Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension: A Pediatric Surgical Oncology Research Collaborative Study.

Autor:	Naik-Mathuria B; Department of Surgery, Division of Pediatric Surgery, University of Texas Medical Branch, Galveston, TX., Utria AF; Department of Surgery, Division of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA., Ehrlich PF; Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, MI., Aldrink JH; Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH., Murphy AJ; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN., Lautz T; Department of Surgery, Division of Pediatric Surgery, Lurie Children's Hospital, Northwestern School of Medicine, Chicago, IL., Dasgupta R; Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH., Short SS; Department of Surgery, Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT., Lovvorn HN 3rd; Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN., Kim ES; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA., Newman E; Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, MI., Lal DR; Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI., Rich BS; Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/., Piché N; Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada., Kastenberg ZJ; Department of Surgery, Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT., Malek MM; Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA., Glick RD; Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/., Petroze RT; Division of Pediatric Surgery, University of Florida, Gainesville, FL., Polites SF; Department of Surgery, Mayo Clinic, Rochester, MN., Whitlock R; Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX., Alore E; Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX., Sutthatarn P; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN., Chen SY; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA., Wong-Michalak S; Department of Surgery, Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA., Romao RL; Division of Pediatric Surgery and Pediatric Urology, IWK Health, Dalhousie University, Halifax, NS, Canada., Al-Hadidi A; Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH., Rubalcava NS; Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, MI., Marquart JP; Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI., Gainer H; Division of Pediatric Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI., Johnson M; Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH., Boehmer C; Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH., Rinehardt H; Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA., Seemann NM; Department of Surgery, Division of Pediatric Surgery, Western University, London, ON, Canada., Davidson J; Department of Surgery, Division of Pediatric Surgery, Western University, London, ON, Canada., Polcz V; Division of Pediatric Surgery, University of Florida, Gainesville, FL., Lund SB; Department of Surgery, Mayo Clinic, Rochester, MN., McKay KG; Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN., Correa H; Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN., Rothstein DH; Department of Surgery, Division of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Mar 01; Vol. 279 (3), pp. 528-535. Date of Electronic Publication: 2023 Jun 02.
DOI:	10.1097/SLA.0000000000005921
Abstrakt:	Objective: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. Background: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. Methods: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. Results: Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P =0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P =0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. Conclusions: Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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