At the time of tumor resection the extent of disease should be assessed. Local lymph nodes should be biopsied and neural foramina inspected when relevant.
Complete or even partial resection may be sufficient therapy and is the treatment of choice for patients with a favourable outlook or low risk disease. When the tumor is localized (20 - 40%) then an attempt at resection should be made. Sacrifice of a major organ should be avoided.
It is easiest to remove tumors arising from the side of the sympathetic chain in the neck, thorax and pelvis. Most abdominal tumors involve the retroperitoneal ganglia and so excision is difficult.
Curative resection is usually possible for Stage 1 disease and sometimes for Stage 2A.
Delayed resection after chemotherapy is frequently performed for tumors that were initially unresectable with or without widespread metastases.
Second look surgeries are also commonly performed after chemotherapy and RT. This approach has shown benefit for stage 2 and 3 patients. In stage 4 there is an improvement in local control, but not for overall survival.