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Surgical Management of Wilms Tumors with Intravenous Extension: A Multicenter Analysis of Clinical Management with Technical Insights.
Pio, Luca; Abib, Simone; Guerin, Florent; Chardot, Christophe; Blanc, Thomas; Sarrai, Nadia; Martelli, Helene; De Souza, Fernanda K M; Fanelli, Mayara C A; Tamisier, Daniel; Guilhen, José Cícero S; Le Bret, Emmanuel; Belli, Emré; Fadel, Elie; Cypriano, Monica D S; Minard, Véronique; Pasqualini, Claudia; Schleiermacher, Gudrun; Lemelle, Lauriane; Rod, Julien; Irtan, Sabine; Pistorio, Angela; Gauthier, Frederic; Branchereau, Sophie; Sarnacki, Sabine.
Afiliación
  • Pio L; Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France. luca.pio@stjude.org.
  • Abib S; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA. luca.pio@stjude.org.
  • Guerin F; Paris Kids Cancer, Paris, France. luca.pio@stjude.org.
  • Chardot C; Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Blanc T; Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Sarrai N; Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
  • Martelli H; Paris Kids Cancer, Paris, France.
  • De Souza FKM; Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France.
  • Fanelli MCA; Paris Kids Cancer, Paris, France.
  • Tamisier D; Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France.
  • Guilhen JCS; Paris Kids Cancer, Paris, France.
  • Le Bret E; Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
  • Belli E; Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
  • Fadel E; Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Cypriano MDS; Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Minard V; Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Pasqualini C; Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Schleiermacher G; Department of Cardiovascular Surgery, Hôpital Universitaire Necker Enfants Malades-Université de Paris Cité, Paris, France.
  • Lemelle L; Department of Cardiovascular Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Rod J; Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France.
  • Irtan S; Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France.
  • Pistorio A; Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France.
  • Gauthier F; Pediatric Oncology, Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
  • Branchereau S; Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France.
  • Sarnacki S; Paris Kids Cancer, Paris, France.
Ann Surg Oncol ; 31(7): 4713-4723, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38578552
ABSTRACT

BACKGROUND:

About 5% of Wilms tumors present with vascular extension, which sometimes extends to the right atrium. Vascular extension does not affect the prognosis, but impacts the surgical strategy, which is complex and not fully standardized. Our goal is to identify elements of successful surgical management of Wilms tumors with vascular extensions. PATIENTS AND

METHODS:

A retrospective study of pediatric Wilms tumors treated at three sites (January 1999-June 2019) was conducted. The inclusion criterion was the presence of a renal vein and vena cava thrombus at diagnosis. Tumor stage, pre and postoperative treatment, preoperative imaging, operative report, pathology, operative complications, and follow-up data were reviewed.

RESULTS:

Of the 696 pediatric patients with Wilms tumors, 69 (9.9%) met the inclusion criterion. In total, 24 patients (37.5%) had a right atrial extension and two presented with Budd-Chiari syndrome at diagnosis. Two died at diagnosis owing to pulmonary embolism. All patients received neoadjuvant chemotherapy and thrombus regressed in 35.6% of cases. Overall, 14 patients had persistent intra-atrial thrombus extension (58%) and underwent cardiopulmonary bypass. Most thrombi (72%) were removed intact with nephrectomy. Massive intraoperative bleeding occurred during three procedures. Postoperative renal insufficiency was identified as a risk factor for patient survival (p = 0.01). With a median follow-up of 9 years (range 0.5-20 years), overall survival was 89% and event-free survival was 78%.

CONCLUSIONS:

Neoadjuvant chemotherapy with proper surgical strategy resulted in a survival rate comparable to that of children with Wilms tumors without intravascular extension. Clinicians should be aware that postoperative renal insufficiency is associated with worse survival outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Venas Renales / Tumor de Wilms / Neoplasias Renales / Nefrectomía Límite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Venas Renales / Tumor de Wilms / Neoplasias Renales / Nefrectomía Límite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Estados Unidos