Proceedings: The surgical treatment of nephroblastoma (Wilms' tumor)

Wilms' tumor

Wilms' tumor is the most common renal malignancy of childhood. Survival rates for favorable histology of Wilms' tumor currently approach 90%. Recent advances in the molecular genetics of Wilms' tumor have led to insights into the genetic factors involved in the development of Wilms' tumor, normal renal development, and the mechanisms of tumorigenesis.

Bilateral nephrectomy for Wilms tumor

Bilateral nephrectomy was performed in 4 patients with bilateral Wilms tumor. The current philosophy regarding the need to preserve maximum renal parenchyma is discussed. New guidelines suggested by the National Wilms Tumor Study group discourage unilateral nephrectomy and partial nephrectomy at initial exploration for bilateral Wilms tumor. Alternatively, it is recommended that continued treatment with chemotherapy and/or radiation therapy followed by second and third-look operations to maximize preservation of renal parenchyma be done with bilateral nephrectomy as a last resort option.

Wilms' tumor--model of a curable pediatric malignant solid tumor

Wilms' tumor is the model of the treatment of a pediatric solid tumor. Initially it appeared that multi-modality therapy, consisting of transabodominal nephrectomy, post-operative radiation therapy to the tumor bed and adjuvant, single agent chemotherapy provided the highest likelihood of disease-free survival. The identification of important prognostic factors, such as histology, tumor weight, lymph node involvement and age at diagnosis has led to a re-examination of the treatment of Wilms' tumor. Future therapeutic developments will include the administration of less therapy to some well defined groups of patients, and the exploration of new programs for patients who have been demonstrated to have a poor prognosis using currently accepted treatment techniques.

Neonatal oncology

All known tumor types have been reported in the neonate. A numerical listing and discussion are beyond the scope of this review. Wells and Fraumeni give some insight into common congenital malignant neoplasms. Table 2 lists the percentage of neonatal deaths caused by type-specific cancers. Retinoblastoma is probably the most common malignant tumor in the neonate. About seven per cent of these tumors have been apparent at birth. This tumor is not discussed in either article because it is not lethal until muypes in neonatal and pediatric patients. Some congenital malformations in the in the neonate are recognized as being frankly benign (cysts), potentially malignant (teratomas), and frankly malignant (neuroblastoma). A high percentage of teratomas are benign in the newborn period. Leukemia in the newborn appears to be more aggressive yet neuroblastoma has a better prognosis. More studies are needed to help us define why the neonate does better with some tumors and worse with others. Surface cell markers on neonatal leukemia, B and T cell function studies, and other immunologic surveillance studies are needed. Study of neonatal oncology may add to our knowledge of carcinogenesis and oncogenesis in the future.

Experience with the thoraco-abdominal incision for nephroblastoma in children less than 3 years old

Our results with the routine use of a modified thoraco-abdominal incision in the treatment of patients with nephroblastoma are reported herein. We have used this incision successfully in 5 patients less than 3 years old and are impressed with the improved exposure. In our limited experience the thoracic extension has not adversely altered the operative or postoperative course.