The impact of preoperative chemotherapy on resectability of primary tumour and complication rate in metastatic neuroblastoma.

231 children with metastatic neuroblastoma prospectively followed up in three clinical trials underwent first look surgery at diagnosis or delayed first look operation after application of chemotherapy and partly second look surgery and were evaluated for resectability and complication rate. More than 85% of the primary tumours were located within the abdomen. The incidence of macroscopically complete removal increased from 30% to 60% after preoperative chemotherapy (p less than 0.001). There was no difference between the efficacy of delayed first look and second look surgery and between children with stage IV and stage IV S neuroblastoma. The mean complication rate was 20% (complication per patient) and 23% (complication per operation). Complications included local problems (7.9%), infections (5.9%), organ dysfunctions (8.3%) and rare other complications (1.3%). No significant difference was found between the three surgical modalities, i.e. preoperative chemotherapy did neither increase the complication rate nor change the complication pattern. The biological meaning of primary tumour control is still unclear. However, a 40% local recurrence rate suggests an aggressive surgical attitude. Our study provides a basis that preoperative chemotherapy may be an effective tool to achieve complete removal of initially non-resectable primary tumours without increasing the complication rate.