1
|
Lopez-Gonzalez M, Ariceta G. WT1-related disorders: more than Denys-Drash syndrome. Pediatr Nephrol 2024; 39:2601-2609. [PMID: 38326647 DOI: 10.1007/s00467-024-06302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
Historically, specific mutations in WT1 gene have been associated with distinct syndromes based on phenotypic characteristics, including Denys-Drash syndrome (DDS), Frasier syndrome (FS), Meacham syndrome, and WAGR syndrome. DDS is classically defined by the triad of steroid-resistant nephrotic syndrome (SRNS) onset in the first year of life, disorders of sex development (DSD), and a predisposition to Wilms tumor (WT). Currently, a paradigm shift acknowledges a diverse spectrum of presentations beyond traditional syndromic definitions. Consequently, the concept of WT1-related disorders becomes more precise. A genotype-phenotype correlation has been established, emphasizing that the location and type of WT1 mutations significantly influence the clinical presentation, the condition severity, and the chronology of patient manifestations. Individuals presenting with persistent proteinuria, with or without nephrotic syndrome, and varying degrees of kidney dysfunction accompanied by genital malformations should prompt suspicion of WT1 mutations. Recent genetic advances enable a more accurate estimation of malignancy risk in these patients, facilitating a conservative nephron-sparing surgery (NSS) approach in select cases, with a focus on preserving residual kidney function and delaying nephrectomies. Other key management strategies include kidney transplantation and addressing DSD and gonadoblastoma. In summary, recent genetic insights underscore the imperative to implement individualized, integrated, and multidisciplinary management strategies for WT1-related disorders. This approach is pivotal in optimizing patient outcomes and addressing the complexities associated with these diverse clinical manifestations.
Collapse
Affiliation(s)
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
- University Autonomous of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Cullis PS, Fouad D, Goldstein AM, Wong KKY, Boonthai A, Lobos P, Pakarinen MP, Losty PD. Major surgical conditions of childhood and their lifelong implications: comprehensive review. BJS Open 2024; 8:zrae028. [PMID: 38776252 PMCID: PMC11110943 DOI: 10.1093/bjsopen/zrae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood. METHODS A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership. RESULTS This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer. CONCLUSION The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.
Collapse
Affiliation(s)
- Paul S Cullis
- Department of Paediatric Surgery, Royal Hospital for Children Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Dina Fouad
- Department of Paediatric Surgery, Leicester Children’s Hospital, Leicester, UK
| | - Allan M Goldstein
- Department of Paediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth K Y Wong
- Department of Paediatric Surgery, Queen Mary’s Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ampaipan Boonthai
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pablo Lobos
- Department of Paediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mikko P Pakarinen
- The New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, University of Southern Denmark, Odense, Denmark
| | - Paul D Losty
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
3
|
de Souza FKM, Fanelli MCA, Duarte AAB, Alves MTDS, Lederman HM, Cypriano MDS, Abib SDCV. Surgery in Bilateral Wilms Tumor-A Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1790. [PMID: 38002881 PMCID: PMC10670692 DOI: 10.3390/children10111790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute-GRAACC-Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.
Collapse
Affiliation(s)
- Fernanda Kelly Marques de Souza
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
| | - Mayara Caroline Amorim Fanelli
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
| | - Alexandre Alberto Barros Duarte
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
- Department of Pediatric Surgery, Foundation Regional Faculty of Medicine of São José do Rio Preto, Children’s and Maternity Hospital, São José do Rio Preto 15091-240, Brazil
| | | | - Henrique Manoel Lederman
- Department of Radiology, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil;
| | - Monica dos Santos Cypriano
- Department of Pediatric Oncology, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil;
| | - Simone de Campos Vieira Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
| |
Collapse
|
4
|
Mittal S, Long C, El-Ali A, Talwar R, Lattanzio K, Lawton B, Hamdan D, Balis FM, Mattei P, Back SJ, Kolon TF. Utilizing RENAL nephrometry in pediatric patients undergoing nephron-sparing surgery for renal tumors: A single-institutional cohort. J Pediatr Urol 2023; 19:641.e1-641.e6. [PMID: 37453876 DOI: 10.1016/j.jpurol.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION RENAL Nephrometry is a complexity score validated in adults with renal tumors and describes the likelihood of complication after partial nephrectomy (PN). Utilization in pediatrics has been limited. Thus, our goal is to quantify inter-rater agreement as well as determine how scores correlate with outcomes. We hypothesize that the RENAL Nephrometry Score is reproducible in children with renal tumors and is related to perioperative and post-operative complications. METHODS All pediatric patients who underwent PN for a renal mass from 2006 to 2019 were identified. Patient data, operative details, and outcomes were aggregated. Pre-operative CT/MR imaging was anonymized and scored by 2 pediatric radiologists and 2 pediatric urologists using RENAL Nephrometry metrics. Statistical analysis utilized Fleiss' kappa and the intraclass correlation coefficient (ICC). Comparative analyses were performed based on Nephrometry Score <9 and ≥ 9. RESULTS 28 patients undergoing 33 PN were identified. Median age at surgery was 3.2 years (IQR 1.8-4.0). There is moderate-good agreement across scorers on the domains of RENAL Nephrometry Score, with the lowest agreement noted for anterior vs posterior tumors. Comparing patients with scores <9 and ≥ 9, there was increased operative time (357 vs 267 min, p = 0.003) and LOS for those with a higher score, but no difference in the incidence of 30-day complications. CONCLUSION RENAL Nephrometry Score is an easily reproducible complexity score for renal tumors in pediatric patients. Higher scores are associated with increased length of stay and estimated blood loss but not complications. Reporting of nephrometry scores in future publications on pediatric renal tumors should become standard in the literature.
Collapse
Affiliation(s)
- Sameer Mittal
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Christopher Long
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Alexander El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA.
| | - Ruchika Talwar
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Katherine Lattanzio
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Brendan Lawton
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Dawud Hamdan
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Frank M Balis
- Children's Hospital of Philadelphia, Division of Oncology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Peter Mattei
- Children's Hospital of Philadelphia, Division of General, Thoracic, and Fetal Surgery, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Susan J Back
- Children's Hospital of Philadelphia, Department of Radiology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Thomas F Kolon
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| |
Collapse
|
5
|
Murphy AJ, Davidoff AM. Nephron-sparing surgery for Wilms tumor. Front Pediatr 2023; 11:1122390. [PMID: 36743884 PMCID: PMC9895406 DOI: 10.3389/fped.2023.1122390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
The algorithm that has been used successfully in the surgical management of unilateral Wilms tumor, radical nephroureterectomy, cannot be used in children who present with synchronous bilateral renal masses. Instead, a surgical approach that removes all tumor masses while preserving as much normal renal parenchyma as possible is encouraged to avoid acute and long-term renal insufficiency. We will review technical aspects of the conduct of nephron-sparing surgery for synchronous bilateral Wilms tumor, including the more recent advances in the use of imaging adjuncts such as pre-operative 3D imaging and fluorescence-guided surgery. The potential role of nephron-sparing surgery for unilateral Wilms tumor will also be discussed.
