Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, Connecticut.
J Urol. 2013 Nov;190(5):1846-51. doi: 10.1016/j.juro.2013.05.060. Epub 2013 May 30.
Nephrectomy with lymph node sampling is the recommended treatment for children with unilateral Wilms tumor under the Children's Oncology Group protocols. Using radiological assessment, we determined the feasibility of performing partial nephrectomy in a select group of patients with very low risk unilateral Wilms tumor.
We reviewed imaging studies of 60 patients with a mean age of less than 2 years with very low risk unilateral Wilms tumor (mean weight less than 550 gm) to assess the feasibility of partial nephrectomy. We evaluated percentage of salvageable parenchyma, tumor location and anatomical features preventing a nephron sparing approach.
A linear relationship exists between tumor weight and computerized tomography estimated tumor volume. Mean tumor weight in the study population was 315 gm. Partial nephrectomy was deemed feasible in only 5 of 60 patients (8%).
When considering a select population with very low risk unilateral Wilms tumor (lower volume tumor), only a small percentage of nonpretreated patients are candidates for nephron sparing surgery.
儿童肿瘤协作组的建议治疗方案是对单侧 Wilms 肿瘤患儿进行肾切除术和淋巴结取样。本研究使用影像学评估，旨在确定选择性低危单侧 Wilms 肿瘤患儿行部分肾切除术的可行性。
我们回顾性分析了 60 例年龄小于 2 岁、肿瘤负荷低危（平均体重＜550 克）的单侧 Wilms 肿瘤患儿的影像学资料，以评估行部分肾切除术的可行性。我们评估了保肾手术的可行性，具体包括：可保留肾实质的比例、肿瘤位置以及防止保肾手术的解剖学特征。
肿瘤的 CT 估计体积与肿瘤重量呈线性关系。研究人群中肿瘤的平均重量为 315 克。在 60 例患者中，仅 5 例（8%）被认为可行部分肾切除术。
在考虑低危单侧 Wilms 肿瘤（肿瘤体积较小）的选择性患儿人群中，只有一小部分未经治疗的患者适合行保肾手术。
