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Liu Z, Hong P, Zhu G, Zhang L, Zhao X, Tang S, Yang F, Tian X, Wang G, Zhang S, Zhang H, Huang Y, Liu C, Liu C, Ma L. Pure retroperitoneal laparoscopic radical nephrectomy and thrombectomy with delayed occlusion of the proximal inferior vena cava (DOPI) technique for renal tumor with level II-III venous tumor thrombus. BMC Cancer 2021; 21:627. [PMID: 34044812 PMCID: PMC8161924 DOI: 10.1186/s12885-021-08392-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). Materials and methods From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. Results All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. Conclusions The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Li Zhang
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Chunxia Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Malek MM, Behr CA, Aldrink JH, Dasgupta R, Heaton TE, Gehred A, Lautz TB, Baertschiger RM, Christison-Lagay ER, Tracy ET, Rhee DS, Rodeberg D, Austin MT, Ehrlich PF. Minimally invasive surgery for pediatric renal tumors: A systematic review by the APSA Cancer Committee. J Pediatr Surg 2020; 55:2251-2259. [PMID: 32386972 DOI: 10.1016/j.jpedsurg.2020.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED Minimally invasive nephrectomy is performed routinely for adult renal tumors and for many benign pediatric conditions. Although open radical nephroureterectomy remains the standard of care for Wilms tumor and most pediatric renal malignancies, there are an increasing number of reports of minimally invasive surgery (MIS) for those operations as well. The APSA Cancer Committee performed a systematic review to better understand the risks and benefits of MIS in pediatric patients with renal tumors. METHODS The search focused on MIS for renal tumors in children and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. The initial database search identified 491 published articles, and after progressive review of abstracts and full-length articles, 19 were included in this review. RESULTS There were two direct comparison studies where open surgery and MIS were compared. The remaining studies reported only on minimally invasive nephrectomy. Across all studies, there were a total of 151 patients, 126 of which had Wilms tumor and 10 patients had RCC. 104 patients had MIS, with 47 patients having open surgery. In the two studies in which open surgery and MIS were directly compared, more lymph nodes were harvested during open surgery (median = 2 (MIS) vs 5 (open); mean = 2.47 (MIS) vs 3.8 (open)). Many noncomparison studies reported the harvest of 2 of fewer lymph nodes for Wilms tumor. Several MIS patients were also noted to have intraoperative spill or positive margins. Survival between groups was similar. CONCLUSIONS There is a lack of evidence to support MIS for pediatric renal tumors. This review demonstrates that lymph node harvest has been inadequate for MIS pediatric nephrectomy and there appears to be an increased risk for intraoperative spill. Survival data are similar between groups, but follow-up times were inconsistent and patient selection was clearly biased, with only small tumors being selected for MIS. TYPE OF STUDY Review article. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcus M Malek
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Christopher A Behr
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Todd E Heaton
- Department of Surgery, Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Gehred
- Grant Morrow, III MD Medical Library, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | | | - Emily R Christison-Lagay
- Division of Pediatric General and Thoracic Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT
| | - Elisabeth T Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center
| | - Daniel S Rhee
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Rodeberg
- Department of Surgery, Division of Pediatric Surgery, East Carolina University, Greenville, NC
| | - Mary T Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
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Tian X, Hong P, Liu Z, Huang Y, Wang G, Hou X, Zhang S, Ma L. En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: A single-center experience. Cancer 2020; 126 Suppl 9:2073-2078. [PMID: 32293727 DOI: 10.1002/cncr.32747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The surgical treatment of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. In the current study, the authors have reported their surgical outcomes and experience with en bloc retroperitoneal laparoscopic radical nephrectomy (LRN) with inferior vena cava (IVC) thrombectomy for patients with RCC with level 0 to II VTT. METHODS A retrospective review of the clinical records of 78 patients who underwent retroperitoneal LRN with IVC thrombectomy from March 2015 to September 2018 was performed. The surgical procedures included establishing the retroperitoneal space, ligating and severing the renal artery, clamping the renal vein and IVC, incising the IVC, and placing the renal and tumor thrombus en bloc into a retrieval bag. RESULTS According to the Mayo classification, the tumor thrombus was level 0, I, and II, respectively, in 28 patients, 27 patients, and 23 patients. The median operative time, estimated blood loss, and postoperative hospital stay were 256 minutes, 400 mL, and 8 days, respectively. A total of 67 patients were not converted to open surgery. No patient died during surgery, and no tumor embolization occurred. Thirteen patients experienced complications. The pathological reports indicated clear cell RCC in 70 patients and other RCC in 8 patients. The median follow-up was 14.5 months, and 61 patients were alive at the time of last follow-up. CONCLUSIONS En bloc retroperitoneal LRN with IVC thrombectomy is a challenging but feasible procedure for experienced surgeons in patients with RCC with level 0 to II VTT.