Collapse
Affiliation(s)
- Andrew J. Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| |
Collapse
|
6
|
Fialkowski E, Sudour-Bonnange H, Vujanic GM, Shamberger RC, Chowdhury T, Aldrink JH, Davick J, Sandberg J, Furtwaengler R, Mullen E. The varied spectrum of nephroblastomatosis, nephrogenic rests, and Wilms tumors: Review of current definitions and challenges of the field. Pediatr Blood Cancer 2022; 70 Suppl 2:e30162. [PMID: 36545945 DOI: 10.1002/pbc.30162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
The diagnosis of multiple or diffuse renal lesions in a child is challenging by imaging and/or pathology. Optimal management requires distinguishing benign lesions such as nephrogenic rests from cancerous lesions such as Wilms tumor, but this is often difficult or impossible. This difficulty is compounded by the overlapping nature of our current radiologic and pathologic definitions of lesions along the spectrum of nephrogenic rests/nephroblastomatosis. We provide a review of these issues, as a collaborative effort between the Children's Oncology Group Renal Tumor Committee and International Society of Pediatric Oncology Renal Tumor Study Group. Our aim is to discuss current challenges in diagnosis and management of these renal lesions, encouraging future work toward consensus definitions for research and patient care.
Collapse
Affiliation(s)
- Elizabeth Fialkowski
- Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Gordan M Vujanic
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - Robert C Shamberger
- Boston Children's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanzina Chowdhury
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jonathan Davick
- University of Iowa Hospitals and Clinics/Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jesse Sandberg
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California, USA
| | - Rhoikos Furtwaengler
- Paediatric Haematology and Oncology, Saarland University Hospital, Homburg, Germany
| | - Elizabeth Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Arslan E, Saygili S, Celkan TT, Kurugoglu S, Elicevik M, Camcioglu AE, Konukoglu D, Apak H, Caliskan S, Sever L, Canpolat N. Increased risk for kidney sequelae surrogates in survivors of Wilms tumor. Pediatr Nephrol 2022; 37:2415-2426. [PMID: 35118543 DOI: 10.1007/s00467-022-05460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence of increased risk of hypertension, albuminuria, and development of chronic kidney disease (CKD) in long-term follow-up of survivors of Wilms tumor (WT). However, most studies were conducted in heterogeneous groups, including patients with solitary kidney. In addition, little is known about tubular dysfunction. This study aimed to investigate kidney sequelae, including CKD development, hypertension, and glomerular and tubular damage in WT survivors. METHODS This cross-sectional, single-center study included 61 patients treated for WT. Surrogates for kidney sequelae were defined as presence of at least one of the following: decrease in GFR for CKD, hypertension detected by ambulatory blood pressure monitoring, albuminuria (albumin-to-creatinine ratio [ACR] > 30 mg/g), or increase in at least one tubular biomarker (beta-2-microglobulin, neutrophil gelatinase-associated lipocalin, kidney injury marker-1, and liver fatty acid-binding protein) in 24-h urine. RESULTS Median age of patients was 11.7 years, with median follow-up of 8.8 years. Thirty-eight patients (62%) had at least one surrogate for kidney sequelae. Twenty-four patients (39%) had CKD, 14 patients (23%) had albuminuria, 12 patients (21%) had hypertension, and 11 patients (18%) had tubular damage. Urine ACR was significantly higher in patients with advanced tumor stage and patients with nephrotoxic therapy than their counterparts (p < 0.05), but neither eGFR nor tubular biomarkers showed any association with tumor- or treatment-related factors. CONCLUSIONS A considerable number of patients with WT have kidney sequelae, especially early-stage CKD with a high prevalence. Albuminuria emerges as a marker associated with tumor stages and nephrotoxic treatment. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Emrullah Arslan
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seha Saygili
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tülin Tiraje Celkan
- Department of Pediatric Hematology Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebuh Kurugoglu
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Elicevik
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Abdulhamit Enes Camcioglu
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Dildar Konukoglu
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hilmi Apak
- Department of Pediatric Hematology Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Salim Caliskan
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Lale Sever
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| |
Collapse
|
8
|
Falcone MP, Pritchard-Jones K, Brok J, Mifsud W, Williams RD, Nakata K, Tugnait S, Al-Saadi R, Side L, Anderson J, Duncan C, Marks SD, Bockenhauer D, Chowdhury T. Long-term kidney function in children with Wilms tumour and constitutional WT1 pathogenic variant. Pediatr Nephrol 2022; 37:821-832. [PMID: 34608521 PMCID: PMC8960606 DOI: 10.1007/s00467-021-05125-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/25/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Wilms tumour (WT) survivors, especially patients with associated syndromes or genitourinary anomalies due to constitutional WT1 pathogenic variant, have increased risk of kidney failure. We describe the long-term kidney function in children with WT and WT1 pathogenic variant to inform the surgical strategy and oncological management of such complex children. METHODS Retrospective analysis of patients with WT and constitutional WT1 pathogenic variant treated at a single centre between 1993 and 2016, reviewing genotype, phenotype, tumour histology, laterality, treatment, patient survival, and kidney outcome. RESULTS We identified 25 patients (60% male, median age at diagnosis 14 months, range 4-74 months) with WT1 deletion (4), missense (2), nonsense (8), frameshift (7), or splice site (4) pathogenic variant. Thirteen (52%) had bilateral disease, 3 (12%) had WT-aniridia, 1 had incomplete Denys-Drash syndrome, 11 (44%) had genitourinary malformation, and 10 (40%) had no phenotypic anomalies. Patient survival was 100% and 3 patients were in remission after relapse at median follow-up of 9 years. Seven patients (28%) commenced chronic dialysis of which 3 were after bilateral nephrectomies. The overall kidney survival for this cohort as mean time to start of dialysis was 13.38 years (95% CI: 10.3-16.4), where 7 patients experienced kidney failure at a median of 5.6 years. All of these 7 patients were subsequently transplanted. In addition, 2 patients have stage III and stage IV chronic kidney disease and 12 patients have albuminuria and/or treatment with ACE inhibitors. Four patients (3 frameshift; 1 WT1 deletion) had normal blood pressure and kidney function without proteinuria at follow-up from 1.5 to 12 years. CONCLUSIONS Despite the known high risk of kidney disease in patients with WT and constitutional WT1 pathogenic variant, nearly two-thirds of patients had sustained native kidney function, suggesting that nephron-sparing surgery (NSS) should be attempted when possible without compromising oncological risk. Larger international studies are needed for accurate assessment of WT1genotype-kidney function phenotype correlation.
