Objective To assess whether pre-operative chemo-therapy followed by delayed nephrectomy. In the latter group, the intravascular thrombus diminished in 16 therapy reduces operative morbidity in children with intravascular extension of renal tumours.patients. Five patients died, one from tumour rupture and four from extensive or progressive tumour disease; Patients and methods Thirty children with intravascular extension of their renal tumour, treated in 10 different the overall 2-year survival was 83%. Unfavourable histology did not adversely affect survival, and patients centres in the UK, were reviewed retrospectively. Results Twenty-nine patients had nephroblastoma and having pre-operative chemotherapy appeared to have a better outcome. one child had clear cell sarcoma (favourable histology in 23, unfavourable histology in six). Patients wereConclusion CT remains the best imaging modality to assess intravascular tumour extension. Pre-operative classified into stage II (17 patients), stage III (three patients) and stage IV (10 patients). Ultrasonography chemotherapy is recommended for patients with intracaval extension of tumour. Those with intra-atrial had been performed in 29 patients and had correctly diagnosed intravascular extension in 11 (40%); com-extension or with hepatic vein obstruction (Budd-Chiari syndrome) may require a cardiopulmonary puted tomography (CT) was accurate in 93% of patients. A pre-operative diagnosis was made accu-bypass and primary surgery. Keywords Nephroblastoma, intravascular extension, rately in 24 patients, with caval extension in 18 and atrial extension in six. Nine patients underwent pri-chemotherapy mary surgery, whilst 21 had pre-operative chemoaffected side, congenital anomalies, radiography, treat-
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