[Surgical management in advanced cases of sympathoma]

In advanced stages of neuroblastoma, surgical management is limitedly indicated. In majority of cases (25/26 in own material) surgical procedures were performed for the sake of receiving samples for pathological examination. Surgical treatment was very rarely indicated. The only one case of neuroblastoma in stage IV that was indicated to surgical treatment after complete remission of metastases, the child died in spite of radical excision of the primary tumour. The reason of that was new metastases in distant lymphonodes which appeared when complex therapy was finished. A little larger indications for surgery exist in stage IV-S of neuroblastoma, which gives better prognosis than stage IV. Anyhow indications for surgery in stages IV and IV-S have to be given very cautiously. Histopathological evaluation can be done on the basis of fine needle biopsy, that is much safer for the children.