Current surgical management of Wilms' tumor

Current Opinion in Pediatrics

Volumn 8, Issue 3, 1996, Pages 268-275

  Haase, Gerald M ^a  

^a CHILDREN S HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CANCER CHEMOTHERAPY; CANCER STAGING; CANCER SURVIVAL; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC IMAGING; HYPOTHERMIA; KIDNEY FAILURE; NEPHRECTOMY; NEPHROBLASTOMA; NUCLEAR MAGNETIC RESONANCE IMAGING; PRIORITY JOURNAL; REVIEW; SURGICAL TECHNIQUE;

EID: 0030015407     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-199606000-00015     Document Type: Review

References (65)

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3. D'Angio GJ, Breslow N, Beckwith JB, Evans A, Baum E, DeLorimier A, Fernbach D, Hrabovsky E, Jones B, Kelalis P, et al.: Treatment of Wilms' tumor: results of the third National Wilms' Tumor Study. Cancer 1989, 64:349-360.
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6. Clericuzio CL: Clinical phenotypes and Wilms' tumor. Med Pediatr Oncol 1993, 21:182-187.
7. Mueller RF: The Denys-Drash Syndrome. J Med Genet 1994, 31:471-477.
8. Stanley K, Khoudary KP, Nasrallah PF: Urothelial extension of Wilms' tumor presenting as a prolapsing urethral mass. J Urol 1995, 153:1981-1983. This extreme example of urothelial extension of WT may represent a unique clinical presentation. Contiguous extension of WT into the lower urinary tract is reported to be a poor prognostic sign. Here, the tumor presented as a prolapsing mass through the urethral meatus. This stage II tumor with favorable histology was completely resected, and the patient was treated successfully with chemotherapy.
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11. Ritchey ML, Azizkhan RG, Beckwith JB, Hrabovsky EE, Haase GM: Neonatal Wilms' tumor. J Pediatr Surg 1995, 30:856-859. A review of WTs diagnosed in the first 30 days of life is described. The event is very rare and only 15 cases were found in the files of the NWTS. Primary nephrectomy was undertaken in all cases, and only one patient has died of progressive disease.
12. Xue H, Horwitz JR, Smith MB, Lally KP, Black CT, Cangir A, Takahashi H, Andrassy RJ: Malignant solid tumors in neonates: a 40-year review. J Pediatr Surg 1995, 30:543-545.
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14. Andrews PE, Kelalis PP, Haase GM: Extrarenal Wilms' tumor: results of the National Wilms' Tumor Study. J Pediatr Surg 1992, 27:1181-1184.
15. Coppes MJ, Wilson PCG, Weitzman S: Extrarenal Wilms' tumor: staging, treatment, and prognosis. J Clin Oncol 1991, 9:167-174.
16. Vaughan WG, Sanders DW, Grosfeld JL, Rumley DA, Rescorla FJ, Scherer LR III, West KW, Breitfeld PP: Favorable outcome in children with Beckwith-Wiedemann syndrome and intraabdominal malignant tumors. J Pediatr Surg 1995, 30:1042-1045. This interesting paper analyzes the disease-free survival in children with Beckwith-Wiedemann syndrome and intra-abdominal malignant tumors. Among 16 cases, 12 WTs in 10 patients (two bilateral cases) were reviewed. Nine of the ten patients underwent primary nephrectomy, and one child with bilateral disease received partial nephrectomy after chemotherapy. All children are long-term, disease-free survivors, implying that tumors in the presence of Beckwith-Wiedemann syndrome may be a favorable biologic characteristic.
17. Oddone M, Marino C, Sergi C, Occhi M, Negri F, Kotitza Z, DeBernardi B, Jasonni V, Tomà P: Wilms' tumor arising in a multicystic kidney. Pediatr Radiol 1994, 24:236-238.
18. Coppes MJ, Zandvoort SWH, Sparling CR, Poon AO, Weitzman S, Blanchette VS: Acquired von Willebrand disease in Wilms' tumor patients. J Clin Oncol 1992, 10:422-427.
19. Lim PVH, Mason JDT, Walker D, Gibbin KP: Epistaxis, von Willebrand's type bleeding diathesis and Wilms' tumour: a case report. J Laryngol Otol 1994, 108:1081-1082. This case is a reminder that WTs can be associated with a von Willebrand - type bleeding diathesis. An infant had persistent epistaxis in spite of treatment with fresh frozen plasma and desmopressin. Safe nephrectomy could not be performed until the clotting abnormality was reversed by administration of actinomycin D and vincristine.
