Nephrectomy in children with wilms' tumor: 15 years of experience with “Tumor Delivery Technique”

Abstract

Background:The contemporary surgical approach to Wilms' tumors follows that used in adults with renal cell carcinomas, namely, early occlusion of the renal vessels and then removal of the kidney as an intact mass. For years, the surgical approach at our institution has been different, starting with blunt separation of the kidney from the surrounding tissues, followed by its delivery outside the abdominal cavity while it is only attached to the major blood vessels which are subsequently ligated. We aimed to present this “tumor delivery technique” and evaluate its outcomes.Materials and Methods:We retrospectively reviewed medical records of children who underwent nephrectomy for Wilms' tumor using “tumor delivery technique.” All procedures were performed by the same team, according to the same surgical principles.Results:Between 2000 and 2015, 36 children were operated. Median age was 31 months (interquartile range [IQR]: 6–45 mo), and median maximal tumor diameter was 10 cm (IQR: 8–13.9 cm). Tumors were located to the right side in 47%, left side in 42%, and bilateral in 11%. Twelve children have received preoperative neoadjuvant chemotherapy. Capsular disruption and tumor spillage were documented in 4 cases (11%).Conclusions:“Tumor delivery technique” is an easy and safe approach which might reduce the overall complication rates and the incidence of intraoperative tumor spillage.

Effectiveness of Nephron Sparing Surgery and Radical Nephrectomy in the Management of Unilateral Wilms Tumor: A Meta-Analysis

“…Thereafter, upon excluding the duplicates and applying the inclusion criteria, a total of 20 studies were retained. Thirteen of the included studies were retrospective cohort studies (12,15,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), whereas seven of the included studies were prospective cohort studies (44)(45)(46)(47)(48)(49)(50). Qualitative and quantitative data were then extracted from all the studies and summarized in Table 1.…”

“…The survival rate was compared in six studies. Here, 10 studies reported the survival rate of children operated with radical nephrectomy ( 12 , 37 – 40 , 43 – 45 , 47 , 50 ), whereas six studies reported the outcome after nephron sparing surgery ( 12 , 37 – 39 , 47 , 50 ). A mean survival rate of 90.6 ± 8.7% was reported in 4,623 children operated with radical nephrectomy during a mean follow-up of 5.9 ± 3.5 years.…”

“…Eight studies assessed estimated glomerular filtration rate in cases operated with radical nephrectomy ( 37 , 39 – 41 , 43 , 44 , 46 , 48 ), at a mean follow-up of 10.6 ± 4.9 years. A mean estimated glomerular filtration rate of 104.2 ± 24.3 ml/min per 1.73 m 2 was reported before the operation and 98.3 ± 17.8 ml/min per 1.73 m 2 after the operation.…”

“…In the past decades, radical nephrectomy has been the choice of treatment for managing unilateral Wilms tumor (52,53). The ability of this gold standard approach has been favored because of its ability to limit positive margins (52), spillage (43), residual Weighted effect size is presented as boxes; 95% CIs are presented as whiskers. They demonstrate relapse rate (%) in between cases operated with radical nephrectomy and nephron sparing surgery.…”

“…Likewise, the average duration of follow-up was 7 ± 4.7, 7.4 ± 5.1 years for children operated with nephron sparing surgery and radical nephrectomy, respectively. Two studies did not explicitly specify the duration of follow-up (43,51).…”