Patient selection and technical aspects for laparoscopic nephrectomy in Wilms tumor

• Published in: Surgical oncology 2019-06, Vol.29, p.14-19
• Main Authors: Schmidt, Andreas, Warmann, Steven W., Urla, Cristian, Schaefer, Juergen, Fideler, Frank, Fuchs, Joerg
• Format: Article
• Language: English
• Subjects: Age; Algorithms; Anesthesia; Chemotherapy; Children; Complications; Dissection; Histology; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy; Laparoscopy - methods; Lymph nodes; Lymphatic system; Medical imaging; Medical personnel; Minimally invasive surgery; Minimally Invasive Surgical Procedures - methods; Nephrectomy; Nephrectomy - methods; NMR; Nodes; Nuclear magnetic resonance; Patient Selection; Patients; Prognosis; Radiation therapy; Respiration; Sampling; Surgery; Survival; Tumors; Ureter; Veins & arteries; Wilms tumor; Wilms Tumor - pathology; Wilms Tumor - surgery
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2019.02.007

Only limited data exist to define the role of laparoscopic nephrectomy for Wilms tumor. Our aim was to present our experiences with this method with special regard to patient selection and technical aspects. Records of patients with Wilms tumor who had been operated on using laparoscopic nephrectomy were reviewed retrospectively. Analyzed data contained patient characteristics, outcome, staging, tumor histology, tumor size, lymph node sampling, lymph node histology, pre- and postoperative chemotherapy, radiotherapy, surgical procedures, and complications. From 2010 to 2018 laparoscopic Wilms tumor nephrectomy was performed in 9 children (median age 24 months (12.0–57.5)) who did not qualify for nephron sparing surgery and who met internally defined criteria. Each patient received neoadjuvant chemotherapy to which 7 of the tumors responded substantially. Median tumor volume at surgery, maximal diameter, and specimen weight was 74 ml (15–207), 6.5 cm (3.5–9.3), and 125 g (63–310), respectively. No intra- or postoperative complications occurred. Overall survival and event-free survival was 9/9, median follow up was 48 months (24–78). These data were used to propose a patient selection algorithm. Technical aspects derived from our experience include usage of the ureter as leading structure, usage of a transabdominal traction suture around the ureter, and lymph node sampling before tumor nephrectomy. With increasing expertise of operating surgeons, more complex WT might be a target for minimally invasive surgery, provided that patient selection and technical factors are carefully addressed. •This is a study of a national surgical reference center with special focus on these current issues.•We report on our experience with laparoscopic nephrectomy in unilateral WT in 9 children and discuss which tumors can be safely removed by MIS.•Surgical as well as anesthesiological and radiological aspects of treating patients with WT are described.