Cavectomy for the Treatment of Wilms Tumor With Vascular Extension

Ribeiro, Rodrigo Chaves; Schettini, Sergio Crescenzo Antonio; Abib, Simone de Campos Vieira; Fonseca, José Honório Palma da; Cypriano, Mônica; Silva, Nasjla Saba da

doi:10.1016/s0022-5347(06)00561-1

Cited by 25 publications

(17 citation statements)

References 15 publications

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“…The incidence of intravascular thrombus extension in our study population was 10.3%, similar to other authors' findings, but intracardiac involvement was 5.5%, a little higher than the reported experience (3,4). The thrombus occurrence represents a remarkable difficult factor for surgical procedures, increasing morbidity.…”

Section: Commentssupporting

confidence: 89%

Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

et al. 2007

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Objectives: The aim of this retrospective study is to compare surgical complications and long-term survival in children with Wilms' tumor (WT) and tumor thrombus receiving or not preoperative chemotherapy. Results: Median age was 54 months. 2/16 had cardiac failure as the first symptom. 11/16(7 IVC and 4 atrial extension) (67%) were submitted to preoperative chemotherapy with vincristine plus actinomycin D, and 5/16(1 IVC and 4 atrial) (33%) underwent initial nephrectomy and thrombus resection. So, 11 patients were submitted to preoperative VCR/ACTD and 2/ 11 (18.1%) had complete regression of the thrombus, 6/11(54.5%) partial regression and 3/11 (27%) had no response. Among the partial responders, nephrectomy with thrombus removal was performed in all, including one patient with previous intracardiac involvement, without extracorporeal circulation procedures. In two of the three non-responders, cardiopulmonary bypass was necessary for thrombus removal. There were no surgical related deaths. Long-term survival is 91% in the group submitted to preoperative chemotherapy and 100% in the group who had surgery as first approach. Conclusion: Preoperative chemotherapy was able to reduce thrombus extension in 8/11 (73%) treated patients and cardiopulmonary bypass was avoided in 2 patients with atrial thrombus. Surgical resection of tumor and thrombus was successful in all cases, receiving or not preoperative chemotherapy and overall survival was similar in both groups.

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Section: Commentssupporting

confidence: 89%

Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

et al. 2007

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“…Note that 43 documented papers (Table S1) reported paediatric patients with Wilms tumour and intravascular extension, with age in the range of 7 weeks‐16 years. Sample size ranged from 1 to 165 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Tumour thrombus may extend into the inferior vena cava and the right atrium, which can make a daunting prospect for the surgeon attempting resection. Multiple management options have been described, including preoperative chemotherapy to reduce thrombus, cavotomy and thrombectomy, intrapericardial control of the vena cava to permit resection without bypass, cardiopulmonary bypass (CPB) with deep hypothermic cardiac arrest, and cavectomy . Little validated evidence exists for decision making, and management of these complex and challenging patients is very much on a case‐by‐case basis.…”

Section: Introductionmentioning

confidence: 99%

Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

Morris

Squire

Sznajder

et al. 2019

Pediatric Blood & Cancer

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Introduction:Preoperative chemotherapy is recommended for children with Wilms tumour with intravascular extension. Extended chemotherapy may improve resectability, but increase tumour adherence to vascular endothelium, precluding complete resection. To evaluate the optimal length of preoperative treatment, we report a two-part review comprising systematic review of the literature and investigation of patients treated in the International Society of Paediatric Oncology (SIOP) WT 2001 trial. Methods: Studies were identified using Medline and Embase databases from 1996 to present. English language titles reporting management of intravascular Wilms tumour were analysed. Patients with Wilms tumour and thrombus were identified from the SIOP WT 2001 trial. Overall survival (OS) and event-free survival (EFS), tumour regression, completeness of resection and cavectomy were investigated. Results: The search retrieved 43 articles documenting 498 children. Note that 72% of the patients received neoadjuvant chemotherapy: 101 received standard course (4-6 weeks, standard course neoadjuvant chemotherapy [StC]) and 62 extended course (> 6 weeks, extended course neoadjuvant chemotherapy [EC]). There was no significant difference between the groups in terms of thrombus regression or completeness of resection. EFS was greater in the StC group (78 vs 54%; P = .04). Of 4511 patients registered in the SIOP WT 2001 trial, 166 had thrombus. Note that 97% of the patients received neoadjuvant chemotherapy: 63 StC and 67 EC. There was no significant difference between the groups with regard to tumour regression, complete resection, or cavectomy. Survival was significantly higher in those receiving StC than EC (OS: 95% vs 82%, P = .025; EFS: 88% vs 72%, P = .047). Conclusion:There is no evidence that prolonged courses of neoadjuvant chemotherapy beyond the recommended protocols confer any additional benefit in treating intravascular extension of Wilms tumour.

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“…Bu gibi durumlarda, eğer neoadjuvan kemo- terapi ile bu sorun giderilememişse, karotis endarterektomisinde olduğu gibi kava duvarına küretaj uygulanıp trombüsü almak denenebilir. Bu yöntemin de başarı sağlamadığı koşullarda, anjiografik bulgular ve eksplorasyon verileri iyice değerlendirilmek sureti ile kavektomi işlemi uygulanabilir (18)(19)(20)(21) .…”

Section: B) Wilms Tümöründe Damar Uzanımıunclassified

Special conditions in Wilms tumor: A review of literature and presentation of clinical experience of a teaching institution

Büyükünal¹,

Özcan²,

Emre³

et al. 2016

TCCD

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Cavectomy for the Treatment of Wilms Tumor With Vascular Extension

Abstract: Cavectomy is a safe procedure for treating pediatric patients with Wilms tumor when there is extension and invasion of the vena cava wall without blood flow.

Cited by 25 publications

References 15 publications

Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

Special conditions in Wilms tumor: A review of literature and presentation of clinical experience of a teaching institution

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