Surgical management and outcomes of 12 cases of Wilms tumour with intracardiac extension from a single centre
| Autor: | Alan Davidson, Jenny Thomas, Sharon Cox, Alp Numanoglu, Alastair J. W. Millar, J. Hewitson, A Brooks |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Intraoperative Complication Heart Diseases Heart Ventricles medicine.medical_treatment 030232 urology & nephrology Nephrectomy Wilms Tumor Intracardiac injection law.invention 03 medical and health sciences 0302 clinical medicine law Laparotomy Cardiopulmonary bypass Humans Medicine Heart Atria cardiovascular diseases Cardiac Surgical Procedures Thrombus Stage (cooking) Child Retrospective Studies business.industry Thrombosis General Medicine medicine.disease Kidney Neoplasms Surgery Treatment Outcome Median sternotomy Child Preschool 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health cardiovascular system Female Tomography X-Ray Computed business Progressive disease circulatory and respiratory physiology |
| Zdroj: | Pediatric Surgery International. 34:227-235 |
| ISSN: | 1437-9813 0179-0358 |
| DOI: | 10.1007/s00383-017-4197-x |
| Popis: | To review demographics, effect of preoperative chemotherapy on tumour thrombus, imaging, operative strategy, and outcomes of 12 patients presenting with intracardiac extension of Wilms tumour thrombus. A retrospective audit was undertaken on patients with intracardiac extension of Wilms tumour. Patients were identified from the oncology database and information obtained on clinical presentation, stage, preoperative treatment, surgical procedures and complications, histology, and survival status. Ethics approval was obtained from the University of Cape Town Human Research Ethics Committee. From 1984 to 2016, 337 children with Wilms tumour were treated. Twelve (3.6%) had intracardiac extension of tumour thrombus, nine into the right atrium, and three into the right ventricle. Ultrasound, computerized tomography, magnetic resonance imaging, and echocardiograms were used to assess thrombus level. Patients were staged as stage III(8) and IV(4). All patients received preoperative chemotherapy. Thrombus retracted from the heart in two cases. One patient died preoperatively. Eleven underwent laparotomy, median sternotomy, and cardiopulmonary bypass (CPB). Four underwent cavectomy. Five required cavoatrial patches. Thrombus extending into the hepatic veins was extracted in five patients. There was one intraoperative complication and one perioperative death. Thrombus histology showed viable tumour in 9 of 11 patients. Three patients died of progressive disease. Seven patients are currently disease free. A combination of imaging is required to determine thrombus extent, and this facilitates surgical planning. Preoperative chemotherapy may cause thrombus regression, thus avoiding CPB. CPB offers appropriate conditions for safe tumour thrombus excision. Full management in centres with appropriately experienced staff and facilities for CPB is recommended. |
| Databáze: | OpenAIRE |
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