Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia.
Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia.
J Pediatr Urol. 2018 Aug;14(4):327.e1-327.e7. doi: 10.1016/j.jpurol.2018.03.016. Epub 2018 Apr 12.
To reduce long-term morbidity (adhesions-related complications and impaired quality of life due to scars), laparoscopy has been used as an alternative to open surgery in Wilms tumours (WTs). However, concerns have been raised on the risk of local recurrence after this type of resection.
The aim was to determine the incidence of local recurrence after laparoscopic transperitoneal radical nephrectomy (LTRN).
We analysed 18 local cases and conducted a review of the English literature in Pubmed from 2004 to 2017 with the following keywords: (Wilms OR nephroblastoma) AND (laparoscopy OR minimally invasive surgery) AND 2004:3000. The review was conducted according to PRISMA guidelines. Data were collected independently in duplicate in a preformed Excel database. Review articles and duplicated case reports were excluded. Patients with retroperitoneoscopic or nephron-sparing surgery were also excluded.
One hundred and four LTRNs have been performed for WT with neoadjuvant chemotherapy in 93 cases. Tumour was ruptured preoperatively in three cases but never intraoperatively. The median volume of the tumour was 229.4 mL (3.8-776 mL). Local stage was specified in 86 cases: 49 stage I, 28 stage II, and nine stage III. Lymph nodes were sampled in 48 patients (median 2.3 [0-14] nodes). Histology was reported in 90 cases: 27 favourable and two unfavourable histology (COG); and six low, 50 intermediate, and five high-risk tumours (International Society of Paediatric Oncology). With a median follow-up of 20.5 months (1-114 months), there were four local recurrences (3.8%) at a median of 8.5 (7-9) months after surgery. Three tumours were initial local stage I (2 intermediate and 1 high risk) and one stage III. The results are presented in the Figure.
The incidence of local recurrence after LTRN is 3.8%. This is lower than previously reported after open resection. However, tumours amenable to minimally invasive surgery are smaller, with higher numbers of low stage and standard histology. Additionally, the quality of the reports is suboptimal and follow-up is relatively short.
LTRN does not seem to increase the incidence of local recurrence in WT but inclusion of patients in international protocols with prolonged and systematic follow-up is of utmost importance to carefully evaluate this risk.
为了降低长期发病率（粘连相关并发症和疤痕引起的生活质量下降），腹腔镜手术已被用于替代开放性手术治疗 Wilms 肿瘤（WT）。然而，人们对这种切除方式后局部复发的风险表示担忧。
旨在确定腹腔镜经腹根治性肾切除术（LTRN）后局部复发的发生率。
我们分析了 18 例局部病例，并在 Pubmed 上检索了 2004 年至 2017 年的英文文献，关键词为（Wilms 或 nephroblastoma）和（laparoscopy 或 minimally invasive surgery），检索结果为 2004:3000。综述按照 PRISMA 指南进行。数据以预先制定的 Excel 数据库形式独立重复收集。排除了回顾性研究和重复病例报告。也排除了后腹腔镜或保肾手术的患者。
93 例患者接受新辅助化疗后，共行 104 例 LTRN 治疗 WT。3 例患者术前肿瘤破裂，但术中从未破裂。肿瘤的中位体积为 229.4ml（3.8-776ml）。86 例患者局部分期明确：49 例 I 期，28 例 II 期，9 例 III 期。48 例患者行淋巴结取样（中位数 2.3[0-14]个淋巴结）。90 例患者报告了组织学：27 例为有利组织学，2 例为不良组织学（COG）；6 例为低危，50 例为中危，5 例为高危肿瘤（国际小儿肿瘤学会）。中位随访 20.5 个月（1-114 个月）后，术后 8.5（7-9）个月时，4 例患者出现局部复发（3.8%）。3 例肿瘤为初始局部 I 期（2 例为中危，1 例为高危），1 例为 III 期。结果如图所示。
LTRN 后局部复发的发生率为 3.8%。这低于先前报道的开放性切除术后的复发率。然而，可接受微创手术的肿瘤体积较小，且更多为低分期和标准组织学类型。此外，报告的质量不理想，随访时间相对较短。
LTRN 似乎不会增加 WT 的局部复发率，但纳入国际协议并进行长期系统随访的患者非常重要，以便仔细评估这种风险。
