Special conditions in Wilms tumor: A review of literature and presentation of clinical experience of a teaching institution
Rahşan Özcan1, Şenol Emre1, Elif Kİrlİ1, Altan Alİm2, Pınar Kendİgelen3, Çiğdem Tütüncü3, Güner Kaya3, Sergülen Dervİşoğlu4, T. Tiraje Celkan5, İnci Yıldız5, Osman Faruk Şenyüz1, Mehmet Elİçevİk1, Haluk Emİr1, Yunus Söylet1, Nur Danİşmend1, S.N Cenk Büyükünal1
1İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Ürolojisi Bilim Dalı, Çocuk Cerrahisi, İstanbul
2İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Ürolojisi Bilim Dalı, Florence Nightingale Hastanesi, İstanbul
3İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Ürolojisi Bilim Dalı, Anesteziyoloji ve Reanimasyon, İstanbul
4İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Ürolojisi Bilim Dalı, Patolojik Anatomi, İstanbul
5İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Ürolojisi Bilim Dalı,Çocuk Sağlığı ve Hastalıkları Anabilim Dalları, İstanbul
Keywords: Wilms’ tumor, bilateral Wilms’ tumor, vascular extension in Wilms’ tumor, horesshoe kidney
Abstract
Aim: The aim of this study is to give the outlines of recent developments in the treatment of special conditions such as: bilateral Wilms’ tumor,vascular extension of Wilms’ tumor,horshoe kidney and Wilms’ tumor and also to present the clinical experience of a teaching institution in this field.
Material and Method: The recent publications of NWTS (COG) and SIOP related with above mentioned subjects and our clinical documents were retrospectively reviewed.
Results: -Recently nephrone sparing procedures became popular in bilateral Wilms’ tumor. These conservative procedures did not change the survival rates,but decreased the rates of kidney insufficiency percentages in long-term period.
-Vascular extension of tumor thrombi did not change the survival rates. However there was a significant operative morbidity as far as atrial thrombus are concerned. Therefore preoperative neoadjuvant chemotherapy should be used especially in thrombis which are extending up to right atrium.
-For the Wilms’ tumors arising from horseshoe kidneys, preoperative chemotherapy seems very effective to increase the percentage of remnant of healthy kidney tissue. Besides preoperative imaging techniques such as CT angiography seems very important since thsee tumors may have various additional vascular branches.
In conclusion, these special conditions need close collaboration among pediatric oncologists, surgeons, pathologists and pediatric anesthesiologist. We think this special conditions has to be treated in special units with pediatric oncologic council facilities and experienced staff.