However, it has become increasingly clear that intensive multi-modality treatment is necessary for favorable outcomes in the advanced forms of the disease, which generally affect about half the children. Since accurate disease staging is essential for planning appropriate treatment a multinational multidisciplinary forum developed the International Neuroblastoma Staging System in 1993. Surgical expertise was important in implementing this system from the standpoint of initial diagnosis, operative therapy, assessment of response, and detection of recurrent disease. Children with low risk disease and many with intermediate risk situations may be cured with surgery and local tumor control techniques alone. Nevertheless, children may develop resistant or recurrent disease and require innovative therapeutic approaches such as intraoperative radiation therapy or radioactive targeted treatment for local tumor control combined with new systemic biologic therapies such as cytokines, immunotherapy, differentiating agents, and viral therapies.
Surgery plays a key role in the management of neuroblastoma.
Initial complete tumor resection may cure localized disease with minimal complications in experienced hands. Often preoperative chemotherapy may shrink the tumor and simplify its excision. Surgical planning and execution become far more critical in those patients with advanced metastatic disease, which has resisted initial treatment or has recurred. The crucial issues of timing of operation, extent of resection, relationship to chemotherapy and utilization of innovative operative techniques are carefully assessed and undertaken in surgeons experienced in treating this tumor. The surgery of neuroblastoma.