Radiological detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies.
We showed no impact of the radiological postoperative residue on EFS and OS. But we had an impact on the MIBG positive residue on EFS and OS with a difference of more than 20% of survival.
I completely agree that Between what the surgeon said and what the radiologist says, there's a discrepancy that uh can impact also uh the, the question of should we let a residue or not.
Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025
▶Ep 3 · 0:40
quotePatients with er neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.↗
▶Ep 3 · 0:40
clinicalPatients with high-risk neuroblastoma require chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.↗
▶Ep 3 · 0:48
opinionThe role of surgery in high-risk neuroblastoma remains controversial.↗
▶Ep 3 · 0:48
quoteThe role of surgery in this context remains controversial.↗
▶Ep 3 · 0:52
clinicalKewarm's 2020 JCO paper stated that complete macroscopic excision of the primary tumor improved both overall and event-free survival in 1,531 patients with stage 4 neuroblastoma.↗
▶Ep 3 · 1:08
clinicalKewarm's study based success of intervention and judgment on post-operative residue on the operative report, with no systematic radiological assessment.↗
▶Ep 3 · 1:14
quoteNo systematic radiological assessment of residue has been performed so far.↗
▶Ep 3 · 1:48
epidemiologicalThe study included 283 patients (108 females, 175 males) diagnosed at a median age of 35 months.↗
▶Ep 3 · 1:57
epidemiologicalThe primary tumor site was the abdomen in 95% of patients.↗
▶Ep 3 · 2:02
epidemiologicalThe tumor origin was the adrenal gland in 81% of patients.↗
▶Ep 3 · 2:06
clinicalPost-operative imaging was performed at a median of 62 days after surgery and was mainly CT scan or MRI.↗
▶Ep 3 · 2:17
epidemiologicalResidue was present in half of the patients.↗
▶Ep 3 · 2:20
epidemiologicalThe median volume of the residue was 0.27 mL.↗
▶Ep 3 · 2:25
clinicalIn 28 patients the residue was a microcalcification.↗
▶Ep 3 · 2:29
epidemiologicalExcluding patients with microcalcifications, the median residue volume was 1.04 mL.↗
▶Ep 3 · 2:29
epidemiologicalOnly 11% of patients had a residue of more than 5 mL.↗
▶Ep 3 · 2:40
epidemiologicalMIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available.↗
▶Ep 3 · 2:40
epidemiologicalThe residue was linked to the presence of IDRF in 71% of patients.↗
▶Ep 3 · 2:58
clinicalRadiological post-operative residue showed no impact on event-free survival and overall survival.↗
▶Ep 3 · 2:58
quoteWe showed no impact of the radiological postoperative residue on EFS and OS. But we had an impact on the MIBG positive residue on EFS and OS with a difference of more than 20% of survival.↗
▶Ep 3 · 3:08
clinicalMIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival.↗
▶Ep 3 · 3:20
epidemiologicalPatients with MIBG-positive residue had 25% and 27% five-year event-free survival.↗
▶Ep 3 · 3:20
epidemiologicalPatients with no residue or no MIBG-positive residue had 51% five-year event-free survival.↗
▶Ep 3 · 3:20
clinicalThe survival difference between MIBG-positive and MIBG-negative residue groups was confirmed for five-year overall survival.↗
▶Ep 3 · 3:45
clinicalExternal validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results.↗
▶Ep 3 · 4:04
clinicalThe survival difference between MIBG-positive residue and no/MIBG-negative residue was present even for patients with partial or minimal metastatic response, with a 10% survival difference.↗
▶Ep 3 · 4:26
epidemiologicalHalf of patients operated on in expert centers have a tumor residue objectively identified on post-operative images of less than 1 mL.↗
▶Ep 3 · 4:36
epidemiologicalThe residue was MIBG-positive in around 20% of patients.↗
▶Ep 3 · 4:40
clinicalRadiologically detected post-operative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning.↗
▶Ep 3 · 4:40
quoteRadiological detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies.↗
▶Ep 3 · 4:54
quoteWe confirmed that complete resection should be maintained as a major surgical goal. However, metastatic response is an important prognostic cofactor.↗
▶Ep 3 · 4:54
guidelineComplete resection should be maintained as a major surgical goal.↗
▶Ep 3 · 4:59
clinicalMetastatic response is an important prognostic cofactor.↗
