What is the risk of local recurrence after laparoscopic transperitoneal radical nephrectomy in children with Wilms tumours? Analysis of a local series and review of the literature

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Aim We present the preliminary results of robotic‐assisted laparoscopic (RAL) total and partial nephrectomy for renal malignant tumors in children. Methods This is a prospective study of patients operated with RAL between December 2016 and September 2018. Patients with Wilms tumors were treated according to the SIOP‐2001 protocol. Patient and tumor characteristics, type of surgery, surgical‐related morbidity, and oncologic outcomes were recorded. Results were compared with a series of patients with similar age‐ and tumor‐related characteristics operated during the same period by an open surgical approach. Results Ten children underwent RAL nephrectomy with a mean age of five years (3.2–14.1 years). Total nephrectomy was done in six cases for Wilms tumor and in one case for renal sarcoma; three cases were converted. Complete removal of tumor without rupture was achieved in all cases. Postoperative course was uneventful, and patients were discharged between days 2 and 7. Neither recurrence nor medium‐term complications occurred. Nine patients are alive with a median follow‐up of 16 months (6–27 months) and one female died from complications of central nervous system metastases one year after surgery. When compared with the open surgical approach group, median tumor volume was smaller (P = 0.005), hospital stay was shorter (P = 0.01), and operative time was similar (P = 0.20). Conclusions RAL total and partial nephrectomy procedure for renal tumor in children may be an option in carefully selected cases. Indication should be discussed at tumor boards and surgery performed while adhering strictly to oncological surgical rules.

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Robotic‐assisted laparoscopic management of renal tumors in children: Preliminary results

Blanc

Pio

Clermidi

et al. 2019

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“…First described in 2004 by Duarte, 4 the use of MIS for WT has been reported in the literature in approximately 100 cases 5 . There are, however, concerns with this approach, in particular with regard to the difficulty of lymph node sampling and the risk of local recurrence 5 . Hence, the UMBRELLA SIOP‐RTSG 2016 Wilms tumor protocol has defined criteria for the use and contraindications of MIS in WT 6 .…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

Bouty

Blanc

Leclair

et al. 2020

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Purpose To evaluate feasibility and outcomes of minimally invasive surgery (MIS) in Wilms tumor (WT). Methods International multicenter review of MIS total nephrectomies for WT between 2006 and 2018. Medical records of confirmed WT were retrospectively assessed for demographic, imaging, treatment, pathology, and oncological outcome data. Results Fifty patients, with a median age of 38 months (6‐181), were included in 10 centers. All patients received neoadjuvant chemotherapy, as per SIOP protocol. Median tumor volume post‐chemotherapy was 673 mL (18‐3331), 16 tumors crossed the lateral border of the spine, and three crossed the midline. Six patients with tumors that crossed the lateral border of the spine (tumor volumes 1560 mL [299‐2480]) were converted to an open approach. There was no intraoperative tumor rupture. Overall, MIS was completed in 19% of the 195 nephrectomies for WT presenting during the study period. Tumor was stage I in 29, II in 16, and III in 5, and histology was reported as low in three, intermediate in 42, and high risk in five. Three patients had positive tumor margins. After a median follow‐up of 34 months (2‐138), there were two local recurrences (both stage I, intermediate risk, 7 and 9 months after surgery) and one metastatic relapse (stage III, high risk, four months after surgery). The three‐year event‐free survival was 94%. Conclusion MIS is feasible in 20% of WT, with oncological outcomes comparable with open surgery, no intraoperative rupture, and a low rate of local relapse. Ongoing surveillance is, however, needed to evaluate this technique as it becomes widespread.

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Abdelhafeez

Reljic

Kumar

et al. 2022

Background Survival of Wilms tumor (WT) is > 90% in high‐resource settings but < 30% in low‐resource settings. Adapting a standardized surgical approach to WT is challenging in low‐resource settings, but a local control strategy is crucial to improving outcomes. Objective Provide resource‐sensitive recommendations for the surgical management of WT. Methods We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Recommendations Initiation of treatment should be expedited, and surgery should be done in a high‐volume setting. Cross‐sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6–12 weeks. Neither routine use of complex hilar control techniques during nephron‐sparing surgery nor nephron‐sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post‐chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole‐lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. Conclusion We provide evidence‐based recommendations for the surgical management of WT, considering the benefits/risks associated with limited‐resource settings.