20. Lin RY, Argenta PA, Sullivan KM, Stern R, Adzick NS: Urinary hyaluronic acid is a Wilms' tumor marker. J Pediatr Surg 1995, 30:304-308. This interesting study measured urinary hyaluronic acid levels from WT specimens in 105 patients as compared with levels in 17 age-matched control subjects. Preoperative levels were elevated as compared with control subjects in 74% of cases. Persistent disease or relapse also caused higher levels than noted in disease-free patients. The specificity was 95%.
21. D'Angio GJ, Rosenberg H, Sharples K, Kelalis P, Breslow N, Green DM: Position paper: imaging methods for primary renal tumors of childhood. Costs versus benefits. Med Pediatr Oncol 1993, 21:205-212.
22. Cohen MD: Staging of Wilms' tumour [review]. Clin Radiol 1993, 47:77-81.
23. Law PJ, Ng YY, Dicks-Mireauz C: The accuracy of CT scanning in the staging of Wilms' tumour. Clin Radiol 1992, 45:62.
24. Chernoff DM, Silverman SG, Kikinis R, Adams DF, Seltzer SE, Richie JP, Loughlin KR: Three-dimensional imaging and display of renal tumors using spiral CT: a potential aid to partial nephrectomy. Urology 1994, 43:125-129.
25. Gylys-Morin V, Hoffer FA, Kozakewich H, Shamberger RC: Wilms' tumor and nephroblastomatosis: Imaging characteristics at Gadolinium-enhanced MR imaging. Radiology 1993, 188:517-521.
26. Ferrer FA, McKenna PH, Donnal JF: Noninvasive angiography in preoperative evaluation of complicated pediatric renal masses using phase contrast magnetic resonance angiography. Urology 1994, 44:254-259.
27. Ditchfield MR, De Campo JF, Waters KD, Nolan TM: Wilms' tumor: a rational use of preoperative imaging. Med Pediatr Oncol 1995, 24:93-96. This excellent study gives a 10-year overview of preoperative imaging for WT in 60 patients. Patient staging was accomplished by plain radiograph and abdominal ultrasound. Abdominal CT scanning was necessary in only three children because of tumor size and complexity. A chest CT was performed in eight patients because of equivocal radiographic findings or as a baseline if metastatic disease was detected. The routine use of limited preoperative imaging did not reduce patient survival (90% at 4 years).
28. Ritchey ML, Green DM, Breslow NB, Moksness J, Norkool P: Accuracy of current imaging modalities in the diagnosis of synchronous bilateral Wilms' tumor: a report from the National Wilms' Tumor Study Group. Cancer 1995, 75:600-604. This important study analyzed the NWTS experience with preoperative detection of synchronous bilateral WT. Of 122 patients, nine instances of bilaterality were missed by all preoperative imaging studies. No imaging study was able to detect more than 50% of tumors less than 1 cm in diameter. Formal exploration of the contralateral kidney at the time of primary nephrectomy is still recommended.
29. Green DM, Breslow NE, D'Angio GJ: The treatment of children with unilateral Wilms' tumor [editorial]. J Clin Oncol 1993, 11:1009-1010.
30. Dykes EH, Marwaha RK, Dicks-Mireaux C, Sams V, Risdon RA, Duffy PG, Ransley PG, Pritchard J: Risks and benefits of percutaneous biopsy and primary chemotherapy in advanced Wilms' tumour. J Pediatr Surg 1991, 26:610-612.
31. Lee IS, Nguyen S, Shanberg AM: Needle tract seeding after percutaneous biopsy of Wilms' tumor. J Urol 1995, 153:1074-1076. This important case report documents tumor implantation along the needle tract after a percutaneous biopsy of a WT. This finding tempers the enthusiasm for percutaneous biopsy, which is thought to be less morbid than open surgical biopsy. The patient in this report has progressive disease and is currently receiving salvage chemotherapy.
32. Tournade MF, Com-Nougué C, Voûte PA, Lemerle J, deKraker J, Delemarre JFM, Burgers M, Habrand JL, Moorman CGM, Bürger D, et al.: Results of the Sixth International Society of Pediatric Oncology Wilms' Tumor Trial and Study: a risk-adapted therapeutic approach in Wilms' tumor. J Clin Oncol 1993, 11:1014-1023.
33. Zuppan CW, Beckwith JB, Weeks DA, Luckey DW, Pringle KC: The effect of preoperative therapy on the histologic features of Wilms' tumor: an analysis of cases from the third National Wilms' Tumor Study. Cancer 1991, 68:385-394.
34. Zoeller G, Pekrun A, Lakomek M, Ringert R-H: Wilms' tumor: the problem of diagnostic accuracy in children undergoing preoperative chemotherapy without histological tumor verification. J Urol 1994, 151:169-171.