Collapse
Affiliation(s)
- Maria Pia Falcone
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Paediatric Residency Program, University of Foggia, Foggia, Italy
| | - Kathryn Pritchard-Jones
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Jesper Brok
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - William Mifsud
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Richard D Williams
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Kayo Nakata
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Suzanne Tugnait
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Reem Al-Saadi
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Side
- Dept. of Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John Anderson
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Catriona Duncan
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen D Marks
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Dept. of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Dept. of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Department of Renal Medicine, London, UK
| | - Tanzina Chowdhury
- Department of Paediatric Oncology Great Ormond Street Hospital, UCL Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| |
Collapse
|
9
|
Sarin Y. Nephron-sparing surgery in nonsyndromic unilateral wilms' tumor: An insight into the ongoing surgical controversy. J Indian Assoc Pediatr Surg 2022; 27:13-24. [PMID: 35261509 PMCID: PMC8853590 DOI: 10.4103/jiaps.jiaps_205_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Unilateral Wilms' tumor (uWT) is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy (RN) has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative complications associated with this procedure. Nephron-sparing surgery (NSS) has been reported to avoid such postoperative complications and have high technical success rate. However, not much literature is available comparing the efficacy of RN and NSS for managing nonsyndromic uWT, which makes it less acceptable globally. Materials and Methods and Results: A systematic identification of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. Out of 1017 records, 20 manuscripts including 312 patients were included in the review; 4 patients treated by the author (unpublished data) have also been included. The studies included 7 retrospective case series with no comparison group, 4 retrospective case series with comparison group, 4 retrospective series with a cursory mention of NSS in uWT, 2 case reports, 1 protocolized prospective trial with comparison group, 1 administrative database analysis with comparison group, and 1 randomized controlled study. In all, 316 patients with nonsyndromic uWT were studied. The pretherapy volumes of the WT ranged from 2.4 to 640 ml. Majority of them were administered preoperative chemotherapy. About half of the patients (n = 159) (50.3%) were Stage I tumors. Stage II, III, and IV tumors were seen in 23 (7.3%), 20 (6.3%), and 3 (1%) patients. Stage was not specified in 111 (35.1%) patients. Majority of them were “intermediate risk” WT. All these tumors were nonanaplastic. Surgical margins were reported positive in 13 (4%) patients. Overall and event-free survivals were 100% in most of the studies; only handful of relapses were noted in this systematic review. Conclusions: This qualitative systematic review recommends the use of NSS for nonsyndromic uWT. The procedure accounts for higher postoperative renal function and lesser incidence of hypertension as compared to the radical nephrectomy. Overall and event-free survivals are comparable or even better with NSS.
Collapse
|
10
|
Jain P, Prasad A, Jain S, Rahul KM. Cystic Nephroma and its Varied Management Scenarios: A Report of two Cases. J Indian Assoc Pediatr Surg 2021; 26:268-270. [PMID: 34385775 PMCID: PMC8323577 DOI: 10.4103/jiaps.jiaps_152_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/02/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022] Open
Abstract
Cystic nephroma is a rare benign cystic neoplasm of the kidney. The preoperative diagnosis with its malignant counterparts cystic partially differentiated nephroblastoma or cystic Wilms' tumor is not easy but is important when one is considering for nephron-sparing surgery.
Collapse
Affiliation(s)
- Prashant Jain
- Department of Paediatric Surgery and Pediatric Urology, BLK Center For Child Health, BLK Super Speciality Hospital, New Delhi, India
| | - Ashish Prasad
- Department of Paediatric Surgery and Pediatric Urology, BLK Center For Child Health, BLK Super Speciality Hospital, New Delhi, India
| | - Sarika Jain
- Department of Radiodiagnosis, Doda Imaging, Pusa Road, New Delhi, India
| | - Kanta M Rahul
- Department of Anesthesia, BLK Super Speciality Hospital, New Delhi, India
| |
Collapse
|
11
|
Schiavetti A, Ferrara E, De Grazia A, Cozzi DA. Abdominal Recurrence after Robotic Nephron-Sparing Surgery for Wilms Tumor in an Adult Patient. Urol Int 2021; 105:716-719. [PMID: 33780957 DOI: 10.1159/000514595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
A 31-year-old man was referred to an adult urologist for a renal polar mass that measured 7.2 cm in maximum diameter. Robotic assisted complete tumor excision for suspicious renal cell carcinoma was carried out, preserving the rest of the left kidney. Histopathology showed a Wilms tumor (WT) with positive margins. No postoperative therapy was made, and the patient shortly presented an abdominal recurrence. The patient was referred to our pediatric oncology unit; he received preoperative chemotherapy, followed by surgery (completion nephrectomy and removal of neoplastic deposits in the omentum and parietal peritoneum), postoperative chemotherapy, and abdomen radiotherapy. He is well at the 5-year follow-up. Peritoneal dissemination after laparoscopic nephron-sparing surgery (NSS) in a child with a 10-cm WT was previously reported. We suggest open NSS for large WT may be safer than laparoscopic or robotic NSS because carbon dioxide pneumoperitoneum and traumatic handling of tumor may predispose to tumor cell migration. An abdominal WT relapse in adults can be salvaged by multimodal therapy recommended by current pediatric WT guidelines.
Collapse
Affiliation(s)
| | - Eva Ferrara
- Pediatric Oncology Unit, "Sapienza" University Rome, Rome, Italy
| | | | - Denis A Cozzi
- Pediatric Surgery Unit, "Sapienza" University Rome, Rome, Italy
| |
Collapse
|
12
|
Dávila Fajardo R, Pieters BR, Wilde JCH, Heij HA, Chrzan R, Tytgat G, Mavinkurve-Groothuis AMC, Smets A, Kroon PS, Van Damme A, van de Ven KP, de Krijger RR, Lilien MR, Wijnen MH, van den Heuvel-Eibrink MM, Janssens GO. A Role of brachytherapy in bilateral Wilms tumors: A long-term follow-up of three highly selected cases and literature review. Brachytherapy 2020; 20:478-484. [PMID: 33309284 DOI: 10.1016/j.brachy.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe experience with partial nephrectomy combined with brachytherapy as part of the local management of bilateral Wilms tumor (WT) including a review of the available literature. RESULTS (METHODS AND CASE DESCRIPTION) Between 2011 and 2014, three highly selected patients (age nine months, 16 months, and 4 years) with bilateral WT (two synchronous and one metachronous) underwent enucleation and perioperative brachytherapy to the tumor bed. With a minimum follow-up of 5 years, all three patients are in continuous complete remission with preserved kidney function. CONCLUSIONS Although nephron sparing surgery aiming at tumor free-margins remains the gold standard for bilateral WT, tumor enucleation followed by brachytherapy may be considered in carefully selected patients at high risk for end-stage kidney failure. Given the rarity and complexity of the procedure, concentration of care of such patients is mandatory.
