gms | German Medical Science

Background: Although several studies have been conducted on the role of surgery in localized neuroblastoma, the impact of surgical timing and extent of primary tumor resection on outcome remains controversial.

Materials and methods: Patients from the German prospective clinical trial NB97 with neuroblastoma stage 1-3 age >18 months till 18 years were included for retrospective analysis. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome.

Results: A total of 191 patients were included in this study. Before chemotherapy, complete resection (95-100%), gross total resection (90-95%), incomplete resection (50-90%), and biopsy or no surgery were performed in 44.5%, 7.3%, 7.3% and 41.0%, respectively. At this time, patients with complete resection or gross total resection had a better local progression-free survival (LPFS) and event-free survival (EFS) than patients with incomplete resection or biopsy. 5-year overall survival (OS) differed significantly (p .001) between biopsy group (70.8%) and resection of any extent (89.9%), but the extent of resection had no impact. Complication rate was 17.4%. Image defined risk factors (IDRF) predicted extent of resection. During treatment, 22.0% of patients underwent complete resection of the primary tumor, 11.5% underwent gross total resection, and 9.9% had incomplete surgery of the primary tumor. Surgery associated mortality rate was 0.7% and complication rate was 30.1%. Patients with complete resection had a significantly better LPFS and EFS than the other groups. After best possible operation, patients with complete resection had a 5-y-OS of 90.1%±0.27, followed by gross total resection (73.1%±0.77) and incomplete resection (64.6%±0.95).

Conclusion: In patients with localized neuroblastoma age 18 months or older at diagnosis, extended surgery of the primary tumor site has an impact on local control rate and outcome at the time of first and best operation with an acceptable complication risk.