Background The currently utilized International Neuroblastoma Risk Group (INRG) staging system developed in 2009 uses image-defined risk factors as a measure of surgical risk,separating resectable neuroblastoma from those best preceded by chemotherapy.The previous International Neuroblastoma Staging System was based primarily on surgical findings.We hypothesized there would be a change to the role of the surgeon in neuroblastoma treatment in the more recent decade.Methods This is a single center 20-year retrospective analysis of 104 patients with International Classification of Diseases-9 and-10 codes for neuroblastoma.Patient demographics,tumor site,cancer treatment modality,survival,biopsy technique,surgical intervention,and pathology staging were collected.Data was analyzed by analysis of variance (ANOVA) and Stu-dent\'s t test.Results There was a decrease in open surgeries for extra-adrenal neuroblastomas in the later decade (77％,31％,P =0.01).There was a narrowing of the time interval to surgery in the later cohort,likely as a result of uniformity in surgical timing on treatment protocols relying on INRG staging.Conclusions Our findings mirror changes in practice patterns globally.We found an increase in minimally invasive approaches but did not find a difference in the role of the surgeon under the INRG staging system.