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Sforza S, Palmieri VE, Raspollini MR, Roviello G, Mantovani A, Basso U, Affinita MC, D'Angelo A, Antonuzzo L, Carini M, Minervini A, Masieri L. Robotic approach with neoadjuvant chemotherapy in adult Wilms' tumor: A feasibility study report and a systematic review of the literature. Asian J Urol 2023; 10:128-136. [PMID: 36942112 PMCID: PMC10023547 DOI: 10.1016/j.ajur.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 06/04/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The incidence of Wilms' tumor (WT) among adult individuals accounts for less than 1% of kidney cancer cases, with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70% for the adult patients versus 90% for the pediatric cases. The diagnosis and treatment of WT are complex in the preoperative setting; neoadjuvant chemotherapy (NAC) or robotic surgery has rarely been described. This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy. Methods We reported a case of WT managed in a multidisciplinary setting. Furthermore, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations, a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out. Results A 33-year-old female had a diagnosis of WT. She was scheduled to NAC, and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection, she was managed with no intraoperative rupture, a favorable surgical outcome, and a follow-up of 25 months, which did not show any recurrence. The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT. Of these, approximately 15 patients were carried out using robotic surgery in adolescents while none in adults. Moreover, NAC has not been administered before minimally invasive surgery in adults up until now. Conclusion WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far. The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario. Notwithstanding, additional cases of adult WT need to be identified and investigated to improve the oncological outcome.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
- Corresponding author. Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
| | | | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Alberto Mantovani
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Maria Carmen Affinita
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - Lorenzo Antonuzzo
- Clinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
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Jiang HF, Tian XM, Ma W, Shi QL, Lu P, Liu F, Liu X, He DW, Lin T, Wei GH. Practice status and influencing factors of adrenalectomy in patients with Wilms tumor. Asian J Surg 2023; 46:52-57. [PMID: 35618582 DOI: 10.1016/j.asjsur.2022.05.004] [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: 02/09/2022] [Revised: 03/30/2022] [Accepted: 05/06/2022] [Indexed: 01/07/2023] Open
Abstract
To investigate the clinical practice status and factors that influence adrenalectomy along with the impact on prognosis in patients with Wilms Tumor (WT). We retrospectively reviewed the demographic, clinical, and follow-up data of patients with WT, including age, tumor side, tumor volume, tumor location within the kidney, stage, pathological type, tumor rupture, levels of adrenocorticotropin (ACTH), renin, aldosterone, and adrenal management, as well as outcomes. The primary outcomes are adrenal practice status and 5-year relapse-free survival (RFS). A total of 162 patients were enrolled in this study. Of these, 131 patients underwent radical nephrectomy with adrenalectomy, and adrenal invasion was only noted in three patients (2.3%). Adrenalectomy was associated with tumor volume and clinical stage (P < 0.05). Multivariable logistic regression analysis (OR = 3.982, P = 0.005) and ROC curve analysis (AUC = 0.708, P = 0.0003) revealed that a larger tumor volume independently increased the risk of adrenalectomy. Adrenalectomy was not significantly associated with tumor location, tumor rupture, or local recurrence (P > 0.05). In addition, the study median follow-up was 50.95 months. The 5-year RFS rates of patients with removed adrenal gland and preserved adrenal gland were 90.3% and 75.8%, respectively (P = 0.078). We followed up children more than 3 years after removal of the adrenal glands, and no children with reduced ACTH, aldosterone, or renin were found. Multivariate Cox regression analysis showed no significant difference on prognosis (P = 0.203), even after adjusting for clinical stage and pathological type. Finally, no evidence of adrenal insufficiency was reported during the follow-up examinations. Our data indicated that invasion of the ipsilateral adrenal gland is rare in WT. Preserving the ipsilateral adrenal gland was not associated with prognosis. Preoperative adequate assessment tumor volume and intraoperative detection of adrenal invasion were necessary to determine whether or not to perform an adrenal resection.
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Affiliation(s)
- Hong-Fei Jiang
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xiao-Mao Tian
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Wei Ma
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Qin-Lin Shi
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China.
| | - Peng Lu
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Feng Liu
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xing Liu
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Da-Wei He
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Tao Lin
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Guang-Hui Wei
- Department of Urology, Children Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
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Vu MT, Shalkow J, Naik-Mathuria B, Qureshi SS, Ozgediz D, Lakhoo K, Abdelhafeez H. Wilms’ tumor in low- and middle-income countries: survey of current practices, challenges, and priorities. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To identify the current practices and priorities in Wilms’ tumor management for surgeons in low- and middle-income countries (LMICs).
Methods
One hundred thirty-seven pediatric surgeons from 44 countries completed surveys on Wilms’ tumor surgical strategy in LMIC. This survey was distributed through the Global Initiative for Children’s Surgery, Pan-African Pediatric Surgical Association, and Latin American Pediatric Surgical Oncology Group.
Results
Ninety-two respondents (67.2%) participated from 19 lower middle-income countries (43.2%). Twenty-one respondents (15.3%) participated from nine lower income countries (20.5%). Nineteen respondents (13.9%) participated from 13 upper middle-income countries (29.5%). Most providers do not obtain biopsy for suspected Wilms’ tumor (79%). Delayed resection after preoperative chemotherapy is the preferred approach (70%), which providers chose due to protocol (45%), to decrease tumor rupture (22%), and to decrease complications (8%). The providers’ goal was to prevent tumor spillage and upstaging (46%) or to prevent bleeding, complication, or other organ resections (21%). Most surgeons believed that upfront resection increased the risk of tumor spillage (72%).
Conclusion
Providers in LMICs prefer delayed resection after preoperative chemotherapy to reduce the incidence of tumor spillage and upstaging of Wilms’ tumor. An evidence-based guideline tailored to the LMIC context can be developed from these findings.
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Brisse HJ, de la Monneraye Y, Cardoen L, Schleiermacher G. From Wilms to kidney tumors: which ones require a biopsy? Pediatr Radiol 2020; 50:1049-1051. [PMID: 32248272 DOI: 10.1007/s00247-020-04660-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022]
Abstract
Ninety percent of childhood renal tumors are Wilms tumors (nephroblastoma). While the Children's Oncology Group (COG) recommends primary surgery, the International Society of Paediatric Oncology (SIOP) recommends neoadjuvant chemotherapy, which can be initiated without histological confirmation if the presentation is typical for Wilms tumor. This review article describes the clinical, biological and radiologic criteria used by the SIOP community to consider diagnostic biopsy, i.e. when the renal origin is doubtful, when a pseudotumor is suspected or when a non-Wilms histology may be anticipated.
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Affiliation(s)
- Hervé J Brisse
- Department of Imaging, Institut Curie, 26 rue d'Ulm, 75005, Paris, France.
- Paris Sciences et Lettres Research University, Paris, France.
| | - Yvan de la Monneraye
- Oncology Center SIREDO (Care, innovation, research for cancer in children, adolescents and young adults), Institut Curie, Paris, France
| | - Liesbeth Cardoen
- Department of Imaging, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
- Paris Sciences et Lettres Research University, Paris, France
| | - Gudrun Schleiermacher
- Paris Sciences et Lettres Research University, Paris, France
- Oncology Center SIREDO (Care, innovation, research for cancer in children, adolescents and young adults), Institut Curie, Paris, France
- INSERM U830 Transfer Department, RTOP (Translational Research in Pediatric Oncology), Institut Curie, Paris, France
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5
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Qureshi SS, Kembhavi SA, Bhagat M, Kapadia T, Prasad M, Vora T, Chinnaswamy G, Ramadwar M, Laskar S, Khanna N, Baheti A, Shah S, Kurkure P, Talole S. Customized approach for upfront or delayed resection using radiological criteria in unilateral, nonmetastatic pediatric renal tumors: A prospective study. Pediatr Blood Cancer 2019; 66 Suppl 3:e27815. [PMID: 31099132 DOI: 10.1002/pbc.27815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The availability of robust, equivalent data regarding outcomes for upfront or delayed surgery for renal tumors in children leads to a dilemma in selecting the initial treatment. Imaging criteria associated with the probability of rupture or incomplete resection may provide a more objective assessment for customization for the timing of surgery. PROCEDURE Eighty-three children with unilateral, nonmetastatic renal tumors were enrolled between January 2012 and April 2018. Upfront nephrectomy was performed in the absence or delayed surgery (after a biopsy and chemotherapy) in the presence of one or more imaging-based high-risk features, including perinephric spread or adjacent organ infiltration, tumors crossing the midline, intravascular thrombus, and extensive adenopathy. Post hoc analysis for interobserver concordance for high-risk imaging features was also performed. RESULTS The upfront surgery group (19) had predominantly stage I or II diseases (89%) and the histological types were Wilms (13), non-Wilms (5) renal tumor, and an inflammatory lesion. The delayed surgery group had 60% with stage I or II diseases and the histological types were Wilms (60) and non-Wilms (4) tumor. In addition, high-risk pathology was identified in nine patients. Overall, 27 patients with Wilms tumors required radiotherapy and anthracycline because of stage III disease, including one in the immediate surgery group. The event-free and overall survival (OS) at a median follow-up of 39 months for Wilms tumor are 88% (95% confidence interval [CI]: 78.5-94.9%) and 89% (95% CI: 81.4-96.6%), 85.1% (95% CI: 73.8-93.4%) and 86.5% (95% CI: 77.4-95.8%) for the delayed, and 100% event-free survival as well as OS (P = .1) in the upfront surgery group. CONCLUSION A customized approach pivoted on image-based high-risk features facilitates identification of patients with early-stage renal tumor when the timing of surgery is tailored. Moreover, non-Wilms tumor and high-risk pathology are also identified.
