The surgeon has a crucial role in the management of neuroblastoma. Initial diagnosis and assessment of MYCN amplification, histopathology, DNA index (ploidy), and other parameters are dependent on close collaboration between the surgical oncologist, pediatric oncologist, and pathologist. In particular, the surgeon must obtain an adequate tumor sample for both histopathology and molecular studies. During surgical resection of the primary tumor, efforts should be made to preserve normal organs, such as the kidney. Furthermore, the surgeon must evaluate the status of both ipsilateral and contralateral lymph nodes and accurately describe the extent of primary tumor resection to ensure accurate assignment of stage and risk status. Finally, supportive procedures, including institution of reliable vascular access and management of treatment-related complications like typhlitis, bowel obstructions, and others are important in the surgical management of neuroblastoma patients. This chapter describes the role of surgical intervention in the management of this heterogeneous and challenging tumor.

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