In an in vitro model we defined the ultrasound parameter region within which purely cavitational ablation of tissue is possible with a negligible thermal component. Additional research is needed to optimize the parameters for in vivo cavitational tissue ablation, incorporating the influence of tissue perfusion.

The results of our study have shown that histotripsy is capable of precise prostatic tissue destruction and results in subcellular fractionation of prostate parenchyma. Histotripsy can also produce prostatic urethral damage and thereby facilitate drainage of finely fractionated material per urethra, producing immediate debulking.

Histotripsy produces mechanical fractionation of cellular and architectural structures. The resultant acellular material appears to be readily reabsorbed within 60 days in the rabbit. This may prove to be a significant advantage for imaging assessment of residual tumor after ablation of renal malignancy.

Purpose The aim of the study was to determine the prognostic impact of lymph node (LN) involvement and sampling in patients with Wilms tumor (WT) and the minimum number of LNs needed for accurate staging. Methods We reviewed all patients with unilateral, nonmetastatic WT enrolled in the National Wilms Tumor Study 4 or 5. Data were abstracted on patient demographics, tumor histology, staging, number of LNs sampled, and disease-specific and overall patient outcomes. Results A total of 3409 patients had complete information on LN sampling. Five-year event-free survival (EFS) was lower in patients with nodal disease (P = .001); the effect of LN positivity was greater for patients with anaplastic (P = .047) than with favorable histology (P = .02). The likelihood of obtaining a positive LN was higher when sampling at least 7 LNs. However, after controlling for tumor histology and stage, the number of LNs sampled did not predict EFS variations (P = .75). Among patients with stage II disease, patients with LN sampling (P = .055) had improved EFS, largely reflecting poorer EFS in patients with anaplastic tumors (P = .03). Conclusions Lymph node sampling is particularly important for patients with stage II anaplastic WT. Although the likelihood of finding a positive LN was greater when more than 7 LNs were sampled, EFS was not impacted by the number of LNs sampled.

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Objectives Wilms tumor (WT) is the most common renal cancer in children. Approximately 5% of children with WT 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 2001-2014. 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 (eGFR). Results Forty-two patients with BWT were identified. Thirty-nine (92.9%) patients underwent bilateral NSS; only three patients (7.1%) underwent unilateral nephrectomy with contralateral NSS. Post-operative complications included prolonged urine leak (10), infection (6), intussusception (2) and transient renal insufficiency (1). Three patients required early (within four months) repeat NSS for residual tumor. Long-term, seven (16.7%) patients had local tumor recurrence (managed with repeat NSS in 6 and completion nephrectomy in 1) and three 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 patients had an eGFR>60mL/min/1.73m2 at last follow-up; no patient developed end-stage renal disease. Conclusions In patients with synchronous, bilateral Wilms tumor, bilateral nephron-sparing surgery is safe and almost always feasible, there by preserving maximal renal parenchyma. With this approach, survival was excellent, as was maintenance of renal function.

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The RP approach reduces operative time, LOS, and some types of complications without compromising the quality of tumor resection. Complications in the retroperitoneal space are not associated with higher EBL. Anatomic considerations and surgeon experience may improve outcomes.