The surgical challenge of neuroblastoma.

The first successful excision of a neuroblastoma took place in 1916. For many years there was no other form of treatment, and the outlook remained dismal. The use of radiotherapy (1928) and subsequently combination chemotherapy (1965) had a modest impact. More accurate staging has allowed a more coherent approach to diagnosis and treatment. Surgery has not been standardized to the same degree. A review of the author's experience with 129 patients over a 10-year period confirms that surgery is the mainstay of treatment for localized nonadvanced disease (stages I and II). Fourteen of 15 such patients are alive and disease-free. Combination chemotherapy may shrink advanced tumors (stages III and IV) and ablate metastases. Subsequent complete surgical excision does not improve survival. Approximately two thirds of those with stage III disease and one third of those with stage IV disease survive regardless of whether excision is complete. The present results do not support the value of complete surgical excision.