Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025

Patients with high-risk neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.

The role of surgery in high-risk neuroblastoma remains controversial.

The study included 283 patients (108 females, 175 males) who had a diagnosis at a median age of 35 months.

The primary tumor site was the abdomen in 95% of patients.

The tumor origin was the adrenal gland in 81% of patients.

The postoperative imaging was performed at a median of 62 days after surgery and was mainly a CT scan or MRI.

Residue was present in half of the patients on post-operative imaging.

The median volume of the residue was 0.27 mL.

The residue was a microcalcification in 28 patients.

Excluding patients with microcalcifications, the median residue volume was 1.04 mL, and only 11% of patients had a residue of more than 5 mL.

The residue was linked to the presence of IDRF in 71% of patients.

MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available.

There was no impact of the radiological postoperative residue on event-free survival and overall survival.

MIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival.

Patients 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.

External 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.

The 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.

Half of the patients operated on in expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL.

The residue was MIBG-positive in around 20% of patients.

Radiologically 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.

Complete resection should be maintained as a major surgical goal.

Metastatic response is an important prognostic cofactor in stage 4 neuroblastoma.

In COG data, there was zero correlation between what the surgeon said they resected and what was actually present on post-operative imaging.

For patients for whom the surgeon said they left nothing, almost half of the patients had still something on the postoperative images.

For 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.