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Eur J Pediatr Surg 2014; 24(06): 457-460
DOI: 10.1055/s-0034-1396425
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Current Concepts in Surgery for Wilms Tumor—The Risk and Function-Adapted Strategy

Jan Godzinski
1   Department of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland
2   Department of Emergency Medicine, Medical University, Wroclaw, Poland
,
Norbert Graf
3   Department of Pediatric Hematology and Oncology, Homburg University, Homburg, Germany
,
Georges Audry
4   Sorbonnes Universite, UPMC Universite, Paris, France
5   Department of Paediatric Surgery, Trousseau Hospital, Paris, France
› Author Affiliations
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Publication History

03 November 2014

04 November 2014

Publication Date:
05 December 2014 (online)

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Abstract

This article describes the current status of surgical approach to Wilms tumor. Combined multimodal treatment including classical open nephrectomy is still the most recommended and offers excellent survivals. Patients suffering from Wilms tumor as potentially very long-term survivors also need great care of quality of their further life. Nephron-sparing surgery seems an important step in this regard; however, selection of patients is necessary to avoid failures and decreasing survival rate. A new method of describing this kind of procedure developed within the SIOP Renal Tumours Study Group (RTSG) offers an opportunity for further comparisons and assessment. Minimally invasive nephrectomy is not recommended in the treatment of Wilms tumor; however, in experienced hands and correctly selected (rare) cases, minimally invasive nephrectomy may offer the same outcome as the classical open approach. Lymph nodes sampling, essential for reliable staging, appeared rarely correct in children operated by this technique. Any competition with partial nephrectomy should be avoided in favor of the nephron-sparing approach. A small proportion of patients still create surgical difficulties and this is in fact the target group for further surgical reviews. Their prognosis seems at least in part surgeon-dependent. Few clinical factors available preoperatively (tumor side, age, and tumor volume) were detected as influencing potential risk of surgical failures. Once identified, this needs increased attention from the surgical point of view.

