PERIPHERAL NEUROGENIC TUMORS - SURGICAL THERAPY OF NEUROBLASTOMA - SURVEY AND PERSONAL EXPERIENCES

From January 1, 1982 to November 1, 1992 24 patients suffering from ne uroblastoma were operated in the course of a neuroblastoma study at th e Department of Surgery, Cologne University. 23 patients were in advan ced stages 3, 4 and 4s. In 13 cases the initial operation was prior to applying chemotherapy, whereas in 10 cases chemotherapeutical treatme nt had taken place before. As a result of preoperative chemotherapy op eration time and blood loss could be reduced, respectively, and despit e delayed operative treatment a better demarcation of the tumor and an easier preparation were seen. Due to the preoperative treament, tumor s could be operated on more radically without increasing the rate of c omplications. Utilizing all possible surgical means, secondary and ter tiary operative procedures and chemotherapeutical treatment. all patie nts in stage 2, 3 and 4s survived with safe remission. Nine of the fif teen patients in stage 4 died due to side effects from bown marrow tra nsplantation or from recurrent neuroblastomas and not because of the s urgical procedures. In the light of existing current multicenter neuro blastoma studies stage oriented surgical and chemotherapeutical concep ts were developed, that are presented in this paper.