Outcomes of incomplete thrombectomy in Wilms tumour with intravascular extension: A commentary

Boam, Tristan; Rogoyski, Bethan G.; Gabriel, Melissa; Losty, Paul D.

doi:10.1002/pbc.29623

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Upstaging in case of incomplete resection with additional radiotherapy after surgery may overcome a negative impact on survival after incomplete resection of VCT. This assumption is also supported by Boam [33]. Histologic risk group significantly affected survival.…”

Section: Discussionmentioning

confidence: 68%

Vena Cava Thrombus in Patients with Wilms Tumor

Meier

Furtwängler

Schweinitz

et al. 2022

Cancers

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(1) Background: Vena cava thrombus (VCT) is rare in Wilms tumor (WT) (4–10%). The aim of this study is to identify factors for an outcome to improve treatment for better survival. (2) Methods: 148/3015 patients with WT (aged < 18 years) and VCT, prospectively enrolled over a period of 32 years (1989–2020) by the German Society for Pediatric Oncology and Hematology (SIOP-9/GPOH, SIOP-93-01/GPOH and SIOP-2001/GPOH), are retrospectively analyzed to describe clinical features, response to preoperative chemotherapy (PC) (142 patients) and surgical interventions and to evaluate risk factors for overall survival (OS). (3) Results: 14 VCT regressed completely with PC and another 12 in parts. The thrombus was completely removed in 111 (85.4%), incompletely in 16 (12.3%), and not removed in 3 (2.3%). The type of removal is unknown in four patients. Patients without VCT have a significantly (p < 0.001) better OS (97.8%) than those with VCT (90.1%). OS after complete resection is (89.9%), after incomplete (93.8%) and with no resection (100%). Patients with anaplasia or stage IV without complete remission (CR) after PC had a significantly worse OS compared to the remaining patients with VCT (77.1% vs. 94.4%; p = 0.002). (4) Conclusions: As a result of our study, two risk factors for poor outcomes in WT patients with VCT emerge: diffuse anaplasia and metastatic disease, especially those with non-CR after PC.

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Section: Discussionmentioning

confidence: 68%

Vena Cava Thrombus in Patients with Wilms Tumor

Meier

Furtwängler

Schweinitz

et al. 2022

Cancers

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Wilms Tumor with Vena Caval Intravascular Extension: A Surgical Perspective

Gehle,

Morrison,

Halepota

et al. 2024

Children

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Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus extension is usually diagnosed by imaging. Neoadjuvant chemotherapy is indicated for thrombus extension above the level of the hepatic veins and often leads to thrombus regression, obviating the need for cardiopulmonary bypass in cases of cardiac thrombus at diagnosis. In cases of tumor extension to the retrohepatic cava, neoadjuvant therapy is not strictly indicated, but it may facilitate the regression of tumor thrombi, making resection safer. Hepatic vascular isolation and cardiopulmonary bypass increase the risk of bleeding and other complications when utilized for tumor thrombectomy. Fortunately, WT patients with vena caval with or with intracardiac extension have similar overall and event-free survival when compared to patients with WT without intravascular extension when thrombectomy is successfully performed. Still, patients with metastatic disease at presentation or unfavorable histology suffer relatively poor outcomes. Dedicated pediatric surgical oncology and pediatric cardiothoracic surgery teams, in conjunction with multimodal therapy directed by a multidisciplinary team, are preferred for optimized outcomes in this patient population.

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Outcomes of incomplete thrombectomy in Wilms tumour with intravascular extension: A commentary

Cited by 2 publications

References 14 publications

Vena Cava Thrombus in Patients with Wilms Tumor

Vena Cava Thrombus in Patients with Wilms Tumor

Wilms Tumor with Vena Caval Intravascular Extension: A Surgical Perspective

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