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

All right, we're going to go on to uh, the next paper from IPO, uh, Dr. Sabine Ertan, uh, and only MIG post-operative, uh, MIG positive post surgery residues impact on outcomes in patients with stage four neuroblastoma, results from the HRNL1 Syap and trial. Thanks for the opportunity to present this work, entitled Only MIG positive post surgery residues impact on outcomes in patients with stage for neuroblastoma, results from the Iris neuroblastoma one Syap and trial. Patients with Iris neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. The role of surgery in this context remains controversial. In his paper published in GCO in 2020, Keithworm started that complete macroscopic excision of the primary tumor improved both overall and even free survival in a cohort of 1,531 patients with stage four neuroblastoma. The success of the intervention and judgment on the post-operative residue was based on the operative report. No systematic radiological assessment of residue has been performed so far. The aim of the study was to evaluate the role of post surgical radiologically identified tumor residues in children between 0 and 18 years with a Iris neuroblastoma ENSS stage 4, treated according to the Iris neuroblastoma one Syap and protocol, who had surgery of the primary tumor and available images at diagnosis pre-operative and post-operative assessment. We 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 90 5%, and the tumor origin was the adrenal gland in 81%. The post-operative imaging was performed at a median of 62 days after surgery and was mainly CT scan or MRI. The residue was present in half of the patients. The median volume of the residue was 0.27 ml. The residue was in 28 patients a micro calcification. If we exclude these patients, the median residue volume was 1.04 ml, and only 11% of the patients had a residue of more than 5 ml. The residue was linked to the presence of IDRF in 71% of patients, and the MIG positivity of the residue was present in 70.5% of patients with a post-operative MIG available. We show no impact of the radiological post-operative residue on EFS and OS. But we had an impact on the MIG positive residue on EFS and OS with a difference of more than 20% of survival. Patients who had a MIG residue at 25 and 27% of five years EFS, whereas patients with no residue of no MIG residue had 51% of five year EFS, and this difference was still true for the five year OS. We did an external validation of this result on the entire Iris neuroblastoma cohort in patient with stage 4 neuroblastoma, who had a surgery and a post-surgical MIG evaluation available, and we confirm this result. Especially the patient had a complete response of the metastasis, but this difference between patients with MIG positive residue and patients with no residue or no MIG positive residue was still present for patients with a partial or a minimal response with a 10% survival difference. To conclude, half of the patients operated on expert have a tumor residue objectively identified on post-operative images of less than 1 ml. The residue was MIG evident around 20% of patients. Radiological detected post-operative tumor residues impact outcomes, only if active disease was demonstrated through post-operative MIG scanning, which could have an impact on future radio therapy strategies. We confirm that complete rection should be maintained as a major surgical goal. However, metastatic response is an important prognostic co-factor. Thank you for that presentation. Great paper. Um it continues this long discussion about how important is surgical resection in neuroblastoma. I like this paper because it confirms my bias that it's important. Um but uh when we looked at this with COG data, we looked at the operative reports compared to the imaging and found that there was zero correlation between what the surgeons said they resected and what was actually present on post-operative imaging. Uh did you actually make that comparison for this study? I think it would be uh it would be interesting to know. Yeah, yeah, we did that. Thank you very much for the question because it's it's an important question. And we we show that for the patients uh for whom the surgeon said I left nothing, uh for almost half of the patients had still something on the uh post-operative images. And for those patients uh uh the surgeon said I left something, we we found something in two-thirds of the patients and not in one third and one third of the patient are no uh residue on the on the images. So I completely agree that between what the surgeon said and what the radiologist says, there's discrepancy that uh can impact also uh the the question of should we let a residue or not? Perfect. Um, well, thank you so much for this uh presentation. Thank you for I I failed to mention uh that you're joining us from uh Sorbonne University in Trousseau Hospital in Paris, France. So thank you for for joining us from there. Great presentation.