35. Weeks DA, Beckwith JB, Luckey DW: Relapse-associated variables in stage 1 favorable histology Wilms' tumor: a report of the National Wilms' Tumor Study. Cancer 1987, 60:1204-1212.
36. Green DM, Beckwith JB, Weeks DA, Moksness J, Breslow NE, D'Angio GJ: The relationship between microsubstaging variables, age at diagnosis, and tumor weight of children with stage 1/favorable histology Wilms' tumor: a report from the National Wilms' Tumor Study. Cancer 1994, 74:1817-1820.
37. Green DM, Breslow NE, Beckwith JB, Takashima J, Kelalis P, D'Angio GJ: Treatment outcomes in patients less than 2 years of age with small, stage 1, favorable-histology Wilms' tumors: a report from the National Wilms' Tumor Study. J Clin Oncol 1993, 11:91-95.
38. Shamberger RC, Macklis RM, Sallan SE: Recent experience with Wilms' tumor: 1978-1991. Ann Surg Oncol 1994, 1:59-65.
39. Zaghloul MS, Hussein MH, El Koutbey M: Wilms' tumor: long-term results from a single institution. J Surg Oncol 1994, 56:25-31.
40. Othersen HB Jr, DeLorimier A, Hrabovsky E, Kelalis P, Breslow N, D'Angio GJ: Surgical evaluation of lymph node metastases in Wilms' tumor. J Pediatr Surg 1990, 25:330-331.
41. Crombleholme TM, Jacir NN, Rosenfield CG, Lew S, Harris BH: Preoperative chemotherapy in the management of intracaval extension of Wilms' tumor. J Pediatr Surg 1994, 29:229-231.
42. Federici S, Galli G, Ceccarelli PL, Rosito P, Sciutti R, Dòmini R: Wilms' tumor involving the inferior vena cava: preoperative evaluation and management. Med Pediatr Oncol 1994, 22:39-44.
43. Pannek J, Goepel M, Kremens B, Otto T, Sadony V: Surgical management of Wilms' tumor with intracardiac neoplastic extension. Thorac Cardiovasc Surg 1994, 42:108-111.
44. Przybylo HJ, Stevenson GW, Backer C, Luck SR, Webb CL, Morgan E, Hall SC: Anesthetic management of children with intracardiac extension of abdominal tumors. Anesth Analg 1994, 78:172-175.
45. Oberholzer HF, Falkson G, De Jager LC: Successful management of inferior vena cava and right atrial nephroblastoma tumor thrombus with preoperative chemotherapy. Med Pediatr Oncol 1992, 20:61-63.
46. Ritchey ML, Haase GM, Green DM, Kelalis PP, Shochat SJ, D'Angio G: Preoperative therapy for intracaval and atrial extension of Wilms' tumor. Cancer 1993, 71:4104-4110.
47. Dale PS, Webb HW, Wilkinson AH Jr: Resection of the inferior vena cava for recurrent Wilms' tumor. J Pediatr Surg 1995, 30:121-122. In this report of a patient with recurrent WT presenting as an intraluminal caval thrombus 4 years after resection of a right-sided stage I tumor, the authors show that the left kidney often has abundant potential collateral venous drainage. Caval resection to completely remove an intravascular tumor thrombus is possible and may be necessary to achieve long-term survival in recurrent disease.
48. Ritchey ML, Pringle KC, Breslow NE, Takashima J, Moksness J, Zuppan CW, Beckwith JB, Thomas PRM, Kelalis PP: Management and outcome of inoperable Wilms' tumor: a report of National Wilms' Tumor Study 3. Ann Surg 1994, 220:683-690.
49. Ritchey ML, Green DM, Thomas PRM, Smith GR, Haase GR, Shochat S, Moksness J, Breslow NE: Renal failure in Wilms' tumor patients: a report from the National Wilms' Tumor Study Group. Med Pediatr Oncol 1996, 26:75-80. This report defines the incidence and etiology of renal failure after treatment for WT. Only 55 patients out of almost 3500 who had survived at least 5 years from diagnosis had an elevated serum creatinine level. Of the 15 children with unilateral disease, 10 had Denys-Drash syndrome. The incidence of renal insufficiency, though small, is of significant concern and appears to increase with time. Follow-up must include measurements of blood pressure, urine protein, serum creatinine, renal clearance, and renal size.
50. Mpofu C, Mann JR: Urinary protein/creatinine index in follow up of patients with Wilms' tumour after nephrectomy. Arch Dis Child 1992, 67:1462-1466.
51. Levitt GA, Yeomans E, Dicks Mireaux C, Breatnach F, Kingston J, Pritchard J: Renal size and function after cure of Wilms' tumour. Br J Cancer 1992, 66:877-882.
52. Finklestein JZ, Norkool P, Green DM, Breslow N, D'Angio GJ: Diastolic hypertension in Wilms' tumor survivors: a late effect of treatment? A report from the National Wilms' Tumor Study Group. Am J Clin Oncol 1993, 16:201-205.
