title: Neuroblastoma: a 20-year experience in a UK regional centre.
abstract: OBJECTIVE
  The role of surgery in the management of neuroblastoma yields conflicting reports. We report a 20-year experience from a UK centre in the context of evolving cancer therapies for neuroblastoma.
  
  
  METHODS
  Hospital records of 91 neuroblastoma patients from 1985 to 2005 were studied. Patient demographics, data from operating notes and tumour biology (MYCN status) where available were analysed.
  
  
  RESULTS
  Surgery consisted of primary resection or delayed operation following tumour biopsy/chemotherapy. Overall survival was 100% for stage 1(n = 3), 90% for stage 2 (n = 10), 46% for stage 3 (n = 13), 13% for stage 4 (n = 55) and 56% for stage 4S disease (n = 9). During the eras 1985-1994 versus 1995-2005, survival for stage 3 lesions was 25% and 80% (P = 0.04) with marginal increase in survival observed in stage 4 disease (12% vs. 22%, P = 0.083). Delayed tumour resection was not performed in 20 (36%) stage 4 patients due to progressive disease. Complete tumour resection was achieved in 62% of stage 3-4 patients during 1995-2005 compared to 38% in 1985-1994. The extent of surgical resection (complete vs. partial) showed no significant differences in overall survival or relapse rates. Postoperative morbidity occurred in 15.7% of cases emphasising technical challenges in resection of neuroblastoma. No child with MYCN amplification survived versus 59% survival in non-amplified cases (P = 0.012).
  
  
  CONCLUSIONS
  While complete tumour resection may be desirable in advanced neuroblastoma (stage 3-4) these findings suggest that the radicality of operation is not significantly associated with better overall survival/relapse. Improving outcomes in the 1995-2005 era for patients with stage 3-4 tumours complements the introduction of new high dose-intensive chemotherapy regimens and other adjuvant therapies for this enigmatic disease.
authors.affiliation: Academic Paediatric Surgery, Division of Child Health, University of Liverpool, Liverpool, UK.
authors.forename: Adeline
authors.initials: A
authors.lastname: Salim
authors.forename: Dhanya
authors.initials: D
authors.lastname: Mullassery
authors.forename: Barry
authors.initials: B
authors.lastname: Pizer
authors.forename: Heather P
authors.initials: HP
authors.lastname: McDowell
authors.forename: Paul D
authors.initials: PD
authors.lastname: Losty
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents