1
|
Ardicli B, User IR, Ciftci AO, Akyuz C, Kutluk MT, Yalcin B, Gonc N, Ozon ZA, Alikasifoglu A, Oguz B, Haliloglu M, Orhan D, Tanyel FC, Karnak I, Ekinci S. Adrenocortical tumours in children: a review of surgical management at a tertiary care centre. ANZ J Surg 2021; 91:992-999. [PMID: 33438328 DOI: 10.1111/ans.16542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adrenocortical tumours (ACT) are rare tumours of childhood usually presenting with endocrine dysfunction. This retrospective study is designed to review our institutional experience in surgical management. METHODS Records of children treated for ACT between 1999 and 2019 were reviewed retrospectively. RESULTS The median age of 24 children was 78 months. Fourteen patients had adrenocortical carcinoma, nine had adrenocortical adenoma and one had neuroendocrine differentiation of ACT. Endocrine dysfunction was noted in 79% of the patients. Five patients had preoperative chemotherapy but none had a decrease in tumour size. Transabdominal approach was used in all but two patients who had thoracoabdominal incision for excision of giant tumours and ipsilateral lung metastases. Two patients had visceral excision to achieve R0 resection. Five patients, four of whom had spillage and one with partial resection died of widespread disease. Two patients with stage 4 adrenocortical carcinoma are still on chemotherapy. All patients with stage I-III disease who had total excision without spillage (n = 17) are disease-free for 2-170 months. CONCLUSIONS Our results show the importance of excision in ACT without spillage for survival. However, multicentre prospective studies should enhance the knowledge of children about ACT and develop alternative therapies for stage III and IV cases.
Collapse
Affiliation(s)
- Burak Ardicli
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Idil R User
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Arbay O Ciftci
- Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Canan Akyuz
- Department of Paediatric, Paediatric Oncology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mustafa T Kutluk
- Department of Paediatric, Paediatric Oncology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalcin
- Department of Paediatric, Paediatric Oncology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Nazli Gonc
- Department of Paediatric, Paediatric Endocrinology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Zeynep A Ozon
- Department of Paediatric, Paediatric Endocrinology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ayfer Alikasifoglu
- Department of Paediatric, Paediatric Endocrinology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Paediatric Radiology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Paediatric Radiology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Paediatrics, Paediatric Pathology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Feridun C Tanyel
- Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Karnak
- Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
Karakus SC, User IR, Akcaer V, Ozokutan BH, Ceylan H. A simple technique for small-diameter urethrocutaneous fistula repair: Ligation. J Pediatr Urol 2017; 13:88-90. [PMID: 28034639 DOI: 10.1016/j.jpurol.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/27/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a simple and effective technique for repairing a small-diameter urethrocutaneous fistula. METHODS AND TECHNIQUE A total of 13 patients with a solitary and small-diameter (≤2 mm) urethrocutaneous fistula underwent repair with a ligation technique. RESULTS None of the patients had voiding difficulties. One recurrent urethrocutaneous fistula occurred and it was successfully repaired with the same technique. CONCLUSION This is a simple, quick and useful technique, particularly for small-diameter (≤2 mm) urethrocutaneous fistulas.
Collapse
Affiliation(s)
- S C Karakus
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
| | - I R User
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - V Akcaer
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - B H Ozokutan
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - H Ceylan
- Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| |
Collapse
|
3
|
User IR, Ekinci S, Kale G, Akyüz C, Büyükpamukçu M, Karnak I, Çiftçi AÖ, Tanyel FC, Şenocak ME. Management of bilateral Wilms tumor over three decades: The perspective of a single center. J Pediatr Urol 2015; 11:118.e1-6. [PMID: 25842994 DOI: 10.1016/j.jpurol.2014.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Outcomes of Wilms tumor improved in last 50 years and excellent survival rates can be achieved especially in case of non-metastatic disease and favorable histology. Nevertheless, bilateral cases still stand as a therapeutic challenge. Prognosis of bilateral Wilms tumor (BWT) is not as good as the unilateral tumors of similar stage and histology in terms of survival and renal function. OBJECTIVE Management of BWT is constantly evolving and still stands as a therapeutic challenge. This study is designed to review and share our experiences on this topic from a surgical standpoint. STUDY DESIGN The records of patients treated in our clinic between 1980 and 2013 according to Turkish Pediatric Group of Oncology protocol were analyzed retrospectively and clinical data, surgical details, pathology results, long term outcomes were analyzed. RESULTS Thirteen girls and 7 boys with a mean age of 2,5 years were treated. There were 2 patients with Wilms tumor-Aniridia-Growth Retardation complex and one with isolated hemihypertrophy. Metastasis were detected in lungs of 4 patients; liver of 2 and in the cranium of one. All patients except one with the presumptive diagnosis of unilateral Wilms tumor were given preoperative chemotherapy. To sum up; 19 nephroureterectomies, 8 partial nephrectomies and 13 enucleations were performed to 36 kidneys without any major early or late postoperative complications. Pathologic results revealed positive surgical margins in 2 lesions with enucleation and in 2 with partial nephrectomies and anaplasia in 4 patients. Two patients were not operated due to parental disapproval. Two patients had the need of dialysis; one was anephric and the others' renal functions recovered over a year. Seven patients received radiotherapy for pulmonary metastasis, positive surgical margins or local recurrences. Overall, 13 patients survived and 7 died due to metastasis, recurrences, and complication of dialysis and refusal of surgical treatment. Survival among all patients was 65% and 72.2% among operated ones. Of the 7 patients with the partial nephrectomy, 2 died and 5 survived. Among enucleation group, 8 out of 10 survived and 2 died. Survival was slightly higher among enucleation group (80% vs 71.4%). Median time of follow-up for survivors of disease is 5.8 years (min: 6 months and max: 14 years). DISCUSSION Outcomes of BWT management have changed dramatically during the last few decades from only survival, to a long life expectancy without the need of renal replacement therapy owing to improvements in treatment options. We argue that positive surgical margins do not necessarily lead to local recurrence. For this reason it may be wiser to favor on more nephron sparing surgery than to achieve negative surgical margins. Adjuvant chemotherapy and radiotherapy may be adequate to prevent local recurrence. Also, survival did not differ significantly between different ways of nephron sparing surgeries, so it may be wiser to choose enucleation over partial nephrectomy which preserves more nephrons. Nephron-sparing surgery should have utmost importance despite the risk of positive margins. On the other hand, there is not enough data to interpret if positive surgical margins have role on distant metastases or not. Presence of metastasis and recurrence seems to be an important determinant of prognosis given the fact that none of the survivors had any metastasis or recurrence. CONCLUSION Nephron preservation should be the aim while taking positive surgical margin risk on nephron sparing surgery side relying on postoperative chemotherapy and carefully planned radiotherapy to avoid recurrence. However, there is significant diversity on the management BWT in different centers and a certain validated guideline or protocol to provide the optimal treatment is still lacking.
Collapse
Affiliation(s)
- I R User
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Ekinci
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - G Kale
- Pediatric Pathology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - C Akyüz
- Pediatric Oncology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Büyükpamukçu
- Pediatric Oncology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - I Karnak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Ö Çiftçi
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F C Tanyel
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M E Şenocak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|