Standardizing lymph nodal sampling for Wilms tumor: A feasibility study with outcomes

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Cancer Research

Background:

• Omission of nodal sampling is a frequent protocol deviation in Wilms tumor surgery.
• Lack of defined nodal sampling guidelines leads to surgeon practice variation.
• A systematic method for nodal sampling is proposed to reduce interoperator variation.

Purpose of the Study:

• To assess the feasibility and yield of systematic lymph node sampling in Wilms tumor surgery.
• To evaluate factors influencing nodal metastasis in Wilms tumor patients.

Main Methods:

• Prospective evaluation of 113 Wilms tumor patients from 2015-2019.
• All patients underwent systematic 5-station lymph node sampling.
• Analysis of nodal yield and metastasis based on tumor characteristics.

Main Results:

• Median lymph node yield was 8 nodes.
• 13.2% of patients had positive nodal disease.
• Interaortocaval nodes showed metastasis in 46.7% of positive cases, often as skip metastases (28.6%). Right-sided tumors and high-risk histology increased nodal metastasis risk.

Conclusions:

• Systematic station-wise lymph node sampling provides a surgical template.
• Routine sampling of interaortocaval nodes is recommended due to high disease incidence and potential for skip metastases.
• This approach enhances consistency in nodal staging for Wilms tumor.