The impact of gross total resection on survival in children with stage III/IV neuroblastoma--study of clinical efficacy in 21 cases.

OBJECTIVES: A retrospective study was conducted in 21 children with stage III/IV retroperitoneal neuroblastoma to evaluate the outcome of gross total tumor resection using vascular skeletonization. PATIENTS AND METHODS: Between 2003 and 2008, 22 patients with stage III/IV neuroblastoma were included in this study. The treatment was initiated with four to six cycles of induction chemotherapy using the most recent Children's Oncology Group (COG) regimen to reduce the size of the tumors. This was followed by a primary gross total resection by skeletonising the blood vasculature. Gross total resection was accomplished in 21 patients who also received subsequent chemotherapy and bone marrow transplant. Routine follow-ups were performed by phone calls or letters to acquire information about postoperative recovery, distant metastasis or recurrence at the primary site, mortality and cause of death. RESULTS: Twenty-one patients received gross total resection with complete resection rate of 95.45%. Neither severe postoperative complications nor perioperative death occurred. Three patients were excluded due to a loss in follow-up. Tumor-free survival reached 55.56% (n=10). Three tumor-bearing patients (16.67%) survived. Five patients (27.78%) died after surgery. Overall five-year survival reached 72.22% (13/18). CONCLUSIONS: Using the skeletonizing major vasculature of retroperitoneum approach to achieve delayed total gross resection for advanced neuroblastoma, significantly improved postoperative survival.