Collapse
Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Jim C H Wilde
- Division of Pediatric Surgery, Hôpitaux Universitaires de Genève, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
| | - Hugo A Heij
- Department of Paediatric Surgery, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Rafal Chrzan
- Department of Pediatric Urology, Children's University Hospital Cracow, Jagiellonian University Medical College, Krakow, Poland
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Anne Smets
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - An Van Damme
- Department of Pediatric Hematology and Oncology, University Hospital Saint-Luc, Brussels, Belgium
| | - Kees P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc R Lilien
- Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc H Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
13
|
Mrad C, Coulomb-Lhermine A, Tabone MD, Ulinski T, Audry G, Irtan S. Evaluation of the nephron-sparing surgery formula in Wilms tumors. Pediatr Blood Cancer 2020; 67:e28661. [PMID: 32808461 DOI: 10.1002/pbc.28661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023]
Abstract
AIM Definitions of nephron-sparing surgery (NSS) procedures in Wilms tumor (WT) are not clear. The new UMBRELLA protocol offers a formula (NSS(X)-SRM(n)-PRM(n)-RRP(n%)) to better define the different NSS parameters. We aimed to assess the advantages and limits of this new formula. METHODS This retrospective monocentric study included patients operated by NSS for WT from 1975 to 2018. We reviewed the medical records and applied the NSS formula to all included patients. RESULTS Eighty kidneys were operated on 56 patients at a mean age of 19.2 months (4 days-7.5 years), with 49 partial nephrectomies and 31 tumorectomies. The assessment of the surgical resection margins (SRM) showed a doubt in six cases and one tumor breach. An intact pseudocapsule along the resection margin with no renal parenchyma was found in four cases at pathological resection margins (PRM) assessment, whereas a tumor breach was described in seven cases. Among the six patients with a surgical doubt, only one had a pathological stage III. There were no surgical doubts in the seven patients with tumor breach at pathology. At a mean follow-up of eight years (15 days-28.6 years), eight patients had elevated blood pressure levels. Ten had proteinuria. These two parameters were significantly increased in patients with a remaining renal parenchyma (RRP) of less than half of the initial total renal parenchyma. The serum creatinine level was normal for all except two patients. CONCLUSION The new NSS formula described all the crucial elements of NSS. RRP seemed essential for the evaluation of long-term renal function.
Collapse
Affiliation(s)
- Chaima Mrad
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Aurore Coulomb-Lhermine
- Pathology Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Dominique Tabone
- Pediatric Oncology Department, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Georges Audry
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sabine Irtan
- Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
14
|
Abstract
Overall survival (OS) for children with Wilms tumor (WT) currently stands at around 90%. This is markedly improved from the survival rates of around 30% reported in the middle of the last century. This improvement is due to the development of multimodal treatment for this disease, based on the evidence yielded through international collaboration on trials conducted by the Société Internationale d'Oncologie Pédiatrique (SIOP) and the Children’s Oncology Group (COG). In this article, we review some of the current surgical controversies surrounding the management of WT.
Collapse
Affiliation(s)
- Karen Milford
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Keara DeCotiis
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Nephron Sparing Surgery for Synchronous Bilateral Wilms-Operative Steps. Indian J Surg Oncol 2018; 9:601-604. [PMID: 30538398 DOI: 10.1007/s13193-018-0793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022] Open
Abstract
Approximately 5% of children with Wilms tumor present with bilateral disease. The treatment challenge is to achieve a high cure rate while maintaining adequate long-term renal function. We report the feasibility and outcome of nephron sparing surgery in a child with bilateral Wilms tumor who was treated at our institution.
Collapse
|
16
|
Murphy AJ, Davidoff AM. Bilateral Wilms Tumor: A Surgical Perspective. CHILDREN-BASEL 2018; 5:children5100134. [PMID: 30250006 PMCID: PMC6210093 DOI: 10.3390/children5100134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 12/27/2022]
Abstract
Historically, the management of bilateral Wilms tumor (BWT) was non-standardized and suffered from instances of prolonged chemotherapy and inconsistent surgical management which resulted in suboptimal renal and oncologic outcomes. Because of the risk of end-stage renal disease associated with the management of BWT, neoadjuvant chemotherapy and nephron-sparing surgery have been adopted as the guiding management principles. This management strategy balances acceptable oncologic outcomes against the risk of end-stage renal disease. A recent multi-institutional Children’s Oncology Group study (AREN0534) has confirmed the benefits of standardized 3-drug neoadjuvant chemotherapy and the utilization of nephron-sparing surgery in BWT patients; however, less than 50% of patients underwent bilateral nephron-sparing surgery. The coordination of neoadjuvant chemotherapy and the timing and implementation of bilateral nephron-sparing surgery are features of BWT management that require collaboration between oncologists and surgeons. This review discusses the surgical management strategy in the context of BWT disease biology, with an emphasis on timepoints during therapy at which surgical decision making can greatly impact this disease and minimize long-term toxicities.
Collapse
Affiliation(s)
- Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
| |
Collapse
|
17
|
Powis M. Quality-assured cancer surgery for Wilms tumour: What is the role of the clinical trials groups? Pediatr Blood Cancer 2016; 63:1882-3. [PMID: 27472065 DOI: 10.1002/pbc.26151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mark Powis
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK.
| |
Collapse
|
18
|
Abstract
Surgeons play a pivotal role in the decision-making and multidisciplinary management of childhood solid tumours.1 Evidence-based medicine-"aims to optimise decision making by emphasising on the use of best evidence from well-designed conducted research." This article offers a brief overview in an effort to demonstrate how a selection of well-conducted, recently published studies can help address some topical and controversial themes in paediatric surgical oncology practice.
