Successful pulmonary artery embolectomy in a patient with a saddle Wilms tumor embolus

Cooper, Lindsey; Moore, Colin; Branchford, Brian R.; Greffe, Brian; Capocelli, Kelley E.; Kuder, Austine; Mehta, Inder; Mourani, Peter M.

doi:10.1002/pbc.23215

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Our study suggests that young and high-risk WT patients who receive intensive treatment regimens (i.e., for bilateral WT) seem to require unplanned PICU admission more often. This finding has not been described previously and is not consistently reflected in the previously reported cases of WT patients with complications requiring PICU admission [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. In the SIOP93-01 and SIOP2001 studies, patients aged 6 months to 2 years were shown to have an excellent survival, with a higher event-free survival when compared to older age groups [ 2 , 3 , 32 ].…”

Section: Discussioncontrasting

confidence: 70%

“…Case reports confirm that children with WT may require unplanned intensive care treatment due to various tumor- and treatment-related emergencies. These cases revealed not only relatively well-known emergencies associated with WT at presentation, such as malignant hypertension and extensive (intracardial) tumor thrombus, but also postoperative hemorrhage, cardiomyopathy and hepatotoxicity, intracranial bleeding, and seizures [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Steur

Raymakers-Janssen

Kneyber

et al. 2022

Cancers

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Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.

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Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Steur

Raymakers-Janssen

Kneyber

et al. 2022

Cancers

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“…Note that 43 documented papers (Table S1) reported paediatric patients with Wilms tumour and intravascular extension, with age in the range of 7 weeks‐16 years. Sample size ranged from 1 to 165 patients.…”

Section: Resultsmentioning

confidence: 99%

Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

Morris

Squire

Sznajder

et al. 2019

Pediatric Blood & Cancer

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Introduction:Preoperative chemotherapy is recommended for children with Wilms tumour with intravascular extension. Extended chemotherapy may improve resectability, but increase tumour adherence to vascular endothelium, precluding complete resection. To evaluate the optimal length of preoperative treatment, we report a two-part review comprising systematic review of the literature and investigation of patients treated in the International Society of Paediatric Oncology (SIOP) WT 2001 trial. Methods: Studies were identified using Medline and Embase databases from 1996 to present. English language titles reporting management of intravascular Wilms tumour were analysed. Patients with Wilms tumour and thrombus were identified from the SIOP WT 2001 trial. Overall survival (OS) and event-free survival (EFS), tumour regression, completeness of resection and cavectomy were investigated. Results: The search retrieved 43 articles documenting 498 children. Note that 72% of the patients received neoadjuvant chemotherapy: 101 received standard course (4-6 weeks, standard course neoadjuvant chemotherapy [StC]) and 62 extended course (> 6 weeks, extended course neoadjuvant chemotherapy [EC]). There was no significant difference between the groups in terms of thrombus regression or completeness of resection. EFS was greater in the StC group (78 vs 54%; P = .04). Of 4511 patients registered in the SIOP WT 2001 trial, 166 had thrombus. Note that 97% of the patients received neoadjuvant chemotherapy: 63 StC and 67 EC. There was no significant difference between the groups with regard to tumour regression, complete resection, or cavectomy. Survival was significantly higher in those receiving StC than EC (OS: 95% vs 82%, P = .025; EFS: 88% vs 72%, P = .047). Conclusion:There is no evidence that prolonged courses of neoadjuvant chemotherapy beyond the recommended protocols confer any additional benefit in treating intravascular extension of Wilms tumour.

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“…Additionally, 1 patient was found to have massive tumor embolism, which, to our knowledge, has only been reported in case reports. 3,[8][9][10] In a recent study from Pelland-Marcotte et al, 11 researchers compared 49 pediatric patients with MPE and SMPE combined versus patients with low-risk PE at 2 centers in Canada over a similar time period. Compared with this study, our cohort appeared to have lower proportions of infants ,1 year, cardiac disease, and presence of central venous catheters.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Massive and Submassive Pulmonary Embolism: A Single-Center Experience

Ross

Shih

Kleinman

et al. 2020

Hospital Pediatrics

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To describe and compare patient and event characteristics and outcomes in pediatric massive pulmonary embolism (MPE) and submassive pulmonary embolism (SMPE). METHODS: A retrospective cohort study at a quaternary-care pediatric hospital was conducted. Patients age ,19 years with MPE (acute pulmonary embolism [PE] with cardiac arrest, hypotension, or compensated shock due to PE) or SMPE (right ventricular strain due to acute PE) between January 1997 and June 2019 were included. RESULTS: Thirty-three patients were identified, including 9 (27%) patients with MPE and 24 (73%) patients with SMPE. The most commonly identified risk factor was use of oral contraceptive pills in 16 (49%) patients. Six (18%) patients died, 3 (9%) of which were PE-related deaths. Before PE, patients with MPE were more likely to be hospitalized (89% vs 13%, P , .001), have major comorbidities (89% vs 25%, P 5 .002), central venous catheters (67% vs 17%, P 5 .01), critical illness (56% vs 8%, P 5 .009), immobility (67% vs 13%, P 5 .005), and be postoperative (44% vs 4%, P 5 .01). MPE patients were also more likely to die before discharge (56% vs 4%, P 5 .003). Both groups were equally likely to have primary reperfusion attempts (78% of MPE versus 67% of SMPE, P 5 .69). CONCLUSIONS: Pediatric MPE and SMPE differed in presentation, comorbidities, and risk factors, many of which were associated with hospitalization status. Pediatric-specific studies are warranted to determine risk assessment and management strategies, which may differ from adult guidelines.

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Successful pulmonary artery embolectomy in a patient with a saddle Wilms tumor embolus

Cited by 4 publications

References 16 publications

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

Pediatric Massive and Submassive Pulmonary Embolism: A Single-Center Experience

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