Keywords

Nephroblastoma - Surgery - SIOP - nephron sparing
 

  • References

  • 1 De Kraker J, Graf N, Pritchard-Jones K , et al. Nephroblastoma Clinical Trial and Study SIOP 2001, Protocol. SIOP RTSG 2001
    Google Scholar
  • 2 Lemerle J, Voûte PA, Tournade MF , et al. Preoperative versus postoperative radiotherapy, single versus multiple courses of actinomycin D, in the treatment of Wilms' tumor. Preliminary results of a controlled clinical trial conducted by the International Society of Paediatric Oncology (S.I.O.P.). Cancer 1976; 38 (2) 647-654
    CrossrefPubMedGoogle Scholar
  • 3 Lemerle J, Voûte PA, Tournade MF , et al. Effectiveness of preoperative chemotherapy in Wilms' tumor: results of an International Society of Paediatric Oncology (SIOP) clinical trial. J Clin Oncol 1983; 1 (10) 604-609
    PubMedGoogle Scholar
  • 4 Godzinski J, Tournade MF, De Kraker J , et al. The role of preoperative chemotherapy in the treatment of nephroblastoma: the SIOP experience. Societe Internationale d'Oncologie Pediatrique. Semin Urol Oncol 1999; 17 (1) 28-32
    PubMedGoogle Scholar
  • 5 Tournade MF, Com-Nougué C, Voûte PA , 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 (6) 1014-1023
    PubMedGoogle Scholar
  • 6 Graf N, van Tinteren H, Bergeron C , et al. Characteristics and outcome of stage II and III non-anaplastic Wilms' tumour treated according to the SIOP trial and study 93-01. Eur J Cancer 2012; 48 (17) 3240-3248
    CrossrefPubMedGoogle Scholar
  • 7 Gross RE. The surgery of Infancy and childhood. Philadelphia, PA: WB Saunders Co.; 1953
    Google Scholar
  • 8 Vujanić GM, Harms D, Sandstedt B, Weirich A, de Kraker J, Delemarre JF. New definitions of focal and diffuse anaplasia in Wilms tumor: the International Society of Paediatric Oncology (SIOP) experience. Med Pediatr Oncol 1999; 32 (5) 317-323
    CrossrefPubMedGoogle Scholar
  • 9 Delemarre JF, Sandstedt B, Harms D, Boccon-Gibod L, Vujanić GM ; International Society of Paediatric Oncology. The new SIOP (Stockholm) working classification of renal tumours of childhood. Med Pediatr Oncol 1996; 26 (2) 145-146
    CrossrefPubMedGoogle Scholar
  • 10 Boccon-Gibod L, Rey A, Sandstedt B , et al. Complete necrosis induced by preoperative chemotherapy in Wilms tumor as an indicator of low risk: report of the International Society of Paediatric Oncology (SIOP) nephroblastoma trial and study 9. Med Pediatr Oncol 2000; 34 (3) 183-190
    CrossrefPubMedGoogle Scholar
  • 11 Jereb B, Tournade MF, Lemerle J , et al. Lymph node invasion and prognosis in nephroblastoma. Cancer 1980; 45 (7) 1632-1636
    CrossrefPubMedGoogle Scholar
  • 12 Godzinski J, Tournade MF, deKraker J , et al; International Society of Paediatric Oncology Nephroblastoma Trial and Study Committee. Rarity of surgical complications after postchemotherapy nephrectomy for nephroblastoma. Experience of the International Society of Paediatric Oncology-Trial and Study “SIOP-9”. Eur J Pediatr Surg 1998; 8 (2) 83-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Shamberger RC, Guthrie KA, Ritchey ML , et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg 1999; 229 (2) 292-297
    CrossrefPubMedGoogle Scholar
  • 14 Ritchey ML, Kelalis PP, Breslow N , et al. Surgical complications after nephrectomy for Wilms' tumor. Surg Gynecol Obstet 1992; 175 (6) 507-514
    PubMedGoogle Scholar
  • 15 Gentil Martins A, Espana M. Partial nephrectomy for nephroblastoma—a plea for less radical surgery. Med Pediatr Oncol 1989; 17: 320
    PubMedGoogle Scholar
  • 16 Moorman-Voestermans CGM, Staalman CR, Delamarre JFM. Partial nephrectomy in unilateral Wilms' tumour is feasible without local recurrence. Med Pediatr Oncol 1994; 23: 218
    CrossrefPubMedGoogle Scholar
  • 17 Moorman-Voestermans CGM, Aronson DC, Staalman CR, Delemarre JF, de Kraker J. Is partial nephrectomy appropriate treatment for unilateral Wilms' tumor?. J Pediatr Surg 1998; 33 (2) 165-170
    CrossrefPubMedGoogle Scholar
  • 18 Cozzi DA, Schiavetti A, Morini F, Castello MA, Cozzi F. Nephron-sparing surgery for unilateral primary renal tumor in children. J Pediatr Surg 2001; 36 (2) 362-365
    CrossrefPubMedGoogle Scholar
  • 19 Wilde JCH, Aronson DC, Sznajder B , et al. Nephron sparing surgery (NSS) for unilateral Wilms tumor (UWT): The SIOP 2001 experience. Pediatr Blood Cancer 2014; 61 (12) 2175-2179
    CrossrefPubMedGoogle Scholar
  • 20 Godzinski J, van Tinteren H, de Kraker J , et al; SIOP Nephroblastoma Trial & Study Committee. Nephroblastoma: does the decrease in tumor volume under preoperative chemotherapy predict the lymph nodes status at surgery?. Pediatr Blood Cancer 2011; 57 (7) 1266-1269
    CrossrefPubMedGoogle Scholar
  • 21 Blute ML, Kelalis PP, Offord KP, Breslow N, Beckwith JB, D'Angio GJ. Bilateral Wilms tumor. J Urol 1987; 138 (4, Pt 2) 968-973
    PubMedGoogle Scholar
  • 22 Gruner M, Audry G, Heloury Y. Partial nephrectomy in nephroblastoma [in French]. Chir Pediatr 1985; 26 (5) 300-304
    PubMedGoogle Scholar
  • 23 Coppes MJ, de Kraker J, van Dijken PJ , et al. Bilateral Wilms' tumor: long-term survival and some epidemiological features. J Clin Oncol 1989; 7 (3) 310-315
    PubMedGoogle Scholar
  • 24 Horwitz JR, Ritchey ML, Moksness J , et al. Renal salvage procedures in patients with synchronous bilateral Wilms' tumors: a report from the National Wilms' Tumor Study Group. J Pediatr Surg 1996; 31 (8) 1020-1025
    CrossrefPubMedGoogle Scholar
  • 25 Fuchs J, Wünsch L, Flemming P, Weinel P, Mildenberger H. Nephron-sparing surgery in synchronous bilateral Wilms' tumors. J Pediatr Surg 1999; 34 (10) 1505-1509
    CrossrefPubMedGoogle Scholar
  • 26 Godzinski J, Warmann SW, van Tinteren H, Graf N, Fuchs J. Minimally Invasive Surgery for Nephroblastoma—Data from SIOP 2001. Berlin: World Congress of Pediatric Surgery; 2013
    PubMedGoogle Scholar
  • 27 Duarte RJ, Dénes FT, Cristofani LM, Srougi M. Laparoscopic nephrectomy for Wilms' tumor. Expert Rev Anticancer Ther 2009; 9 (6) 753-761
    CrossrefPubMedGoogle Scholar
  • 28 Varlet F, Stephan JL, Guye E, Allary R, Berger C, Lopez M. Laparoscopic radical nephrectomy for unilateral renal cancer in children. Surg Laparosc Endosc Percutan Tech 2009; 19 (2) 148-152
    CrossrefPubMedGoogle Scholar
  • 29 Fuchs J, Schafbuch L, Ebinger M, Schäfer JF, Seitz G, Warmann SW. Minimally invasive surgery for pediatric tumors - current state of the art. Front Pediatr 2014; 2: 48
    PubMedGoogle Scholar
  • 30 Godzinski J, deKraker J, Graf N , et al. Is the number of lymph nodes (ln) sampled at Wilms tumour (wt) nephrectomy predictive for detection of the regional extention of the disease?. Pediatr Blood Cancer 2004; 43 (4) 329 [Abstract Book] SIOP XXXVI Congress Meeting, Oslo
    PubMedGoogle Scholar
  • 31 Kieran K, Anderson JR, Dome JS , et al. Lymph node involvement in Wilms tumor: results from National Wilms Tumor Studies 4 and 5. J Pediatr Surg 2012; 47 (4) 700-706
    CrossrefPubMedGoogle Scholar
  • 32 Godzinski J, Heij H, Fuchs J , et al. How to predict the risk of failure of surgery in patients with Wilms tumor?. Dublin, Ireland: EUPSA; 2014
    Google Scholar