Concentration of surgery has improved operations for childhood cancer

Neuroblastoma is a tumor of the sympathetic nervous system that occurs mainly in young children. Every year, 25 children in the Netherlands receive this diagnosis. Surgery to remove the tumor tissue forms an important part of the treatment plan. Since November 2014, care for children in the Netherlands with a solid tumor, including neuroblastoma, has been concentrated in one national research hospital, the Princess Máxima Center for pediatric oncology in Utrecht.

To investigate the effect of concentrating surgery for children with neuroblastoma, researchers from the Princess Máxima Center looked at the medical records of 244 children who had undergone surgery in the five former pediatric oncology centers in the Netherlands between 1998 and 2014. They compared this data with that of the 111 children whose surgery was performed in the Princess Máxima Center between 2014 and 2021. The research was published in the European Journal of Surgical Oncology, and was partly funded by KiKa.

The researchers saw that operations took 40% less time after the concentration of care: the procedure took an average of two hours and forty-five minutes, an hour and forty-five minutes less than before. In addition, the amount of blood loss during the operation was strongly reduced, from an average of 450 milliliters to just 50 milliliters.

The number of side effects in the first month after surgery remained the same, the researchers found, but the severity of the side effects decreased. Before the concentration of surgery, there were more frequent side effects of the operation that required repeat surgery, and which in some cases were life-threatening.

The researchers also found tentative evidence of an improvement in survival rates for children operated on for neuroblastoma, but further research is needed to establish this difference with more certainty.

Prof. dr. Marc Wijnen, pediatric oncology surgeon and research group leader at the Princess Máxima Center for pediatric oncology, led the study. He says:

‘With this analysis we show concrete results of bringing together all care and research for children with cancer. Less damage was done to the healthy tissue during the operation, resulting in fewer complications for the child.

‘As a general rule, the more experience a surgeon has, the better the results. The outcome of the investigation did not surprise me. It shows that we can now offer children with cancer the best possible treatment.’

Prof. dr. Rob Pieters, medical director and co-initiator of the Princess Máxima Center for pediatric oncology, was also involved in the research. He says:

‘Our main starting point when establishing a single national research hospital for childhood cancer was that as a parent you want the very best care for your child. What we already knew from practice, we now see expressed in numbers: by treating a rare disease more often, doctors become increasingly better at that treatment. And that leads to better outcomes for our children.

‘In this study, we focus on the outcomes of surgery in children with neuroblastoma. I expect that now – almost five years after the opening of the Princess Máxima Center - the benefits of concentrated care and research will become clear for more and more forms of childhood cancer.’

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About concentration

Since November 2014, care for children in the Netherlands with a solid tumor – such as bone cancer, kidney cancer and neuroblastoma – has been concentrated in the Princess Máxima Center for pediatric oncology in Utrecht. Since June 2018, children with all forms of cancer – including children with leukemia or a brain tumor – have been treated at the Princess Máxima Center.

In the Princess Máxima Center, children with neuroblastoma are operated on by a team of five surgeons. Before that, operations for the same number of children were spread over five different academic centers in the Netherlands, and forty surgeons.

About neuroblastoma

Neuroblastoma is a tumor of the sympathetic nervous system, which activates the body’s ‘fight-or-flight’ response. It is a rare disease: each year, 25 children in the Netherlands are diagnosed with neuroblastoma. Fifteen of them have a high-risk form of the disease. Half of children with high-risk neuroblastoma die within five years of their diagnosis.

About the Princess Máxima Center for pediatric oncology

When a child is seriously ill from cancer, only one thing matters: a cure.

That is why in the Princess Máxima Center for pediatric oncology, we work together with passion, pushing the boundaries to improve survival and quality of life for children with cancer. Now, and in the long term. Because children have their entire lives ahead of them.

The Princess Máxima Center for pediatric oncology is no ordinary hospital but a research hospital, the biggest childhood cancer center in Europe. Here, more than 450 scientists and 900 healthcare professionals work closely with Dutch and international hospitals to find new treatments and new perspectives for a cure.

In this way, we offer children today the very best care, and take important steps toward improving survival for the children who are not yet cured.