Martin Dübbers1, Thorsten Simon2, Frank Berthold3, Janina Fischer4, Ruth Volland5, Barbara Hero6, Grigore Cernaianu7. 1. Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: martin.duebbers@uk-koeln.de. 2. Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: thorsten.simon@uk-koeln.de. 3. Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: frank.berthold@uk-koeln.de. 4. Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: janina.fischer@uk-koeln.de. 5. Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: ruth.volland@uk-koeln.de. 6. Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: barbara.hero@uk-koeln.de. 7. Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany. Electronic address: grigorec@hotmail.com.
Abstract
BACKGROUND/ PURPOSE: The impact of abdominal topography and surgical technique on resectability and local relapse pattern of relapsed abdominal high-risk neuroblastoma (R-HR-NB) is not clearly defined. METHODS: A sample of thirty-nine patients with R-HR-NB enrolled in the German neuroblastoma trials between 2001 and 2010 was analyzed retrospectively using surgical and imaging reports. We evaluated resectability and local relapse pattern within 6 standardized abdominal regions, impact of extent of the first resective surgery on overall survival (OS), and of number of operations and a higher cumulative surgical assessment score (C-SAS) on OS after the first event. RESULTS: In the left upper abdomen, rates for tumor persistence and relapse were 45.9% and 13.5% and in the left lower abdomen 27.7% and 8.3%, respectively. OS in months did not differ between complete and incomplete first resections (median (interquartile range): 35 (45.6) vs. 40 (65.4), P=.649). Better OS after the first event was associated with repeated as compared to single surgery (47.7 (64.7) vs. 4.3 (12.5), P=.000), and with higher as compared to lower C-SAS (47.7 (64.3) vs. 7.6 (14.7), P=.002). CONCLUSIONS: OS after relapse/progression was not dependent on the extent of first resection. The number of operations was associated with better outcome after event. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: LEVEL III Retrospective comparative study.
BACKGROUND/ PURPOSE: The impact of abdominal topography and surgical technique on resectability and local relapse pattern of relapsed abdominal high-risk neuroblastoma (R-HR-NB) is not clearly defined. METHODS: A sample of thirty-nine patients with R-HR-NB enrolled in the German neuroblastoma trials between 2001 and 2010 was analyzed retrospectively using surgical and imaging reports. We evaluated resectability and local relapse pattern within 6 standardized abdominal regions, impact of extent of the first resective surgery on overall survival (OS), and of number of operations and a higher cumulative surgical assessment score (C-SAS) on OS after the first event. RESULTS: In the left upper abdomen, rates for tumor persistence and relapse were 45.9% and 13.5% and in the left lower abdomen 27.7% and 8.3%, respectively. OS in months did not differ between complete and incomplete first resections (median (interquartile range): 35 (45.6) vs. 40 (65.4), P=.649). Better OS after the first event was associated with repeated as compared to single surgery (47.7 (64.7) vs. 4.3 (12.5), P=.000), and with higher as compared to lower C-SAS (47.7 (64.3) vs. 7.6 (14.7), P=.002). CONCLUSIONS: OS after relapse/progression was not dependent on the extent of first resection. The number of operations was associated with better outcome after event. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: LEVEL III Retrospective comparative study.