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Affiliation(s)
- Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Morris L, Squire R, Sznajder B, van Tinteren H, Godzinski J, Powis M. Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial. Pediatr Blood Cancer 2019; 66:e27930. [PMID: 31339231 DOI: 10.1002/pbc.27930] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/16/2019] [Accepted: 06/28/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Preoperative chemotherapy is recommended for children with Wilms tumour with intravascular extension. Extended chemotherapy may improve resectability, but increase tumour adherence to vascular endothelium, precluding complete resection. To evaluate the optimal length of preoperative treatment, we report a two-part review comprising systematic review of the literature and investigation of patients treated in the International Society of Paediatric Oncology (SIOP) WT 2001 trial. METHODS Studies were identified using Medline and Embase databases from 1996 to present. English language titles reporting management of intravascular Wilms tumour were analysed. Patients with Wilms tumour and thrombus were identified from the SIOP WT 2001 trial. Overall survival (OS) and event-free survival (EFS), tumour regression, completeness of resection and cavectomy were investigated. RESULTS The search retrieved 43 articles documenting 498 children. Note that 72% of the patients received neoadjuvant chemotherapy: 101 received standard course (4-6 weeks, standard course neoadjuvant chemotherapy [StC]) and 62 extended course (> 6 weeks, extended course neoadjuvant chemotherapy [EC]). There was no significant difference between the groups in terms of thrombus regression or completeness of resection. EFS was greater in the StC group (78 vs 54%; P = .04). Of 4511 patients registered in the SIOP WT 2001 trial, 166 had thrombus. Note that 97% of the patients received neoadjuvant chemotherapy: 63 StC and 67 EC. There was no significant difference between the groups with regard to tumour regression, complete resection, or cavectomy. Survival was significantly higher in those receiving StC than EC (OS: 95% vs 82%, P = .025; EFS: 88% vs 72%, P = .047). CONCLUSION There is no evidence that prolonged courses of neoadjuvant chemotherapy beyond the recommended protocols confer any additional benefit in treating intravascular extension of Wilms tumour.
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Affiliation(s)
- Louise Morris
- Department of Paediatric Surgery, Nottingham University Hospitals, Nottingham, UK
| | - Roly Squire
- Department of Paediatric Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Beata Sznajder
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Harm van Tinteren
- Biostatistics Department, Netherlands Cancer Institute-Antonie van Leeuwenhoekhuis Plesmanlaan, Amsterdam, The Netherlands
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, and Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals, Leeds, UK
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Duarte RJ, Cristofani LM, Odone Filho V, Srougi M, Dénes FT. Videolaparoscopic radical nephrectomy after chemotherapy in the treatment of Wilms' tumor: Long-term results of a pioneer group. J Pediatr Urol 2017; 13:50.e1-50.e5. [PMID: 28288778 DOI: 10.1016/j.jpurol.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/05/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION A high cure rate for Wilms' tumor has been achieved using a multidisciplinary approach. The natural step forward is to offer the benefits of a minimally invasive technique for surgery, which is an obligatory part of treatment. Nevertheless, some authors resist using videolaparoscopic radical nephrectomy (VRN) because of concerns about reducing the cure index. METHODS The present study included children with unilateral Wilms' tumor treated from December 2003 to December 2015 with neoadjuvant chemotherapy followed by VRN. Patients were selected based on the size of their tumors compared with the contralateral kidney, and on their stature. RESULTS VRN was performed in 24 patients of age range 10-93 months, with an average of 38.04 ± 23.37 months. The tumoral kidney's largest diameter after chemotherapy averaged 10% of a patient's height. There was no tumor rupture or spillage and no patient presented intra or immediate postoperative complications, except for prolonged ileum in two patients. One patient required intraoperative transfusion because of preoperative anemia. Another developed a late herniation in the umbilical port that required surgical correction. After an average of 6.65 years of follow-up, two patients presented relapse: one with a stage IV disease had relapse in the lung and another with a stage III, involving the liver, had local relapse because of an unwanted delay in the adjuvant treatment. CONCLUSION VRN can be considered a feasible alternative to open surgery in selected cases of children with Wilms' tumor. The present experience shows that besides the benefits of minimally invasive procedures and better cosmetic results, there is no evidence of increased tumor rupture or spillage, peritoneal or port site metastasis, and the long-term oncological results are the same as open procedures.
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Affiliation(s)
- Ricardo Jordão Duarte
- Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Lilian Maria Cristofani
- Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Vicente Odone Filho
- Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Francisco Tibor Dénes
- Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
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Eriksen KO, Johal NS, Mushtaq I. Minimally invasive surgery in management of renal tumours in children. Transl Pediatr 2016; 5:305-314. [PMID: 27867856 PMCID: PMC5107380 DOI: 10.21037/tp.2016.09.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Minimally invasive surgery (MIS) in the management of malignant and benign renal tumours in children is gradually becoming more common. Experience is limited and restricted to case reports, retrospective chart reviews and a few cohort studies. There are currently no randomized controlled trials or controlled clinical trials comparing the laparoscopic and open surgical approach for the management of renal tumours in children. MIS may offer the same oncologic outcome in malignant renal tumours whilst providing the advantages associated with MIS in correctly selected cases. The technique for tumour resection has been shown to be feasible in regards to the recommended oncologic principles, although lymph node sampling can be inadequate in some cases. Preliminary reports do not show an increased risk of tumour rupture or inferior oncologic outcomes after MIS. However, the sample size remains small and duration of follow-up inadequate to draw any firm conclusions. Implementation of MIS is lacking in the protocols of the major study groups, and standardized recommendations for the indications and contra-indications remain undefined. The objective of this article is to present a review of the literature on the role of MIS in the management of renal tumours in children, with the main focus on Wilms' tumour (WT). Further studies on MIS in renal tumours are required to evaluate the incidence of oncological complications such as complete tumour resection and intra-operative tumour spillage. A long-term follow-up of patients managed by MIS is essential to compare recurrence rates and overall survival rates.