Collapse
Affiliation(s)
- Paul D Losty
- Alder Hey Children׳s Hospital NHS Foundation Trust, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| |
Collapse
|
19
|
Overall Survival and Renal Function of Patients With Synchronous Bilateral Wilms Tumor Undergoing Surgery at a Single Institution. Ann Surg 2015; 262:570-6. [PMID: 26366536 DOI: 10.1097/sla.0000000000001451] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Wilms tumor is the most common renal cancer in children. Approximately 5% of children with Wilms tumor present with disease in both kidneys. The treatment challenge is to achieve a high cure rate while maintaining long-term renal function. We retrospectively reviewed our institutional experience with nephron sparing surgery (NSS) in patients with synchronous bilateral Wilms tumor (BWT) operated on between 2001 and 2014. METHODS Imaging studies, surgical approach, adjuvant therapy, and pathology reports were reviewed. Outcomes evaluated included surgical complications, tumor recurrence, patient survival, and renal function, as assessed by estimated glomerular filtration rate. RESULTS A total of 42 patients with BWT were identified: 39 (92.9%) patients underwent bilateral NSS; only 3 patients (7.1%) underwent unilateral nephrectomy with contralateral NSS. Postoperative complications included prolonged urine leak (10), infection (6), intussusception (2), and transient renal insufficiency (1). Three patients required early (within 4 months) repeat of NSS for residual tumor. In the long-term, 7 (16.7%) patients had local tumor recurrence (managed with repeat NSS in 6 and completion nephrectomy in 1) and 3 had an episode of intestinal obstruction requiring surgical intervention. Overall survival was 85.7% (mean follow-up, 4.1 years). Of the 6 patients who died, 5 had diffuse anaplastic histology. All of the patients had an estimated glomerular filtration rate more than 60 mL/min/1.73 m at the last follow-up; no patient developed end-stage renal disease. CONCLUSIONS In patients with synchronous, BWT, bilateral NSS is safe and almost always feasible, thereby preserving maximal renal parenchyma. With this approach, survival was excellent, as was maintenance of the renal function.
Collapse
|
20
|
Kieran K, Ehrlich PF. Current surgical standards of care in Wilms tumor. Urol Oncol 2015; 34:13-23. [PMID: 26122713 DOI: 10.1016/j.urolonc.2015.05.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the second most common abdominal tumor in children. METHODS This chapter discusses surgical considerations for the management of unilateral and bilateral WT. RESULTS Currently, survival exceeds 90%, owing to multicenter studies under the auspices of the Children's Oncology Group and Société Internationale d'Oncologie Pédiatrique. Surgical excision remains the mainstay of oncologic control and is also crucial for proper staging of disease in order to direct adjuvant therapy and limit treatment-related morbidity. CONCLUSIONS Careful attention must be paid to proper disease staging, upfront and adjuvant therapy, and surgical technique in order to optimize oncologic outcomes while minimizing short- and long-term morbidity.
Collapse
Affiliation(s)
- Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98109.
| | | |
Collapse
|
21
|
Wilde JCH, Aronson DC, Sznajder B, Van Tinteren H, Powis M, Okoye B, Cecchetto G, Audry G, Fuchs J, Schweinitz DV, Heij H, Graf N, Bergeron C, Pritchard-Jones K, Van Den Heuvel-Eibrink M, Carli M, Oldenburger F, Sandstedt B, De Kraker J, Godzinski J. Nephron sparing surgery (NSS) for unilateral wilms tumor (UWT): the SIOP 2001 experience. Pediatr Blood Cancer 2014; 61:2175-9. [PMID: 25156758 DOI: 10.1002/pbc.25185] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 06/24/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Total nephrectomy (TN) remains the standard treatment of unilateral Wilms tumors (uWT). The SIOP WT-2001 protocol allowed Nephron Sparing Surgery (NSS) for polar or peripherally non-infiltrating tumors. AIM Inventory of the current SIOP NSS-experience. PROCEDURES 2,800 patients with a unilateral, localized or metastatic and an unequivocal surgical technique recorded were included. All had neo-adjuvant chemotherapy and delayed surgery. In 91 (3%) NSS was performed and in 2709 TN. Data was retrieved from the SIOP WT 2001 database. RESULTS NSS group contained 65% stage I tumours and the TN group 48%. Tumor volume (at diagnosis and surgery) was significantly smaller in the NSS group. Within stage III, after NSS, 7/12 (58%) had positive margins (M +), 5 with tumor negative lymph nodes (LN-). After TN, 355/712 (55%) had M + , 182 were LN-. Treatment of M+ in the NSS group resulted in two conversions to TN (one combined with radiotherapy), three patients had radiotherapy only and in two patients local therapy, if given, was not recorded. After NSS, four recurrences occurred. For localized disease the 5-year overall (OS) and event free survival (EFS) in NSS group was 100 and 94.8 (95% CI:89.9-99.9), respectively, while OS and EFS in the TN group were 94.4 (95% CI: 93.2-95.5, log-rank test P = 0.06) and 86.5 (95% CI:85.0-88.1, log-rank test P = 0.06), respectively. CONCLUSIONS NSS was only performed in 3% of patients with uWT. Despite excellent survival with few relapses, the gain of nephrons needs to be weighed against the risk to induce stage III with intensified therapy.
Collapse
Affiliation(s)
- Jim C H Wilde
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Warmann SW, Godzinski J, van Tinteren H, Heij H, Powis M, Sandstedt B, Graf N, Fuchs J. Minimally invasive nephrectomy for Wilms tumors in children - data from SIOP 2001. J Pediatr Surg 2014; 49:1544-8. [PMID: 25475791 DOI: 10.1016/j.jpedsurg.2014.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To analyse the surgical and oncological outcome of minimally invasive surgery (MIS) for tumor nephrectomy in Wilms tumor (WT) patients. METHODS WT patients from the SIOP 2001 trial, undergoing MIS for tumor nephrectomy were analyzed with regard to demographic characterization, surgical specifications, complications, and outcome. RESULTS There were 24 children matching the inclusion criteria. Median age at operation was 40.35 months (14.3-65.4). All patients received preoperative chemotherapy. Median tumor volume was 177.5 ml at diagnosis (46.5-958) and 73.0 ml at surgery (3.8-776). There was one surgical complication (splenic injury), no intraoperative tumor rupture occurred. Abdominal stage was I in 14, II in 7, and III in 3 patients. Adequate lymph node sampling was performed in only 2 patients. One local relapse occurred. Event-free survival was 23/24, overall survival was 24/24, median follow up was 47 months (2-114). CONCLUSIONS We present the largest series so far of minimally invasive nephrectomies for nephroblastoma based on a multinational trial. Treatment results were comparable to those of open surgery; however, experience of operating surgeons was generally high. Discipline of lymph node sampling was inadequate. Based on this analysis a prospective study on MIS in nephroblastoma is planned by the SIOP Renal Tumor Study Group.
Collapse
Affiliation(s)
- Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany.
