Prechemotherapy Transperitoneal Robotic-Assisted Partial Nephrectomy (RAPN) for a Wilms Tumor: Surgical and Oncological Outcomes in a Four-Year-Old Patient

Abstract

Background: Wilms tumor (WT) is the most frequent renal tumor in children. The SIOP-UMBRELLA Guidelines allow for nephron-sparing surgery (NSS) in syndromic patients, as well as in cases of small (<300 mL) non-syndromic unilateral WTs, without lymph node involvement, and with a substantial expected remnant renal function, following neoadjuvant chemotherapy. We present a case of prechemotherapy transperitoneal robot-assisted partial nephrectomy (RAPN) for a unilateral, non-syndromic Wilms tumor. Methods: A four-year-old child presented with a solid mass measuring 3.6 cm in diameter involving the upper right renal pole, incidentally detected during an abdominal echotomography. CT scan and abdominal MRI revealed no local infiltration or lymph node involvement, suggesting that the exophytic mass could be easily resected via an NSS robotic approach. Preoperative imaging did not strongly suggest WT. A virtual 3D reconstruction of the tumor was performed. Results: After the oncologic board approval, a robot-assisted partial nephrectomy with an intraperitoneal approach was performed. Histopathological analysis confirmed the diagnosis of WT. The patient subsequently received 10 doses of vincristine as adjuvant chemotherapy. A 28-month follow-up showed no tumor recurrence. Conclusions: Intraperitoneal RAPN may be an option for selected WT and warrants consideration as a challenging but advantageous approach.

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“…Preoperative imaging is crucial for the development of 3D virtual models and subsequent surgical planning. Utilizing CT and MRI imaging, 3D reconstruction improves the topographic visualization of the tumor and adjacent structures, effectively reducing the risk of inadvertent damage to vessels and surrounding organs [11].…”

“…Given the extended life expectancy of patients with T1 tumors and the heightened risk of long-term complications, such as hypertension and chronic renal failure following radical nephrectomy, NSS should be the preferred surgical option whenever feasible and oncologically safe. The integration of 3D preoperative imaging reconstruction and robot-assisted surgery, particularly in the hands of experienced practitioners, possibly in collaboration with adult urologists, emerges as a valuable tool that will further enhance the feasibility of NSS in pediatric oncology patients in the future [11].…”