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Affiliation(s)
- Sajid S Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Monica Bhagat
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Tejas Kapadia
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| | - Maya Prasad
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Tushar Vora
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Akshay Baheti
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| | - Sneha Shah
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| | - Purna Kurkure
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sanjay Talole
- Department of Biostatistics, Tata Memorial Centre, Mumbai, India
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Brisse H, de La Monneraye Y, Schleiermacher G. Reply to comment on: The diagnostic accuracy and clinical utility of pediatric renal tumor biopsy: Report of the UK experience in the SIOP UK WT2001 trial. Pediatr Blood Cancer 2019; 66:e27828. [PMID: 31115131 DOI: 10.1002/pbc.27828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Hervé Brisse
- Imaging Department, Institut Curie, Paris, France
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Kurose N, Takenaka M, Yamashita M, Shimaguchi C, Nakano M, Britni B, Guo X, Futatsuya C, Shioya A, Yamada S. A case report of infantile cystic nephroblastoma. Diagn Pathol 2018; 13:84. [PMID: 30368245 PMCID: PMC6204273 DOI: 10.1186/s13000-018-0761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nephroblastoma (NB) is a malignant embryonal neoplasm derived from nephrogenic blastemal cells. NB usually forms a solid mass, but in extremely rare cases, it may show cystic changes. CASE PRESENTATION A six-month-old girl with persistent high fevers was found to have pyuria and bacteriuria. Ultrasonography revealed multilocular cysts in the right kidney. Right nephrectomy was performed with cyst wall rupture during surgery. An intraoperative rapid diagnosis, based on peritoneal fluid cytology, confirmed three components of blastemal, stromal, and epithelial cells. The blastemal cells were dyshesive, with scant to no cytoplasm and were the predominant cell type. The spindle-shaped stromal cells were arranged in fascicles. The epithelial cells demonstrated tubular structures. Macroscopically, the resected cystic tumor measured 80 mm in maximum diameter with a prominently thin cyst wall, but solid areas were also apparent. Histologically, the tumor was diagnosed as cystic NB (blastemal-predominant) displaying a triphasic pattern. Hyperchromatic nuclei and apoptotic bodies were found. The clinical stage classification of Japan Wilms Tumor Study group was 3. The patient was treated with chemotherapy and radiotherapy. Tumor recurrence and metastasis have not been observed in the 8 months since surgery. CONCLUSION This is an extremely rare case of infantile cystic NB. We diagnosed the NB cells that appeared in the peritoneal fluid by intraoperative rapid cytology. Cytological examination proved to be a very useful technique for determining the clinical stage of NB. Additionally, we propose that massive tumor degeneration and necrosis be considered as a pathogenic mechanism of cyst formation in NB.
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MESH Headings
- Ascitic Fluid/pathology
- Biopsy
- Chemotherapy, Adjuvant
- Female
- Humans
- Infant
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Nephrectomy
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography
- Wilms Tumor/diagnostic imaging
- Wilms Tumor/pathology
- Wilms Tumor/surgery
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Affiliation(s)
- Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
| | - Michiho Takenaka
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Manabu Yamashita
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Chie Shimaguchi
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Mariko Nakano
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Bryant Britni
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT USA
| | - Xin Guo
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
| | - Chizuru Futatsuya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
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Oue T, Yoneda A, Usui N, Sasaki T, Zenitani M, Tanaka N, Uehara S, Ibuka S, Takama Y, Okuyama H. Image-based surgical risk factors for Wilms tumor. Pediatr Surg Int 2018; 34:29-34. [PMID: 29119252 DOI: 10.1007/s00383-017-4210-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The standard treatment for Wilms tumor (WT) is primary resection. However, in cases with unresectable tumor or tumor spillage, which are considered to have high surgical risks, more intensive chemotherapy and radiotherapy are required. In the present study, we retrospectively analyzed preoperative image parameters to identify factors associated with surgical risks. METHODS Twenty-nine patients with WT were enrolled in this study. Data on various preoperative image parameters, such as tumor size, tumor volume, displacement of great vessels, and contralateral extension of the tumor were collected, and their relationship with surgical factors, including operative time, hemorrhage, tumor spillage, and unresectability were analyzed. RESULTS Patients with unresectable tumor or with tumor spillage (surgical high-risk group) more frequently demonstrated displacement of great vessels and contralateral tumor extension. Operative time and blood loss were also significantly related to tumor size, area, volume, displacement of great vessels and contralateral extension. CONCLUSION Besides tumor size, displacement of great vessels and contralateral extension were significantly associated with surgical risks. These factors are easily determined using CT images and are, therefore, useful to decide whether preoperative chemotherapy should be started instead of primary tumor resection for large localized WTs.
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Affiliation(s)
- Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan.
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Miyakojima Hon-Dori, Miyakojima-ku, Osaka-shi, Osaka, 2-15-16, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Takashi Sasaki
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Natsumi Tanaka
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Osaka City General Hospital, Miyakojima Hon-Dori, Miyakojima-ku, Osaka-shi, Osaka, 2-15-16, Japan
| | - Soji Ibuka
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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