Kidney-preserving radical tumor resection in advanced neuroblastoma.

The possibility of kidney-preserving radical tumor resection in advanced neuroblastoma was evaluated. Eighteen patients with stage III and IV adrenal neuroblastoma underwent delayed primary surgery after chemotherapy consisting of high doses of cyclophosphamide (1,250 mg/m2). Radical tumor resection with nephrectomy was performed in 13 patients (group A) and kidney-preserving radical tumor resection was performed in six patients (group B). Macroscopic findings were evaluated in all patients; angiographic and microscopic findings were evaluated in group A patients and tumor recurrence in group B patients. Macroscopically, the tumors were observed within the tumor capsule (C1) in five, outside the tumor capsule but not beyond the midline (C2) in seven, and beyond the midline (C3) in six. In group A, under microscopic examination, the tumor invasion into the renal parenchyma was observed in only three patients among C2 and C3 cases. Tumor vessels from the capsular and/or perforating arteries plus from the intrarenal arteries could be visualized in all patients, three of whom had tumor invasion into the renal parenchyma. In group B, no tumor recurrence around the kidney occurred, and two patients have survived for greater than 2 years. The kidney-preserving radical tumor resection is recommended in surgical treatment of advanced neuroblastoma following preoperative chemotherapy, and is predictable preoperatively by angiography.