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Surgical Risk Factors in Primary Surgery for Localized Neuroblastoma: The LNESG1 Study of the European International Society of Pediatric Oncology Neuroblastoma Group

From the Department of Pediatrics, Division of Pediatric Surgery, University of Padova; Departments of Pediatric Hematology-Oncology and Surgery, and Service of Diagnostic Radiology, Giannina Gaslini Children's Hospital, Genova, Italy; Department of Pediatric Oncology, and Services of Statistics and Diagnostic Imaging, Institut Curie, and Department of Pediatric Surgery, Armand Trousseau Children's Hospital, Paris, France; Department of Surgery, The National Hospital, Rikshospitalet, Oslo, Norway; Department of Pediatric Surgery, Hospital La Fe, Valencia, Spain; Department of Surgery, Division of Child Surgery, University Hospital, Vienna, Austria; and Department of Pediatric Surgery, St Georges Hospital, London, United Kingdom

Address reprint requests to Bruno De Bernardi, MD, Department of Hematology-Oncology, Giannina Gaslini Children's Hospital, Largo Gerolamo Gaslini 5, 16148, Genova, Italy; e-mail: brunodebernardi{at}ospedale-gaslini.ge.it

PURPOSE: Although tumor resection is the mainstay of treatment for localized neuroblastoma, there are no established guidelines indicating which patients should be operated on immediately and which should undergo surgery after tumor reduction with chemotherapy. In an effort to develop such guidelines, the LNESG1 study defined surgical risk factors (SRFs) based on the imaging characteristics.

PATIENTS AND METHODS: A total of 905 patients with suspected localized neuroblastoma were registered by 10 European countries between January 1995 and October 1999; 811 of 905 patients were eligible for this analysis.

RESULTS: Information on SRFs was obtained for 719 of 811 patients; 367 without and 352 with SRFs. Of these 719 patients, 201 patients (four without and 197 with SRFs) underwent biopsy only. An attempt at tumor excision was made in 518 patients: 363 of 367 patients without and 155 of 352 patients with SRFs (98.9% v 44.0%). Complete excision was achieved in 271 of 363 patients without and in 72 of 155 patients with SRF (74.6% v 46.4%), near-complete excision was achieved in 81 and 61 patients (22.3% v 39.3%), and incomplete excision was achieved in 11 and 22 patients (3.0% v 14.2%), respectively. There were two surgery-related deaths. Nonfatal surgery-related complications occurred in 45 of 518 patients (8.7%) and were less frequent in patients without SRFs (5.0% v 17.4%). Associated surgical procedures were also less frequent in patients without SRFs (1.6% v 9.7%).

CONCLUSION: The adoption of SRFs as predictors of adverse surgical outcome was validated because their presence was associated with lower complete resection rate and greater risk of surgery-related complications. Additional studies aiming to better define the surgical approach to localized neuroblastoma are warranted.

Supported by the Italian Neuroblastoma Association.

Presented in part at the Advances in Neuroblastoma Research 11th Conference, June 16-19, 2004, Genova, Italy.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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