Surgical Management of Wilms Tumor (Nephroblastoma) and Renal Cell Carcinoma in Children and Young Adults

Lopyan, Natalie M.; Ehrlich, Peter F.

doi:10.1016/j.soc.2020.11.002

Cited by 13 publications

(9 citation statements)

References 69 publications

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“…For this reason, different protocols indicate preoperative chemotherapy in such cases ( 8 , 9 , 14 , 15 ). Even with careful preoperative workup, it is advisable that surgeons palpate both the IVC and renal vein, in order to avoid the transection of an unidentified vascular extension during the surgical approach because it can upstage the tumor to stage III ( 16 ). In WT, upstaging to stage III will depend on lymph node status, complete resection of the thrombus (or not), and the presence or absence of viable cells within the thrombus.…”

Section: Discussionmentioning

confidence: 99%

Management of Pediatric Tumors With Vascular Extension

et al. 2022

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Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible.Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol.Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively.Results: A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition.Conclusion: Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.

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Section: Discussionmentioning

confidence: 99%

Management of Pediatric Tumors With Vascular Extension

et al. 2022

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“…Before and after nursing, the self-management efficacy scale (C-SUPPH) ( 10 ) and self-nursing ability scale (ESCA) ( 11 ) were used to evaluate the level of self-efficacy and self-nursing ability of the two groups, respectively. The C-SUPPH scale consisted of 28 items in three dimensions: self-decompression, self-decision-making, and positive attitude, with each item scoring 1–5 points and a total score of 28–140 points.…”

Section: Methodsmentioning

confidence: 99%

Effect of Orem’s Self-Care Theory Combined with Active Pain Assessment on Pain, Stress and Psychological State of Children with Nephroblastoma Surgery

Tang

Chen

2022

Front. Surg.

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BackgroundWith the development of medical technology and the innovation of various surgical options, the survival time of children with nephroblastoma is significantly prolonged. However, postoperative pain and stress response have been plagued by children with nephroblastoma during the postoperative treatment. At present, there is still a lack of effective care programs.MethodsWe accessed our institutional database to retrospectively screen clinical data from all children with nephroblastoma who were surgically treated in our hospital between July 2020 and July 2021. Some children received routine care, while others received Orem-based self-care theory and active pain assessment.ResultsAccording to the inclusion and exclusion criteria, 150 children with nephroblastoma who underwent surgical treatment were included in this study. On the third day after surgery, the scores of pain control effect and satisfaction degree of pain education in the study group were higher than those in the control group, and the physical and daily life influence, emotion influence, and pain experienced in the study group were lower than those in the control group. The differences were statistically significant (p < 0.001). There was no significant difference in C-SUPPH and ESCA scores between the two groups before nursing (p > 0.05). After nursing, the C-SUPPH and ESCA scores of the two groups were higher than those before nursing, and the C-SUPPH and ESCA scores of the study group were higher than those of the control group (p < 0.05). Before nursing, the levels of ACTH, Cor, and ANP between the two groups were not statistically significant (p > 0.05). The levels of ACTH, Cor, and ANP in the two groups were lower than those before nursing and 3 d and 7 d after nursing, and the index levels after 7 d of nursing were lower than those after 3 d of nursing. After nursing, the levels of ACTH, Cor, and ANP in the study group at each time point were lower than those in the control group (p < 0.05). There was no significant difference in SAS and SDS scores between the two groups before nursing (p > 0.05). After nursing, the SAS and SDS scores of both groups were lower than those before nursing, and the SAS and SDS scores of the study group were lower than those of the control group (p < 0.05). There was no significant difference in PSQI scores between the two groups before nursing (p > 0.05). After nursing, the PSQI scores of the two groups were lower than those before nursing, and the PSQI scores of the study were lower than those of the control group (p < 0.05). The average daily crying time, the average hospitalization time, and postoperative off-bed time in the study group were shorter than those in the control group (p < 0.05).ConclusionOrem’s self-care theory combined with active pain assessment can reduce pain in children undergoing nephroblastoma surgery, improve their stress response and psychological state, and improve their sleep quality, which is conducive to postoperative recovery and worthy of promotion.

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“…The COG classification of WTs distinguishes anaplastic (focal and diffuse) and nonanaplastic (favorable histology) WTs. The COG strategy favors a primary (partial) nephrectomy for unilateral renal masses in patients without WT predisposition, but in BWSp a neoadjuvant chemotherapy (without biopsy) with the aim of preserving renal units and subsequent surgery at 6-12 weeks after initiation of chemotherapy is suggested [53].…”

Section: Relevance For Clinical Managementmentioning

confidence: 99%

Molecular Basis of Beckwith–Wiedemann Syndrome Spectrum with Associated Tumors and Consequences for Clinical Practice

Eggermann

Maher

Kratz

et al. 2022

Cancers

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Beckwith–Wiedemann syndrome (BWS, OMIM 130650) is a congenital imprinting condition with a heterogenous clinical presentation of overgrowth and an increased childhood cancer risk (mainly nephroblastoma, hepatoblastoma or neuroblastoma). Due to the varying clinical presentation encompassing classical, clinical BWS without a molecular diagnosis and BWS-related phenotypes with an 11p15.5 molecular anomaly, the syndromic entity was extended to the Beckwith–Wiedemann spectrum (BWSp). The tumor risk of up to 30% depends on the molecular subtype of BWSp with causative genetic or epigenetic alterations in the chromosomal region 11p15.5. The molecular diagnosis of BWSp can be challenging for several reasons, including the range of causative molecular mechanisms which are frequently mosaic. The molecular basis of tumor formation appears to relate to stalled cellular differentiation in certain organs that predisposes persisting embryonic cells to accumulate additional molecular defects, which then results in a range of embryonal tumors. The molecular subtype of BWSp not only influences the overall risk of neoplasia, but also the likelihood of specific embryonal tumors.

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Surgical Management of Wilms Tumor (Nephroblastoma) and Renal Cell Carcinoma in Children and Young Adults

Cited by 13 publications

References 69 publications

Management of Pediatric Tumors With Vascular Extension

Management of Pediatric Tumors With Vascular Extension

Effect of Orem’s Self-Care Theory Combined with Active Pain Assessment on Pain, Stress and Psychological State of Children with Nephroblastoma Surgery

Molecular Basis of Beckwith–Wiedemann Syndrome Spectrum with Associated Tumors and Consequences for Clinical Practice

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