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Affiliation(s)
| | - Navroop Singh Johal
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Liu JB, Lu ZB, Xiao XM. Laparoscopic Radical Nephrectomy of Wilms' Tumor and Renal Cancer in Children: Preliminary Experience from a Two-Center Study in China. J Laparoendosc Adv Surg Tech A 2015; 25:516-21. [PMID: 25974244 DOI: 10.1089/lap.2014.0342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jiang-Bin Liu
- Department of Pediatric Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Bao Lu
- Department of Pediatric Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xian-Min Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
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Wang W, Wang L, Xu J, Adams TS, Tian Y, Lv W. Pure Retroperitoneal Laparoscopic Radical Nephrectomy for Right Renal Masses with Renal Vein and Inferior Vena Cava Thrombus. J Endourol 2014; 28:819-24. [DOI: 10.1089/end.2014.0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Li Wang
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wencheng Lv
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Malkan AD, Loh AHP, Sandoval JA. Minimally invasive surgery in the management of abdominal tumors in children. J Pediatr Surg 2014; 49:1171-6. [PMID: 24952811 DOI: 10.1016/j.jpedsurg.2014.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The application of minimally invasive surgical techniques to pediatric abdominal tumors is a controversial application towards the surgical management of childhood cancer. Although general pediatric surgeons practice minimally invasive surgery techniques in a vast array of abdominal cases, its role in pediatric oncology is still developing, with no consensus in North America about its use for pediatric solid abdominal tumors. The purposes of this article are to review the current literature about the use of minimally invasive surgery in pediatric abdominal oncology and to examine established indications, procedures and technologic advances.
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Affiliation(s)
- Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - John A Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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10
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Wang W, Xu J, Adams TS, Tian Y, Lv W. Pure Retroperitoneal Laparoscopic Radical Nephrectomy for Left Renal Cell Carcinoma with Differential Extensions of Level I Renal Vein Tumor Thrombus. J Endourol 2014; 28:312-7. [PMID: 24093212 DOI: 10.1089/end.2013.0544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wencheng Lv
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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11
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Xu B, Zhao Q, Jin J, He ZS, Zhou LQ, Zhang Q. Laparoscopic Versus Open Surgery for Renal Masses with Infrahepatic Tumor Thrombus: The Largest Series of Retroperitoneal Experience from China. J Endourol 2014; 28:201-7. [PMID: 24032413 DOI: 10.1089/end.2013.0519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ben Xu
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Qiang Zhao
- Department of Urology, Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing, China
| | - Jie Jin
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Zhi-song He
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Li-qun Zhou
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Qian Zhang
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
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Abstract
Wilms tumor (WT) is one of the most common solid tumors in children. It is the second most common extracranial solid tumor after neuroblastoma. WT has a strong tendency to invade blood vessels in the form of tumor thrombus, into the renal veins, and inferior vena cava and even into the right atrium. Extension of tumor thrombus along to the renal vein into the inferior vena cava occurs in 4-10% of all patients. Tumor thrombus extending to the right atrium is less reported as 0.7-1%. WT with renal vein thrombus has been reported to be more common in the right kidney because of the shorter right renal vein. Most patients with tumor thrombus are asymptomatic and diagnosis is only made on imaging investigations. Several imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI) and Doppler ultrasonography (USG) can demonstrate intravascular tumor thrombus before surgery. In addition to CT and MRI, Doppler USG is reliable in demonstrating the presence and extent of inferior vena cava tumor thrombus. The management of WT with tumor thrombus is determined by multiple factors such as extent of tumor thrombus, chemotherapy response of the tumor. Now, it is generally recommended to use preoperative chemotherapy to a patient presenting with intravascular tumor thrombus. This approach is helpful to decrease the extent of the vascular thrombus which facilitates surgical excision. Most intracaval and intraatrial thrombi in WT show a response to chemotherapy. Neoadjuvant chemotherapy causes tumor regression in nearly half of the patients. Most of them can be managed without the need for cardiac bypass surgery. The decision of initial surgery or preoperative chemotherapy should be carefully determined on every case. Primary surgery would only be indicated in a patient who is unstable because of thrombus that might dislodge and cause acute symptoms. Presence of tumor thrombus in WT needs for multidisciplinary care including pediatric oncologists, pediatric surgeons, and pediatric cardiac surgeons.
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Affiliation(s)
- Suna Emir
- Department of Pediatric Hematology Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Altındağ, Ankara, Turkey
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