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

All right, we're gonna go on to uh the next paper from IPSO, uh, Doctor Sabine Utan, uh, and only MIBG postoperative. Uh, uh, MIG positive post-surgery residues impact on outcomes in patients with stage 4 neuroblastoma results from the HRNBL1 yapen trial. Thanks for the opportunity to present this work entitled Only a Mbei Positive Post-surger Residues Impact on Outcomes in Patients with Stage 4 neuroblastoma Results from the high-risk neuroblastoma 1 yopan trial. Patients with er 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, Kewarm stated that complete macroscopic excision of the primary tumor improved both overall and even free survival in a cohort of 1,531 patients with stage 4 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 the iris neuroblastoma ENSS stage 4 treated according to the iris neuroblastoma once I open protocol, who had surgery of the primary tumor and available images at diagnosis, preoperative, and postoperative 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 95. and the tumor origin was the adrenal gland in 81%. The postoperative imaging was performed at a median of 62 days after surgery and was mainly a 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 microcalcification. 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 MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available. 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. Patients who had a MBGO residue had 25 and 27% of 5 year EFS, whereas patients with no residue of no MBGO residue at 51% of 5-year EFS and this difference was still true for the 5-year OS. We did an external validation of this result on the entire high risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had a surgery and a post-surgical MIBG evaluation available, and we confirmed these results, especially the patient has a complete response of the metastasis. But this, uh, difference between patients with MIBG positive residue and patients with no residue or no MIBG positive residue. was still present for patients with a partial or minimal response with a 10% survival difference. To conclude, half of the patients operated on expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL. The residue was a MIBG on around 20% of patients. 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 confirmed that complete resection should be maintained as a major surgical goal. However, metastatic response is an important prognostic cofactor. 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 surgeon 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, it would be interesting to know. Yeah, yeah, we did that. Thank you very much for the question because it's an important question, and we showed that for the patients. For whom the surgeon said, I left nothing. Uh, almost half of the patients had still something on the postoperative images, and for those patients, the surgeon said, I left something, we found something in 2/3 of the patients and not in 1/3, and 1/3 of the patients and no residue on the on the images, so 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. 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.