Pediatric Surgery Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France.
Pathology Department, Sorbonnes Universités, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France.
Pediatr Blood Cancer. 2020 Dec;67(12):e28661. doi: 10.1002/pbc.28661. Epub 2020 Aug 18.
Definitions of nephron-sparing surgery (NSS) procedures in Wilms tumor (WT) are not clear. The new UMBRELLA protocol offers a formula (NSS(X)-SRM(n)-PRM(n)-RRP(n%)) to better define the different NSS parameters. We aimed to assess the advantages and limits of this new formula.
This retrospective monocentric study included patients operated by NSS for WT from 1975 to 2018. We reviewed the medical records and applied the NSS formula to all included patients.
Eighty kidneys were operated on 56 patients at a mean age of 19.2 months (4 days-7.5 years), with 49 partial nephrectomies and 31 tumorectomies. The assessment of the surgical resection margins (SRM) showed a doubt in six cases and one tumor breach. An intact pseudocapsule along the resection margin with no renal parenchyma was found in four cases at pathological resection margins (PRM) assessment, whereas a tumor breach was described in seven cases. Among the six patients with a surgical doubt, only one had a pathological stage III. There were no surgical doubts in the seven patients with tumor breach at pathology. At a mean follow-up of eight years (15 days-28.6 years), eight patients had elevated blood pressure levels. Ten had proteinuria. These two parameters were significantly increased in patients with a remaining renal parenchyma (RRP) of less than half of the initial total renal parenchyma. The serum creatinine level was normal for all except two patients.
The new NSS formula described all the crucial elements of NSS. RRP seemed essential for the evaluation of long-term renal function.
Wilms 肿瘤（WT）中保肾手术（NSS）的定义不明确。新的 UMBRELLA 方案提供了一个公式（NSS(X)-SRM(n)-PRM(n)-RRP(n%))，以更好地定义不同的 NSS 参数。我们旨在评估这个新公式的优点和局限性。
这是一项回顾性单中心研究，纳入了 1975 年至 2018 年期间接受 NSS 治疗的 WT 患者。我们回顾了病历，并将 NSS 公式应用于所有纳入的患者。
56 名患者的 80 个肾脏接受了手术，平均年龄为 19.2 个月（4 天至 7.5 岁），其中 49 例为部分肾切除术，31 例为肿瘤切除术。评估手术切除边缘（SRM）时，在 6 例中存在疑问，1 例肿瘤突破。在病理切除边缘（PRM）评估中，4 例发现完整的假包膜沿着切除边缘，没有肾实质，而在 7 例中发现肿瘤突破。在 6 例有手术疑问的患者中，只有 1 例病理分期为 III 期。在病理上有肿瘤突破的 7 例患者中，没有手术疑问。平均随访 8 年（15 天至 28.6 年），8 例患者血压升高。10 例患者蛋白尿。在初始总肾实质保留不到一半的患者中，这两个参数显著增加。除了 2 例患者外，其余患者的血清肌酐水平均正常。
新的 NSS 公式描述了 NSS 的所有关键要素。RRP 似乎是评估长期肾功能的关键因素。
