Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study
Journal of Pediatric Surgery(2022)
摘要
Purpose: To review surgical management, tumour stage and clinical outcomes in children with intravas-cular extension of Wilms tumour (WT) registered in a national clinical study (2012-19).Methods: WTs with presence/suspicion of tumour thrombus in the renal vein (RV) or beyond on radiol-ogy, surgery or pathology case report forms were identified. Only cases where thrombus was confirmed by surgeon and/or reference pathologist were included. Surgical management, disease stage, overall (OS) and event free survival (EFS) were investigated.Results: 69/583 (11.8%) patients met the inclusion criteria. Forty-six (67%) had abdominal stage III due to thrombus-related reasons: 11 had macroscopically incomplete resection, including 8 cases where cavo-tomy was not performed; 20 had piecemeal complete resection of thrombus; 15 had microscopically positive resection margins at the RV. 66% of tumour thrombi contained viable tumour. There were eight relapses and five deaths. EFS, but not OS, was significantly associated with completeness of surgical re-section ( P < 0.05). OS and EFS were also significantly associated with histological risk group ( P < 0.05) but not with viability of tumour thrombus ( P = 0.19; P = 0.59).Conclusions: WTs with intravascular extension have a high risk of local stage III due to thrombus-related reasons. Controlled complete removal of the thrombus should be the aim of surgery.Level of Evidence: Level II (c) 2021 Elsevier Inc. All rights reserved.
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关键词
Wilms tumor,Thrombus,Surgery,Local stage,Outcomes
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