▶Ep 3 · 5:43
clinicalFor patients where the surgeon reported leaving nothing, almost half had residue on post-operative images.↗
▶Ep 3 · 5:57
quoteBetween what the surgeon said and what the radiologist says, there's a discrepancy that uh can impact also uh the, the question of should we let a residue or not.↗
▶Ep 3 · 5:57
clinicalFor patients where the surgeon reported leaving residue, imaging found residue in two-thirds and no residue in one-third.↗
Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025
▶Ep 19 · 0:40
quotePatients with er neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.↗
▶Ep 19 · 0:40
clinicalPatients with high-risk neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.↗
▶Ep 19 · 0:48
opinionThe role of surgery in high-risk neuroblastoma remains controversial.↗
▶Ep 19 · 0:48
quoteThe role of surgery in this context remains controversial.↗
▶Ep 19 · 0:52
host_summaryKewarm stated in a 2020 GCO paper that complete macroscopic excision of the primary tumor improved both overall and event-free survival in a cohort of 1,531 patients with stage 4 neuroblastoma.↗
▶Ep 19 · 1:08
host_summaryIn Kewarm's study, the success of the intervention and judgment on the post-operative residue was based on the operative report with no systematic radiological assessment of residue performed.↗
▶Ep 19 · 1:48
epidemiologicalThe study included 283 patients (108 females, 175 males) who had a diagnosis at a median age of 35 months.↗
▶Ep 19 · 1:57
epidemiologicalThe primary tumor site was the abdomen in 95% of patients.↗
▶Ep 19 · 2:02
epidemiologicalThe tumor origin was the adrenal gland in 81% of patients.↗
▶Ep 19 · 2:06
clinicalThe postoperative imaging was performed at a median of 62 days after surgery and was mainly a CT scan or MRI.↗
▶Ep 19 · 2:17
epidemiologicalResidue was present in half of the patients on post-operative imaging.↗
▶Ep 19 · 2:20
epidemiologicalThe median volume of the residue was 0.27 mL.↗
▶Ep 19 · 2:25
epidemiologicalThe residue was a microcalcification in 28 patients.↗
▶Ep 19 · 2:29
epidemiologicalExcluding patients with microcalcifications, the median residue volume was 1.04 mL, and only 11% of patients had a residue of more than 5 mL.↗
▶Ep 19 · 2:40
epidemiologicalThe residue was linked to the presence of IDRF in 71% of patients.↗
▶Ep 19 · 2:40
epidemiologicalMIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available.↗
▶Ep 19 · 2:58
clinicalThere was no impact of the radiological postoperative residue on event-free survival and overall survival.↗
▶Ep 19 · 3:08
clinicalMIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival.↗
▶Ep 19 · 3:20
clinicalPatients who had an MIBG-positive residue had 25% and 27% five-year event-free survival, whereas patients with no residue or no MIBG-positive residue had 51% five-year event-free survival.↗
▶Ep 19 · 3:45
clinicalExternal validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results, especially in patients with complete response of the metastasis.↗
▶Ep 19 · 4:04
clinicalThe difference between patients with MIBG-positive residue and patients with no residue or no MIBG-positive residue was still present for patients with partial or minimal response with a 10% survival difference.↗
▶Ep 19 · 4:26
clinicalHalf of the patients operated on in expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL.↗
▶Ep 19 · 4:36
epidemiologicalThe residue was MIBG-positive in around 20% of patients.↗
▶Ep 19 · 4:40
clinicalRadiologically detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies.↗
▶Ep 19 · 4:54
guidelineComplete resection should be maintained as a major surgical goal.↗
▶Ep 19 · 4:59
clinicalMetastatic response is an important prognostic cofactor in stage 4 neuroblastoma.↗
▶Ep 19 · 5:43
clinicalFor patients for whom the surgeon said they left nothing, almost half of the patients had still something on the postoperative images.↗
▶Ep 19 · 5:57
clinicalFor patients for whom the surgeon said they left something, residue was found in two-thirds of patients and no residue was found in one-third of patients.↗
▶Ep 19 · 5:57
quoteI completely agree that Between what the surgeon said and what the radiologist says, there's a discrepancy that uh can impact also uh the, the question of should we let a residue or not.↗
