Surgical Treatment of Adrenal Neuroblastoma in Children - A Narrative Review.

OBJECTIVE: To analyze the role of surgical treatment in pediatric adrenal neuroblastoma and the operative methods employed according to staging and risk stratification based on patient-related and tumor biological factors. MATERIALS AND METHODS: A narrative literature review was conducted through a structured search of the PubMed/MEDLINE, Scopus, and Web of Science databases. Studies published in English between 2020 and 2025 were included, while classical references were used to contextualize staging and risk stratification systems. Letters, editorials, case reports, and studies not providing specific insight into the topic were excluded. RESULTS: Surgical treatment represents a key component in the management of pediatric adrenal neuroblastoma. Staging and risk stratification determine both the timing of surgery and its role in achieving local disease control. In low-risk neuroblastoma, surgery alone may be curative. In intermediate-risk patients, neoadjuvant chemotherapy precedes resection, reducing surgical complexity and facilitating tumor removal. In high-risk patients, tumor resection exceeding 90% may contribute to improved overall survival (OS). Image-Defined Risk Factors (IDRFs) are essential for staging and surgical planning, as they define the anatomical relationship between the tumor and adjacent vascular and organ structures. Surgical approaches include open surgery and minimally invasive surgery, the latter being appropriate in carefully selected cases. CONCLUSION: Surgical treatment remains fundamental in pediatric adrenal neuroblastoma, and operative strategies should be guided by clinical, biological, and radiologic parameters to achieve maximal oncologic safety.