title: Late complications after surgery in patients with neuroblastoma.
abstract: OBJECTIVE
  The purpose of this study was 2-fold: to study the complications of neuroblastoma treatment and to establish surgical guidelines.
  
  
  METHODS
  The medical records of 92 patients with neuroblastoma (stage 1 or 2, n = 33; stage 3, n = 21; stage 4, n = 31; stage 4S, n = 7) who had undergone surgery in our department between 1985 and 2001 were reviewed, with an emphasis on treatments and late complications.
  
  
  RESULTS
  The disease-free survival rate was 98.3% (58/59) in infantile patients, whereas it was 36.4% (12/33) in advanced patients older than 1 year. The rate was improved up to greater than 50% after the introduction of intensive local therapy with intraoperative radiation (IOR). The treatment-associated morbidity rate was 15.0% in nonadvanced infantile patients, was 42.1% in advanced infantile patients, and was 33.3% in advanced older patients. In the advanced cases, renovascular problems were most frequently seen especially after IOR. Furthermore, pulmonary problems, cardiac problems, and second cancer were highlighted as fatal problems; thyroid dysfunction, vertebral deformity, and growth retardation were also noted.
  
  
  CONCLUSIONS
  Higher incidences of late morbidity and treatment-associated mortality appeared to be more strongly related to disease stage rather than to patient age. Appropriate surgery and IOR with lower doses should be recommended as a surgical strategy for high-risk patients.
authors.affiliation: Department of Surgery, National Center for Child Health and Development, Tokyo 157-8535, Japan. kuroda-t@ncchd.go.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kuroda
authors.forename: Morihiro
authors.initials: M
authors.lastname: Saeki
authors.forename: Toshiro
authors.initials: T
authors.lastname: Honna
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kumagai
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Masaki
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009423:Nervous System Neoplasms / Q000601:surgery* / Q000628:therapy; D009447:Neuroblastoma / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis