Peripheral Neurogenic Tumors - Surgical Therapy Of Neuroblastoma - Survey And Personal Experiences

From January 1, 1982 to November 1, 1992 24 patients suffering from neuroblastoma were operated in the course of a neuroblastoma study at the Department of Surgery, Cologne University. 23 patients were in advanced stages 3, 4 and 4s. In 13 cases the initial operation was prior to applying chemotherapy, whereas in 10 cases chemotherapeutical treatment had taken place before. As a result of preoperative chemotherapy operation time and blood loss could be reduced, respectively, and despite delayed operative treatment a better demarcation of the tumor and an easier preparation were seen.Due to the preoperative treament, tumors could be operated on more radically without increasing the rate of complications. Utilizing all possible surgical means, secondary and tertiary operative procedures and chemotherapeutical treatment. all patients in stage 2, 3 and 4s survived with safe remission. Nine of the fifteen patients in stage 4 died due to side effects from bown marrow transplantation or from recurrent neuroblastomas and not because of the surgical procedures.In the light of existing current multicenter neuroblastoma studies stage oriented surgical and chemotherapeutical concepts were developed, that are presented in this paper.