53. Shaul DB, Srikanth MM, Ortega JA, Mahour GH: Treatment of bilateral Wilms' tumor: comparison of initial biopsy and chemotherapy to initial surgical resection in the preservation of renal mass and function. J Pediatr Surg 1992, 27:1009-1015.
54. DeBacker A, Lamote J, Keuppens F, Willems G, Otten J: Bilateral Wilms' tumor: in situ cooling of the kidney facilitates curative excision of tumors, with preservation of renal function. J Pediatr Surg 1995, 30:1338-1340. This interesting report describes a technique to maximally preserve renal parenchyma and yet deal with multifocal disease in a patient with synchronous bilateral WT. The method involved in situ cooling with appropriate organ preserving solutions and surface techniques and is less complicated than ex vivo "bench" methods. Surgeons experienced in pediatric oncology and organ transplantation will most successfully perform this operation.
55. Polascik TJ, Pound CR, Meng MV, Partin AW, Marshall FF: Partial nephrectomy: technique, complications and pathological findings. J Urol 1995, 154:1312-1318. This excellent study evaluates partial nephrectomy in adult patients and emphasizes details of the surgical technique. Of 67 renal-sparing procedures, only six patients suffered local recurrence. All cases had negative surgical margins, and multifocal disease was implicated as the likely source of recurrence.
56. Sagalowsky AI: Indications and techniques for nephron sparing surgery [editorial]. J Urol 1995, 154:1319-1320. A companion editorial to the article by Polascik et al. (J Urol 1995, 154:1312-1318) emphasizes proper case selection and meticulous technique. A discussion of the importance of recognizing capsular invasion and perinephric extension is particularly beneficial.
57. McLorie GA, McKenna PH, Greenberg M, Babyn P, Thorner P, Churchill BM, Weitzman S, Filler R, Khoury AE: Reduction in tumor burden allowing partial nephrectomy following preoperative chemotherapy in biopsy proved Wilms' tumor. J Urol 1991, 146:509-513.
58. Moorman-Voestermans CGM, Staalman CR, Delemarre JFM: Partial nephrectomy in unilateral Wilms' tumour is feasible without local recurrence. Med Pediatr Oncol 1994, 23:218.
59. Merguerian PA, Seremetis G: Laser-assisted partial nephrectomy in children. J Pediatr Surg 1994, 29:934-936.
60. Diamond DA, Price HM, McDougall EM, Bloom DA: Retroperitoneal laparoscopic nephrectomy in children. J Urol 1995, 153:1966-1968. This study describes three pediatric patients who successfully underwent nephrectomy by the retroperitoneal laparoscopic approach. Conventional transperitoneal laparoscopic nephrectomy is usually indicated for larger tumors or when evaluation of lymph nodes and other intra-abdominal disease is necessary. Nevertheless, this experience provides further evidence of how minimally invasive surgical techniques may be applied.
61. Lobe TE, Schropp KP, Joyner R, Lasater O, Jenkins J: The suitability of automatic tissue morcellation for the endoscopic removal of large specimens in pediatric surgery. J Pediatr Surg 1994, 29:232-234.
62. Ritchey ML, Kelalis PP, Breslow N, Etzioni R, Evans I, Haase GM, D'Angio GJ: Surgical complications after nephrectomy for Wilms' tumor. Surg Gynecol Obstet 1992, 175:507-514.
63. Ritchey ML, Kelalis PP, Etzioni R, Breslow N, Shochat S, Haase GM: Small bowel obstruction after nephrectomy for Wilms' tumor: a report of the National Wilms' Tumor Study 3. Ann Surg 1993, 218:654-659.
64. Pritchard J, Imeson J, Barnes J, Cotterill S, Gough D, Marsden HB, Morris-Jones P, Pearson D: Results of the United Kingdom Children's Cancer Study Group first Wilms' Tumor Study. J Clin Oncol 1995, 13:124-133. Results from the first WT study undertaken by the Children's Cancer Study Group of the United Kingdom is reported. Primary nephrectomy was usually performed. The overall survival is similar to results from the NWTS. The surgical complication rate was only 6%, which is lower than that of NWTS 3, but five patients (1.5%) died as a result of surgical complications, which is higher than the NWTS experience.
65. Green DM, Breslow NE, Li Y, Grundy PE, Shochat SJ, Takashima J, D'Angio GJ: The role of surgical excision in the management of relapsed Wilms' tumor patients with pulmonary metastases: a report from the National Wilms' Tumor Study. J Pediatr Surg 1991, 26:728-733.