Review ArticleThe Role of Surgery in High-risk NeuroblastomaRyan, Anne L. MBBS*,†; Akinkuotu, Adesola MD‡; Pierro, Agostino MD‡; Morgenstern, Daniel A. MD, PhD*; Irwin, Meredith S. MD*Author Information *Department of Paediatrics, Division of Hematology/Oncology ‡Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada †Department of Paediatric Haematology and Oncology, Perth Children’s Hospital, Perth, Australia The authors declare no conflict of interest. Reprints: Meredith S. Irwin, MD, Division of Haematology/Oncology, Hospital for Sick, Children, 555 University Avenue, Toronto, ON, Canada M5G1X8 (e-mail: firstname.lastname@example.org). Received July 4, 2019 Accepted September 4, 2019 Online date: October 9, 2019 Journal of Pediatric Hematology/Oncology: January 2020 - Volume 42 - Issue 1 - p 1–7 doi: 10.1097/MPH.0000000000001607 Buy Metrics Abstract Although intensive multimodal treatment has improved outcomes for patients with high-risk neuroblastoma, the specific role of primary tumor resection remains controversial. Many studies have been designed to determine whether the extent of surgical resection impacts survival; however, these reports have demonstrated conflicting results. There is also ongoing debate regarding the timing of primary tumor resection, with subtle differences in the approach between the large pediatric oncology cooperative consortia. Most of the published literature to date has been approached from a surgical viewpoint. Although most evidence supports surgery as part of the local control approach for high-risk neuroblastoma, recommendations for timing and extent of surgical resection are not consistent. This review summarizes our current understanding from the perspectives of both the pediatric oncologist and pediatric surgeons and discusses how the objectives of neuroblastoma primary surgical resection are different from that of other malignancies. Furthermore, this commentary will address how retrospective surgical outcome data may be interpreted in the setting of modern era high-risk neuroblastoma treatment. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.