Radical excision of primary tumor and lymph nodes in advanced neuroblastoma: combination with intensive induction chemotherapy

The role of surgery in the management of children with advanced neuroblastoma is still unclear; no radical surgical technique for resection of primary tumor and lymph nodes has been established. A radical procedure was developed and has been employed in 13 patients over 1 year of age with stage III or IV disease since 1985, together with intensive induction chemotherapy. For abdominal neuroblastoma, the area of retroperitoneal lymph node dissection was divided into six sections: to the left of the abdominal aorta, between the aorta and vena cava, and to the right of the vena cava, with further subdivision according to the level of the renal vein. After excision of the primary tumor, lymph node dissection was carried out systematically in all six sections; gross complete resection was possible in 12 of the 13 patients. All 12 patients attained complete remission at least once in the course of treatment, and 7 underwent autologous bone marrow transplantation. It is noteworthy that local control of the disease was satisfactory in all but 1 patient who had extensive involvement of both renal hila and showed recurrence in the remaining kidney. Eight patients are alive with an average follow-up of 44 months; 7 of them show no signs of disease. After reviewing the results of our previous series and this series, it was concluded that advances in operative techniques and the introduction of intensive induction chemotherapy did increase surgical resectability, the rate of complete remission, and the number of candidates for bone marrow transplantation. Improvement of survival in patients with advanced neuroblastoma may thus be expected.