Ross J H, Kay R
Section of Pediatric Urology, Cleveland Clinic Foundation, OH 44195, USA.
Semin Urol Oncol. 1999 Feb;17(1):33-9.
Despite the advances in multimodal treatment of Wilms' tumor, surgical staging and tumor resection remain a central component of therapy. Although standard approaches are available through multicenter studies, such as the NWTS and SIOP, controversy exists regarding several aspects of surgical management. Recent data call into question the need for contralateral exploration in the era of modern imaging. Various methods are available for managing caval tumor thrombus. Bilateral Wilms' tumor requires a special surgical strategy. The surgeon plays a key role in determining whether preoperative chemotherapy should be used to facilitate surgical resection. The role of partial nephrectomy is still being defined. And finally, surgery plays an important role in the management of tumor recurrence. Surgeons must be fully aware of the data and philosophical issues that pertain to these areas if they are to fulfill their role in the multidisciplinary team caring for children with Wilms' tumor.
尽管肾母细胞瘤的多模式治疗取得了进展，但手术分期和肿瘤切除仍然是治疗的核心组成部分。虽然通过多中心研究（如NWTS和SIOP）可获得标准方法，但在手术管理的几个方面仍存在争议。最新数据对现代成像时代进行对侧探查的必要性提出了质疑。有多种方法可用于处理腔静脉肿瘤血栓。双侧肾母细胞瘤需要特殊的手术策略。外科医生在决定是否应使用术前化疗以促进手术切除方面起着关键作用。部分肾切除术的作用仍在界定中。最后，手术在肿瘤复发的管理中起着重要作用。如果外科医生要在照顾肾母细胞瘤患儿的多学科团队中发挥作用，就必须充分了解与这些领域相关的数据和理论问题。
