Laparoscopic nephrectomy for Wilms’ tumor

Abstract

The role of minimally invasive surgery for the treatment of pediatric urological tumors has been limited to biopsies and resection for small neuroblastomas and benign tumors. The purpose of this study is to present the experience of a Brazilian group pioneering laparoscopic nephrectomy for Wilms' tumor. A total of 15 children with unilateral non-metastatic Wilms' tumor were preoperatively treated with vincristine and actinomycin D, and afterwards were submitted to laparoscopic nephrectomy and lymph node sampling. A Veress needle umbilical punction was performed and a four-trocar transperitoneal approach was used. The tumor was extracted inside a plastic bag and without morcellation through a Pfannenstiel incision. In all 15 patients the tumor was completely removed, as well as lymph node samples and no ruptures occurred. A fibrous capsule involved the tumor, making the dissection easy to perform. Intraoperative bleeding was minimal. The postoperative course was free of complications and all the patients were discharged early. No recurrences or long-term complications have been detected in 7-61 months or more of follow-up. We conclude that laparoscopic nephrectomy for Wilms' tumor is a feasible and safe procedure in a selected group of children after chemotherapy. It reproduces all the steps of the open surgical approach required to treat this tumor, with the advantages of a short hospital stay and cosmetically more acceptable incisions.

Minimally invasive nephrectomy for Wilms tumors in children – data from SIOP 2001

“…In adults, MIS is regularly used for the surgical treatment of renal malignancies [20]. In children, Wilms tumors (WT) are more and more often resected laparoscopically, however, only infrequent analyses have been published by now, mostly reporting on small patients' cohorts [12][13][14]21,22]. Very recently, Varlet et al published the first multi center study on 17 children undergoing laparoscopic nephrectomy for renal malignancies.…”

“…MIS also plays a certain role in pediatric surgical oncology although the exact relevance in most entities has not yet been determined [9][10][11]. The use of MIS in patients suffering from WT has been reported in singular cases [12][13][14], however, a systematic analysis has not been undertaken so far and by now there are no evidence based data available. This is of importance since the minimally invasive approach seems to be increasingly used.…”

Current Management of Wilms’ Tumor

“…This is usually done in conjunction with preoperative chemotherapy and is likely more feasible after the tumor is reduced in size [41]. Experience with open nephrectomy after chemotherapy has shown that these tumors are less prone to tumor spillage [42].…”

Minimally invasive nephron-sparing surgery for unilateral Wilms tumor

“…However, most series reporting on the subject advocate for the open surgical approach [9][10][11][12][13][14]. Minimally invasive surgery has been used successfully for radical nephrectomy after neoadjuvant chemotherapy in cases of pediatric unilateral WT [15,16]. In the adult population, laparoscopic NSS has been demonstrated to be safe with benefits in terms of recovery time and postoperative complications in the treatment of early renal cancer [17].…”