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw and Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | | | - Hugo Heij
- Pediatric Surgical Center of Amsterdam (ECH-AMC/VUmc), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Bengt Sandstedt
- Childhood Cancer Research Unit, Astrid Lindgren's Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, University Hospital Homburg/Saar, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany
| |
Collapse
|
23
|
Kern AJM, Inouye B, Ko JS, Gorin MA, Allaf ME, Goldstein S, DiCarlo HN, Shah BB, Wang MH. Impact of nephrectomy on long-term renal function in non-syndromic children treated for unifocal Wilms tumor. J Pediatr Urol 2014; 10:662-6. [PMID: 25439657 DOI: 10.1016/j.jpurol.2014.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/20/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present study is designed to assess the long-term renal function of children who underwent radical nephrectomy for unifocal Wilms tumor. METHODS A single institution retrospective cohort study of non-syndromic children treated with radical nephrectomy for unifocal Wilms tumor between 1995 and 2011 was performed to identify risk factors for decreased glomerular filtration rate (GFR). The primary endpoint was decrease in age-adjusted GFR below normal published ranges. The secondary endpoint was progression to chronic renal insufficiency (CRI). RESULTS A total of 55 patients were identified in the cohort. Eight (15%) patients exhibited decreased age-adjusted GFR during the follow-up period, with 2 (4%) progressing to CRI. Increasing time between surgery and the last known GFR follow-up was associated with decreased GFR, with the normal GFR group having median follow-up of 7.32 years versus 11.47 years (p = 0.019) in the decreased GFR group. CONCLUSIONS A trend toward decline in GFR was detected with longer follow-up. Longer follow-up may reveal that clinically significant decline in renal function occurs years following nephrectomy among a subset of Wilms tumor survivors, even among those who do not progress to end stage renal disease.
Collapse
Affiliation(s)
- Adam J M Kern
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Brian Inouye
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joan S Ko
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael A Gorin
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Seth Goldstein
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Heather N DiCarlo
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bhavik B Shah
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ming-Hsien Wang
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
24
|
Nerli RB, Pujar VC, Hiremath MB, Jali SM, Joshi SS, Hiremath SC, Guntaka AK. Nephron sparing surgery for unilateral non-syndromic wilms tumor. Indian J Surg Oncol 2014; 5:11-6. [PMID: 24669161 DOI: 10.1007/s13193-013-0284-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 12/30/2013] [Indexed: 01/26/2023] Open
Abstract
The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66 ± 14.37 months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.
Collapse
Affiliation(s)
- R B Nerli
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India ; Department of Urology, KLE University's JN Medical College, Belgaum, 590010 India
| | - V C Pujar
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India
| | - M B Hiremath
- Department of Studies in Biotechnology & Microbiology, Karnatak University, Dharwad, India
| | - S M Jali
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India
| | - S S Joshi
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India
| | - S C Hiremath
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India
| | - A K Guntaka
- KLES Kidney Foundation, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka India
| |
Collapse
|
25
|
Ehrlich PF. Bilateral Wilms’ tumor: the need to improve outcomes. Expert Rev Anticancer Ther 2014; 9:963-73. [DOI: 10.1586/era.09.50] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Abstract
Wilms tumor represents the most common pediatric renal malignancy and the fourth most common childhood cancer overall. Overall survival from Wilms tumor has increased to over 90 % secondary to multidisciplinary therapy and multi-institutional cooperative group trials. Recent therapeutic focus has shifted to reduction in treatment morbidity and renal preservation while maintaining the high survival rates. Partial nephrectomy is an integral component of the multimodal treatment protocols for Wilms tumor patients with bilateral disease, solitary kidney, or predisposing syndromes. Recent consideration has been given to utilization of nephron sparing surgery (NSS) in carefully selected patients with nonsyndromic unilateral Wilms tumor. While long-term, prospective data in this subgroup of patients is not yet available, case series demonstrate comparable oncologic outcomes after partial versus radical nephrectomy. The relative rarity of Wilms tumor, especially those amenable to upfront partial nephrectomy, presents a challenge to conducting controlled trials.
Collapse
Affiliation(s)
- Miriam Harel
- Connecticut Children's Medical Center, Hartford, CT, USA.
| | | | | |
Collapse
|
27
|
The use of Tachosil as hemostatic sealant in nephron sparing surgery for Wilms tumor: preliminary observations. J Pediatr Surg 2013; 48:689-94. [PMID: 23480936 DOI: 10.1016/j.jpedsurg.2013.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/19/2012] [Accepted: 01/08/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND TachoSil, which is an absorbable collagen sponge coated with human fibrinogen and thrombin, has proven to enhance hemostasis and promote optimal wound healing in adults undergoing nephron sparing surgery (NSS). We report our preliminary experience using this hemostatic agent during NSS in children. METHODS Prospective analysis of 3 patients with Wilms tumor (synchronous bilateral in one) undergoing NSS at our institution over an 18-month period. Primary outcome measures were intraoperative bleeding control and surgery-related postoperative sequelae. RESULTS Overall, 4 kidneys underwent 5 NSS procedures, which included 3 partial nephrectomies and multiple tumor excisions performed on another kidney at initial and second-look surgery. After control of major bleeding and suturing of the collecting system, which was entered during 2 of the 5 NSS procedures, TachoSil was applied to the parenchymal surface of the kidney, achieving immediate hemostasis. All NSS procedures were performed without hilar clamping, drainage or stent placement. None of the patients required blood transfusion. Small perirenal fluid collections were documented postoperatively, and all spontaneously resolved within 4 weeks of surgery. CONCLUSION In children undergoing NSS, TachoSil represents an effective and safe tool for control of mild to moderate bleeding, and also facilitates sealing and wound dressing.
