Wilms' tumor with intracaval thrombus in the UK Children's Cancer Study Group UKW3 trial |
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Authors: | Lall Anupam Pritchard-Jones Kathy Walker Jenny Hutton Caroline Stevens Suzanne Azmy Amir Carachi Robert |
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Institution: | a Department of Pediatric Surgery, Royal Manchester Children's Hospital, M27 4HA Manchester, UK b Department of Pediatric Oncology, Royal Marsden Hospital, SM2 5PT Surrey, UK c Department of Pediatric Surgery, Sheffield Children's Hospital, S10 2TH Sheffield, UK d Medical Statistician, UKCCSG Data Centre, 9 Princess Road West, LE1 6th Leicester, UK e Department of Surgical Pediatrics, Royal Hospital for Sick Children, G3 8SJ Glasgow, UK |
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Abstract: | Background/PurposeTo define the clinical characteristics and surgical management of intracaval involvement in patients enrolled in the UKW3 trial (1991-2001), which recommended elective preoperative chemotherapy for such cases.MethodsCases were identified from preoperative imaging and surgical trial forms. These asked specific questions about whether the surgeon suspected intracaval extension at diagnosis or found it at nephrectomy. For tumors with Wilms' histology, original case notes were examined.ResultsOf 842 patients registered in UKW3, 730 (87%) had Wilms' tumor. Among them, 59 (8.1%) had evidence of intracaval extension, either documented at diagnosis (53) or found unexpectedly at nephrectomy (6). Intracaval extension was also seen in tumors of other histology. The level of thrombus was intraatrial (10), suprahepatic (9), retrohepatic (8), infrahepatic (26), and unknown (6). The median age at diagnosis was 3.75 years compared to 2.97 years in patients without inferior vena cava thrombus (P < .0001). Fifty-two of 59 received preoperative chemotherapy. Thirty-one (52%) needed cavotomy, and 3 (30%) with intraatrial extension required cardiopulmonary bypass. The commonest operative complication was significant hemorrhage and resulted in mortality in 3 cases.ConclusionsPreoperative chemotherapy is a useful adjunct to shrink the tumor and thrombus. This reduces the requirement for cavotomy and cardiopulmonary bypass. Intraoperative hemorrhage remains a significant cause of operative morbidity and mortality. |
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Keywords: | Childhood renal tumor Tumor thrombus Inferior vena cava Operative complications |
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