Ritchey Michael L, Shamberger Robert C, Hamilton Thomas, Haase Gerald, Argani Pedram, Peterson Susan
Division of Urology, University of Texas Houston Medical School, Houston, Texas, USA.
J Urol. 2005 Oct;174(4 Pt 2):1519-21; discussion 1521. doi: 10.1097/01.ju.0000179536.97629.c5.
In children undergoing nephrectomy for Wilms tumor exploration of the contralateral kidney has been recommended to detect occult tumors missed on preoperative evaluation. In this review of the National Wilms Tumor Study (NWTS) 4 cases of bilateral Wilms tumors (BWT) we evaluate incidence and outcome of missed bilateral lesions.
NWTS-4 enrolled 3,335 patients from August 1986 through September 1994. There were 188 patients with BWT or 5.6% of the total registered. The operative records, pathology and imaging reports were reviewed.
In 11 cases synchronous BWT was diagnosed at surgical exploration, which represents 5.9% of the bilateral cases but only 0.3% of all NWTS-4 cases. Two patients did not undergo preoperative imaging and were excluded from analysis. The size of the missed lesions was less than 1 cm in 6 patients and 1 to 2 cm in 3. Computerized tomography was performed in all patients except one who entered early in the study. Management of missed lesions included enucleation in 2 cases, biopsy in 6 and no surgery in 1. No patient underwent irradiation. The postoperative chemotherapy regimen consisted of doxorubicin, dactinomycin and vincristine in 6 children, and dactinomycin and vincristine in 3. Median followup was 9 years. There were no recurrences in any kidney with a missed lesion. All 9 patients were alive and disease-free at last followup.
Routine contralateral renal exploration will identify few occult tumors not detected on preoperative imaging. Omission of routine exploration will not likely affect the outcome or management of newly diagnosed Wilms tumor provided preoperative computerized tomography or magnetic resonance imaging is performed. The outcome in these patients was excellent.
对于因肾母细胞瘤而行肾切除术的儿童，建议探查对侧肾脏以发现术前评估遗漏的隐匿性肿瘤。在对国家肾母细胞瘤研究（NWTS）中4例双侧肾母细胞瘤（BWT）的回顾中，我们评估了遗漏的双侧病变的发生率和结局。
NWTS - 4从1986年8月至1994年9月共纳入3335例患者。其中有188例BWT患者，占总登记人数的5.6%。对手术记录、病理及影像报告进行了回顾。
11例患者在手术探查时诊断为同步性BWT，占双侧病例的5.9%，但仅占所有NWTS - 4病例的0.3%。2例患者未进行术前影像学检查，被排除在分析之外。6例患者遗漏病变的大小小于1 cm，3例为1至2 cm。除1例早期入组研究的患者外，所有患者均进行了计算机断层扫描。遗漏病变的处理包括2例行剜除术，6例行活检，1例未手术。无一例患者接受放疗。6例儿童术后化疗方案为阿霉素、放线菌素D和长春新碱，3例为放线菌素D和长春新碱。中位随访时间为9年。有遗漏病变的任何一侧肾脏均无复发。最后一次随访时，所有9例患者均存活且无疾病。
常规的对侧肾脏探查只能发现少数术前影像学未检测到的隐匿性肿瘤。如果进行了术前计算机断层扫描或磁共振成像，省略常规探查不太可能影响新诊断肾母细胞瘤的结局或治疗。这些患者的结局良好。
