Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia.
Paediatric Surgery Department, Hopital Necker Enfants Malades, Paris, France.
Pediatr Blood Cancer. 2020 May;67(5):e28212. doi: 10.1002/pbc.28212. Epub 2020 Feb 16.
To evaluate feasibility and outcomes of minimally invasive surgery (MIS) in Wilms tumor (WT).
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.
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%.
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.
评估微创外科（MIS）治疗肾母细胞瘤（WT）的可行性和结果。
对 2006 年至 2018 年期间国际多中心微创全肾切除术治疗 WT 的病例进行回顾性分析。对经病理证实的 WT 患者的人口统计学、影像学、治疗、病理和肿瘤学结果数据进行回顾性评估。
在 10 个中心共纳入 50 例患者，中位年龄为 38 个月（6-181 岁）。所有患者均按 SIOP 方案接受新辅助化疗。化疗后肿瘤体积中位数为 673ml（18-3331ml），16 例肿瘤越过脊柱侧缘，3 例越过中线。6 例肿瘤越过脊柱侧缘（肿瘤体积 1560ml[299-2480ml]）的患者转为开放手术。术中无肿瘤破裂。总体而言，在研究期间行 MIS 的 195 例 WT 患者中，19%的患者完成了手术。肿瘤分期 I 期 29 例，II 期 16 例，III 期 5 例，组织学报告低风险 3 例，中危 42 例，高危 5 例。3 例患者肿瘤切缘阳性。中位随访 34 个月（2-138 个月）后，有 2 例局部复发（均为 I 期，中危，分别于术后 7 个月和 9 个月），1 例远处转移复发（III 期，高危，术后 4 个月）。3 年无事件生存率为 94%。
在 20%的 WT 患者中，MIS 是可行的，其肿瘤学结果与开放手术相当，术中无肿瘤破裂，局部复发率低。然而，需要进行长期随访来评估该技术的效果。