Collapse
|
28
|
Romão RL, Pippi Salle JL, Shuman C, Weksberg R, Figueroa V, Weber B, Bägli DJ, Farhat WA, Grant R, Gerstle JT, Lorenzo AJ. Nephron Sparing Surgery for Unilateral Wilms Tumor in Children with Predisposing Syndromes: Single Center Experience Over 10 Years. J Urol 2012; 188:1493-8. [DOI: 10.1016/j.juro.2012.02.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Indexed: 01/26/2023]
Affiliation(s)
- Rodrigo L.P. Romão
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - João L. Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Rosanna Weksberg
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Victor Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Bryce Weber
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Darius J. Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Walid A. Farhat
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ronald Grant
- Department of Pediatrics, Division of Hematology Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - J. Ted Gerstle
- Division of General and Thoracic Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Armando J. Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Szymik-Kantorowicz S, Urbanowicz W, Surmiak M, Sulisławski J. Therapeutic results in stage I Wilms' tumors in children - 15 years of surgical experience. Cent European J Urol 2012; 65:151-5. [PMID: 24578953 PMCID: PMC3921794 DOI: 10.5173/ceju.2012.03.art11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/01/2011] [Accepted: 09/01/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Progress in the therapeutic management of Wilms' tumors (WT) in children has resulted in the fact that presently, almost all children with stage I and favorable histology diseases have a chance for a cure. THE AIM OF THE STUDY The objective of the report is an analysis of therapeutic results in children with unilateral stage I Wilms' tumors depending on the extent of tumor resection. MATERIAL AND METHODS The analysis included children treated between 1993 and 2008 under the Polish Wilms' Tumor Study, initially following the protocol SIOP 93-01 (patients treated up to 2002) and subsequently SIOP 2001. Following neoadjuvant chemotherapy, depending on tumor size and tumor response to treatment, the children were qualified for a radical nephrectomy, simple nephrectomy, or nephron-sparing surgery. Following surgical treatment, all the children were subjected to adjuvant chemotherapy in keeping with the therapeutic protocol obligatory at the time. RESULTS Within the 15 years, 111 children with Wilms' tumor were treated; the group included 43 children with stage I disease, which constituted 38.9% of the total number. Radical nephrectomies were performed in three (6.98%) children, simple nephrectomies in 32 (74.42%), and nephron-sparing surgery in eight (18.6%). Regardless of the employed surgical treatment modality, all the children are alive and none have demonstrated recurrent disease. The mean post-treatment completion follow-up period is 73 months (median value, 68 months). CONCLUSION A simple nephrectomy and, whenever possible, nephron-sparing surgery represents sufficient treatment in 93% of children with stage I Wilms' tumor. To improve qualification for surgical treatment we propose the employment of NSS for stage Ia Wilms' tumors and SN for stage Ib Wilms' tumors.
Collapse
Affiliation(s)
- Sabina Szymik-Kantorowicz
- Department of Pediatric Surgery Collegium Medicum Jagiellonian University in Cracow; Institute of Clinical Farmacy Jagiellonian University Collegium Medicum in Cracow, Poland
| | - Wiesław Urbanowicz
- Department of Pediatric Urology Collegium Medicum Jagiellonian University in Cracow, Poland
| | - Marcin Surmiak
- Laboratory of Molecular Biology and Clinical Genetics Collegium Medicum Jagiellonian University in Cracow, Poland
| | - Janusz Sulisławski
- Department of Pediatric Urology Collegium Medicum Jagiellonian University in Cracow, Poland
| |
Collapse
|
30
|
Cost NG, Lubahn JD, Granberg CF, Sagalowsky AI, Wickiser JE, Gargollo PC, Baker LA, Margulis V, Rakheja D. Pathological review of Wilms tumor nephrectomy specimens and potential implications for nephron sparing surgery in Wilms tumor. J Urol 2012; 188:1506-10. [PMID: 22910241 DOI: 10.1016/j.juro.2012.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE Nephron sparing surgery is accepted as standard of care for children with bilateral Wilms tumor or Wilms tumor in a solitary kidney and some study protocols allow nephron sparing surgery in select cases of unilateral Wilms tumor. With the increasing use of nephron sparing surgery in Wilms tumor, we reviewed pathological features from Wilms tumor radical nephrectomy specimens to determine the potential efficacy of a nephron sparing approach. MATERIALS AND METHODS Medical records of children undergoing pre-chemotherapy radical nephrectomy for unilateral Wilms tumor at our institution were reviewed. Ideal candidates for nephron sparing surgery were defined as those having a unifocal mass outside the renal hilum, sparing a third or more of the kidney, favorable histology, no signs of renal sinus or segmental vascular invasion, no metastatic lymph nodes or gross regional disease, and a distinct interface on pathological review between tumor and remaining parenchyma. RESULTS A total of 78 children at a median age of 3.2 years (range 0.3 to 16.2) underwent pre-chemotherapy radical nephrectomy for unilateral Wilms tumor. Median tumor diameter was 11 cm (range 2.5 to 22). Of these children 36 (46.2%) had tumors sparing a third or more of the kidney and 70 (89.7%) had unifocal tumors. There were 73 specimens (94.6%) that showed favorable histology, and 56 (71.8%) of the specimens had a distinct border between tumor and remaining parenchyma. In total, 19 (24.4%) of the patients reviewed met all of our strict pathological criteria as ideal partial nephrectomy candidates. CONCLUSIONS In a post hoc analysis using strict pathological criteria and accepted surgical oncologic principles, as many as 1 in 4 children undergoing pre-chemotherapy surgery for nonmetastatic, unilateral Wilms tumor have post-resection pathological tumor characteristics favorable for nephron sparing surgery.
Collapse
Affiliation(s)
- Nicholas G Cost
- Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 45229, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Piché N, Barrieras D. Minimally invasive nephron-sparing surgery for unilateral Wilms tumor. J Pediatr Surg 2012; 47:E1-4. [PMID: 22813823 DOI: 10.1016/j.jpedsurg.2012.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/22/2012] [Accepted: 02/08/2012] [Indexed: 11/29/2022]
Abstract
Minimally invasive surgery (MIS) for nephrectomy has been described since the early 1990s. More recently, MIS has been used for nephron-sparing surgery (NSS) when treating benign conditions. However, reports of NSS using MIS for malignant conditions are sparse. In this report, we describe our retroperitoneal laparoscopic approach for NSS for a localized Wilms tumor.
Collapse
Affiliation(s)
- Nelson Piché
- Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | |
Collapse
|
32
|
Nephron-sparing partial nephrectomy for bilateral Wilms' tumor. J Pediatr Surg 2012; 47:1234-8. [PMID: 22703799 DOI: 10.1016/j.jpedsurg.2012.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE Partial nephrectomy is increasingly used in children with bilateral Wilms' tumor (BWT) or contralateral recurrence. Nephron-sparing surgery seeks to achieve complete tumor removal while preserving functional renal parenchyma. Previous series have documented high rates of complications, recurrence, and mortality. METHODS Twelve patients (4 boys and 8 girls aged 9-42 months) with BWT or contralateral recurrence were treated at our institution with unilateral or bilateral partial nephrectomy. Preoperative imaging, operative notes, and pathology reports were reviewed. Outcomes analyzed included complications, recurrence, readmission rate, postoperative glomerular filtration rate (GFR), and survival. RESULTS All patients underwent successful nephron-sparing resection using standard techniques, with only 2 patients requiring unilateral nephrectomy. Median length of stay was 3 days. There were no major complications or urine leaks. Two patients were lost to follow-up. The remaining 10 were followed up for a median of 36 months (range, 3-79 months). There have been no recurrences or unplanned readmissions. Mean GFR is 107.7 (± 32.8) mL/min per 1.73 m(2), with no patient having a GFR below the lower limit of normal for age. CONCLUSION Nephron-sparing resection is a safe and effective approach for children with BWT or contralateral recurrence and should be part of the multimodality therapeutic approach to this disease.
