Laparoscopic Approach for Wilms Tumor

Abstract

LN for Wilms tumor may be considered as an option in selected patients. Minimally invasive surgery allows the surgeon to follow all the oncologic principles required for surgical treatment of this neoplasm and provides the advantages of these techniques for cancer patients. Preoperative chemotherapy is essential to decrease tumor size and facilitate the dissection avoiding tumor rupture.

Systematic Review and Meta-analysis of Laparoscopic Versus Open Radical Nephrectomy for Paediatric Renal Tumours with Focus on Wilms’ Tumour

“…1). Ultimately, the systematic review of LRN included 13 studies on RT 5,6,8,10,11,[13][14][15][25][26][27][28][29] and a subset of 10 studies on WT. 8,11,[13][14][15][25][26][27][28][29] The meta-analysis of LRN versus ORN included 7 studies on RT 5,6,9,14,27,29,30 and a subset of 5 studies on WT.…”

“…Ultimately, the systematic review of LRN included 13 studies on RT 5,6,8,10,11,[13][14][15][25][26][27][28][29] and a subset of 10 studies on WT. 8,11,[13][14][15][25][26][27][28][29] The meta-analysis of LRN versus ORN included 7 studies on RT 5,6,9,14,27,29,30 and a subset of 5 studies on WT. 9,14,27,29,30 All studies were retrospective, published between 2014 and 2020.…”

“…9,14,27,29,30 All studies were retrospective, published between 2014 and 2020. According to both reviewers, two cohort studies 8,10 in the systematic review of LRN were of "poor" quality, whereas the rest cohort and comparative studies were qualitatively "fair." Both reviewers were in agreement that all comparative studies included in the meta-analysis of LRN versus ORN were of "fair" quality; only 2 studies 14,27 nevertheless had a matched-group design.…”

“…Feasibility of laparoscopic approaches to pediatric RT, primarily WT, has been well reported during the last decade by several groups, with the main proposed benefits being: faster recovery (and hence earlier onset of adjuvant treatment), [5][6][7][8] as well as reduced postoperative morbidity related to pain, incisional hernias and adhesive bowel obstruction. 5,[8][9][10] Results of suggested advantages vary among studies, however, and at the same time, legitimate fears about possible adverse effects on cancer-related outcomes persist. These concerns surround the feasibility of laparoscopic resection without an increase in the risk of neoplastic cell spillage and of adequate laparoscopic lymph node sampling for accurate staging.…”

“…These concerns surround the feasibility of laparoscopic resection without an increase in the risk of neoplastic cell spillage and of adequate laparoscopic lymph node sampling for accurate staging. 4,5,8,11 The surgical panel of the International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG) recommends that only localized central RT not extending beyond the ipsilateral border of the spinal column should be considered for laparoscopy. 1,12 These criteria were, however, challenged in practice by some groups, 9,13,14 whereas several tumor volume 6,7,14,15 and diameter 4,5,11 cutoff values have been also suggested as a guide for patient selection.…”