Gao Pengfei, Li Jun, Chen Huadong, Wu Wenrui, Liu Longshan, Jiang Hong, Xu Lingling, Wu Chenglin, Fu Qian, Liu Juncheng, Wang Changxi
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Surg. 2022 Dec 13;9:1047975. doi: 10.3389/fsurg.2022.1047975. eCollection 2022.
Bilateral Wilms tumor (BWT) with renal sinus invasion requires extremely difficult surgical care. This study presents an alternative strategy for tumor removal while at the same time preserving the renal parenchyma.
In total, 9 cases of synchronous BWT were admitted to our hospital between May 2016 to Aug 2020. We retrospectively reviewed the clinical data, surgical technique, and functional and oncological outcomes of these cases.
The 9 cases included 3 males and 6 females, with a median age of 12 months at surgery (range 7-40). A total of 14 kidney units had renal sinus invasion (77.8%), whereas multifocal neoplasms were observed in 7 units (38.9%). The local stage distribution revealed 1 kidney with stage I, 10 kidneys with stage II, and 7 kidneys with stage III. Nephron-sparing surgery was performed on 15 kidney units (83.3%), among which 13 (72.2%) underwent bench surgery with autotransplantation (BS-AT), whereas 2 (11.1%) were subjected to tumor enucleation . Urinary leakage was the most prevalent postoperative complication. We observed negative margins. During the mean follow-up of 28.4 months, 2 patients (22.2%) succumbed from sepsis and renal failure, respectively, whereas the other 7 (77.8%) survived without recurrence. Survivors experienced an estimated glomerular filtration rate of 81 ± 15.4 ml/(min × 1.73 m). The endpoint renal volume of 9 renal units receiving BS-AT significantly increased ( = 0.02).
In summary, the surgical management of bilateral Wilms tumor requires meticulous operative approach and technique. Besides, BS-AT provides a viable alternative to nephron-sparing surgery for BWT patients with renal sinus invasion.
双侧肾母细胞瘤（BWT）伴肾窦侵犯的手术治疗极具挑战性。本研究提出了一种在切除肿瘤的同时保留肾实质的替代策略。
2016年5月至2020年8月期间，我院共收治9例同步性BWT患者。我们回顾性分析了这些病例的临床资料、手术技术以及功能和肿瘤学结局。
9例患者中男性3例，女性6例，手术时的中位年龄为12个月（范围7 - 40个月）。共有14个肾单位存在肾窦侵犯（77.8%），7个肾单位观察到多灶性肿瘤（38.9%）。局部分期分布显示，1个肾为I期，10个肾为II期，7个肾为III期。15个肾单位（83.3%）接受了保留肾单位手术，其中13个（72.2%）接受了体外手术联合自体肾移植（BS - AT），2个（11.1%）接受了肿瘤剜除术。尿漏是最常见的术后并发症。切缘阴性。在平均28.4个月的随访期间，2例患者（22.2%）分别死于败血症和肾衰竭，其余7例（77.8%）存活且无复发。存活者的估计肾小球滤过率为81±15.4 ml/（min×1.73 m²）。接受BS - AT的9个肾单位的最终肾体积显著增加（P = 0.02）。
总之，双侧肾母细胞瘤的手术治疗需要精细的手术方法和技术。此外，对于伴有肾窦侵犯的BWT患者，BS - AT为保留肾单位手术提供了一种可行的替代方案。