Collapse
|
33
|
Abstract
Significant improvement has been made in the treatment of children with Wilms tumor. New protocols are in place designed to maintain a high rate of cure for these patients while minimizing toxicity, based on refinement of the risk-stratification system.
Collapse
Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
34
|
Godzinski J, van Tinteren H, de Kraker J, Graf N, Bergeron C, Heij H, von Schweinitz D, Fuchs J, Cecchetto G, Audry G, Gauthier F, Sandstedt B. Nephroblastoma: does the decrease in tumor volume under preoperative chemotherapy predict the lymph nodes status at surgery? Pediatr Blood Cancer 2011; 57:1266-9. [PMID: 21538820 DOI: 10.1002/pbc.23147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/11/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Partial nephrectomy (NSS) for unilateral nephroblastoma may be beneficial, although in case of regional lymph node (LN) involvement, radiotherapy counteracts the functional benefit of NSS. The aim is to verify whether decrease of tumor volume under preoperative chemotherapy implies clearance of regional LN. PROCEDURE SIOP 9301 (1993-2001) collected 1,450 localized nephroblastoma patients of whom 1,360 (93%) had sufficiently available data and were retrospectively reviewed. RESULTS Histologic subtypes were classically distributed. Patients were divided in those with tumor positive LN (76, 5.5%) and those with tumor negative LN (1,284, 94.5%) at surgery. In the LN(+) group, the tumor volume changed from a median of 554 (318-772) to 192 (63-458) ml = 67% (27-88%) during preoperative ChT. In the LN(-) group-377 (200-612) to 130 (44-294) ml = 62% (28-83%) (NS). Increase of tumor volume was observed in 16% of patients with LN(+), and 11% of those with LN(-) (NS); ranges are interquartile. Initial tumor volume was significantly larger in the LN(+) patients (P = 0.00091) but not different (NS) at surgery; patients with initial tumor volume under 318 ml had the regional LN involved significantly less frequently (P = 0.00751). CONCLUSIONS Change in tumor volume under preoperative chemotherapy is not a predictor for LN status at surgery, although larger initial volume is associated with a higher risk of LN invasion. The decrease of tumor volume is not a good criterion for the safety of NSS. The low rate of LN(+) (5.5%) indicates that this risk is low.
Collapse
Affiliation(s)
- Jan Godzinski
- Marciniak Hospital, Pediatric Surgery, Wroclaw and Technical University of Opole, Institut of Physiotherapy, Opole, Poland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Chui CH, Lee ACW. Peritoneal metastases after laparoscopic nephron-sparing surgery for localized Wilms tumor. J Pediatr Surg 2011; 46:e19-21. [PMID: 21376182 DOI: 10.1016/j.jpedsurg.2010.11.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 02/05/2023]
Abstract
A 2-year-old girl was referred for the management of the progression of her localized Wilms tumor. She had undergone laparoscopic nephron-sparing surgery for her right Wilms tumor 3 months earlier. Postoperative chemotherapy was commenced 6 weeks later. Subsequent computer tomographic evaluation 12 weeks postsurgery showed local recurrence and peritoneal tumors. These findings were confirmed at laparotomy. We report the first case of peritoneal tumor dissemination after laparoscopic nephron-sparing surgery for localized Wilms tumor.
Collapse
Affiliation(s)
- Chan-Hon Chui
- Surgery Centre for Children Pte Ltd, Mount Elizabeth Medical Centre, Singapore.
| | | |
Collapse
|
36
|
Nuwayhid Z, Rodriguez MM, Prescott A, Ciancio G, Rojas CP, Casillas J, Sola JE. Renal glomus tumor in an adolescent: a conservative approach. J Pediatr Surg 2010; 45:e23-6. [PMID: 20620296 DOI: 10.1016/j.jpedsurg.2010.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 03/23/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
The most common renal neoplasms in the second decade of life are renal cell carcinomas and Wilms' tumors. Glomus tumors arising in the kidney are rare. We report an adolescent with a benign renal glomus tumor excised by wedge resection. Nephron-sparing surgery is the therapy of choice for children with benign renal tumors. Glomus tumor should be considered in the differential diagnosis of a renal mass in a young patient.
Collapse
Affiliation(s)
- Zaher Nuwayhid
- Department of Surgery, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Pediatric surgical oncology in China: present and future. World J Pediatr 2009; 5:85-8. [PMID: 19718528 DOI: 10.1007/s12519-009-0018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 10/07/2008] [Indexed: 10/20/2022]
|
38
|
Davidoff AM, Giel DW, Jones DP, Jenkins JJ, Krasin MJ, Hoffer FA, Williams MA, Dome JS. The feasibility and outcome of nephron-sparing surgery for children with bilateral Wilms tumor. Cancer 2008; 112:2060-70. [DOI: 10.1002/cncr.23406] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
39
|
Wilms tumour: prognostic factors, staging, therapy and late effects. Pediatr Radiol 2008; 38:2-17. [PMID: 18026723 DOI: 10.1007/s00247-007-0687-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/15/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
Wilms tumour is the most common malignant renal tumour in children. Dramatic improvements in survival have occurred as the result of advances in anaesthetic and surgical management, irradiation and chemotherapy. Current therapies are based on trials and studies primarily conducted by large multi-institutional cooperatives including the Société Internationale d'Oncologie Pédiatrique (SIOP) and the Children's Oncology Group (COG). The primary goals are to treat patients according to well-defined risk groups in order to achieve the highest cure rates, to decrease the frequency and intensity of acute and late toxicity and to minimize the cost of therapy. The SIOP trials and studies largely focus on the issue of preoperative therapy, whereas the COG trials and studies start with primary surgery. This paper reviews prognostic factors and staging systems for Wilms tumour and its current treatment with surgery and chemotherapy. Surgery remains a crucial part of treatment for nephroblastoma, providing local primary tumour control and adequate staging and possibly controlling the metastatic spread and central vascular extension of the disease. Partial nephrectomy, when technically feasible, seems reasonable not only in those with bilateral disease but also in those with unilateral disease where the patient has urological disorders or syndromes predisposing to malignancy. Partial nephrectomy, however, is frequently not sufficient for an anaplastic variant of tumour. The late effects for Wilms tumour and its treatment are also reviewed. The treatment of Wilms tumour has been a success story, and currently in excess of 80% of children diagnosed with Wilms tumour can look forward to long-term survival, with less than 20% experiencing serious morbidity at 20 years from diagnosis. The late complications are a consequence of the type and intensity of treatment required, which in turn reflects the nature and extent of the original tumour. Continual international trial development and participation will improve matching of treatment needs with prognosis, reducing long-term complications in the majority. The advent of molecular markers of disease severity and improved functional imaging might help.
Collapse
|