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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Surgery for the complex Wilms tumour.

Sharon Cox1, Cenk Büyükünal2, Alastair J W Millar3

  • 1Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa. Sharon.cox@uct.ac.za.

Pediatric Surgery International
|November 9, 2019
PubMed
Summary
This summary is machine-generated.

Wilms tumour survival has improved significantly with modern treatments. Surgical expertise remains crucial for complex cases, including large, ruptured, or invasive tumours, to further enhance outcomes for children.

Keywords:
Bilateral wilmsHorseshoe kidneyIntracardiac extensionIntravascular extensionSurgery of wilms tumour

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Area of Science:

  • Pediatric Oncology
  • Surgical Oncology
  • Nephrology

Background:

  • Wilms tumour survival rates have dramatically increased to nearly 90% due to advancements in adjuvant radiotherapy and chemotherapy over the past 70 years.
  • While overall survival has improved, specific subgroups, including those with anaplastic histology, bilateral disease, high-risk tumours, or relapsed cases, still face lower event-free survival and long-term treatment effects.
  • Current treatment strategies focus on refining risk assessment and tailoring therapies to maximize benefits while minimizing toxicity and long-term morbidity, emphasizing safe and complete tumor resection and staging.

Purpose of the Study:

  • To review and describe surgical strategies and techniques for managing complex Wilms tumours.
  • To highlight the ongoing importance of surgical expertise in the comprehensive treatment of pediatric Wilms tumour patients.
  • To share insights from extensive surgical experience in managing over 300 Wilms tumour cases.

Main Methods:

  • Review of surgical strategies and techniques employed in managing complex Wilms tumours.
  • Analysis of surgical challenges including very large tumours, ruptured tumours, intravascular invasion, and Wilms tumours in horseshoe kidneys.
  • Gleaning insights from the authors' 30-year experience in surgical management of over 300 pediatric Wilms tumour cases.

Main Results:

  • Surgical management of Wilms tumours has evolved significantly, with improved survival rates.
  • Complex cases, such as those with intravascular invasion or in horseshoe kidneys, present unique surgical challenges requiring specialized techniques.
  • The authors' extensive experience provides a basis for refining surgical approaches in difficult Wilms tumour scenarios.

Conclusions:

  • Despite significant progress, surgical challenges persist in managing complex Wilms tumours.
  • Continued advancement and application of specialized surgical expertise are essential for optimizing outcomes in these specific patient subgroups.
  • A multidisciplinary approach integrating surgical proficiency with chemotherapy and radiotherapy remains key to improving long-term survival and reducing morbidity in pediatric Wilms tumour.