Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, et al. The international Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol 2009;27:298–303.
De Bernardi B, Mosseri V, Rubie H, Castel V, Foot A, Ladenstein R, et al. Treatment of localised resectable neuroblastoma. Results of the LNESG1 study by the SIOP Europe Neuroblastoma Group. Br J Cancer 2008;99:1027–1033.
Perez CA, Matthay KK, Atkinson JB, Seeger RC, Shimada H, Haase GM, et al. Biologic variables in the outcome of stages I and II neuroblastoma treated with surgery as primary therapy: a children’s cancer group study. J Clin Oncol 2000;18:18–26.
Powis MR, Imeson JD, Holmes SJ. The effect of complete excision on stage III neuroblastoma: a report of the European Neuroblastoma Study Group. J Pediatr Surg 1996;31:516–519.
Modak S, Kushner BH, Laquaglia MP, Kramer K, Cheung NK. Management and outcome of stage 3 neuroblastoma. Eur J Cancer 2009;45:90–98.
Haase GM, Atkinson JB, Stram DO, Lukens JN, Matthay KK. Surgical management and outcome of locoregional neuroblastoma: comparison of the Childrens Cancer Group and the international staging systems. J Pediatr Surg 1995;30:289–294.
Matthay KK, Villablanca JG, Seeger RC, Stram DO, Harris RE, Ramsay NK, et al. Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid. Children’s Cancer Group. N Engl J Med 1999;341:1165–1173.
La Quanglia MP, Kushner BH, Heller G, Bonilla MA, Lindsley KL, Cheung NK. Stage 4 neuroblastoma diagnosed at more than 1 year of age: gross total resection and clinical outcome. J Pediatr Surg 1994;29:1162–1165.
Kuroda T, Saeki M, Honna T, Masaki H, Tsunematsu Y. Clinical significance of intensive surgery with intraoperative radiation for advanced neuroblastoma: does it really make sense? J Pediatr Surg 2003;38:1735–1738.
Adkins ES, Sawin R, Gerbing RB, London WB, Matthay KK, Haase GM. Efficacy of complete resection for high-risk neuroblastoma: a Children’s Cancer Group study. J Pediatr Surg 2004;39:931–936.
Koh CC, Sheu JC, Liang DC, Chen SH, Liu HC. Complete surgical resection plus chemotherapy prolongs survival in children with stage 4 neuroblastoma. Pediatr Surg Int 2005;21:69–72.
von Schweinitz D, Hero B, Berthold F. The impact of surgical radicality on outcome in childhood neuroblastoma. Eur J Pediatr Surg 2002;12:402–409.
Kiely EM. Radical surgery for abdominal neuroblastoma. Semin Surg Oncol 1993;9:489–492.
Kaneko M, Ohkawa H, Iwanaka M. Is extensive surgery required for treatment of advanced neuroblastoma? J Pediatr Surg 1997;32:1616–1619.
Suita S. Stephen L. Gans overseas lecture. Mass screening for neuroblastoma in Japan: lessons learned and future directions. J Pediatr Surg 2002;37:949–954.
Barrette S, Bernstein ML, Leclerc JM, Champagne MA, Samson Y, Brossard J, et al. Treatment complications in children diagnosed with neuroblastoma during a screening program. J Clin Oncol 2006;24:1542–1545.
Matsumura M, Tsunoda A, Nishi T, Nishimura H, Sasaki Y. Spontaneous regression of neuroblastoma detected by mass screening. Lancet 1991;338(8764):447–448.
Yoneda A, Oue T, Imura K, Inoue M, Yagi K, Kawa K, et al. Observation of untreated patients with neuroblastoma detected by mass screening: A “wait and see” pilot study. Med Pediatr Oncol 20 2001;36:160–162
Masiakos PT, Gerstle JT, Cheang T, Viero S, Kim PC, Wales P. Is surgery necessary for incidentally discovered adrenal masses in children? J Pediatr Surg 2004;39:754–758.
Isaacs H Jr. Fetal and neonatal neuroblastoma: retrospective review of 271 cases. Fetal Pediatr Pathol 2007;26:177–184.
Hasse GM, O’Leary MC, Ramsay NK, Romansky SG, Stram DO, Seeger RC, et al. Aggressive surgery combined with intensive chemotherapy improves survival in poor-risk neuroblastoma. J Pediatr Surg 1991;26:1123–1124.
Kubota M, Yagi M, Kanada S, Okuyama N, Kinoshita Y, Yamazaki S, et al. Long-term follow-up status of patients with neuroblastoma after undergoing either aggressive surgery or chemotherapy — a single institutional study. J Pediatr Surg 2004;39:1328–1332.
Taguchi T. Current progress in neonatal surgery. Surg Today 2008;38:379–389.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kubota, M. The role of surgery in the treatment of neuroblastoma. Surg Today 40, 526–532 (2010). https://doi.org/10.1007/s00595-009-4092-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-009-4092-8