Preoperative Wilms tumor rupture in children
Ying Zhang1, Hong-Cheng Song2, Yan-Fang Yang1
1Department of Urology, Zhengzhou Children's Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
International Urology and Nephrology
|November 27, 2020
Summary
Wilms tumor rupture, classified as stage III, requires careful diagnosis and treatment. While overall survival is similar to non-ruptured cases, ruptured Wilms tumors show a higher risk of recurrence and metastasis.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
Background:
- Wilms tumor with preoperative rupture is often classified as stage III per SIOP and NWTS guidelines.
- Clinical reports on preoperative Wilms tumor rupture are limited, necessitating further investigation.
Purpose of the Study:
- To investigate the diagnosis, treatment, and prognosis of preoperative Wilms tumor rupture.
- To analyze clinical and radiologic signs, treatment strategies, and outcomes in patients with ruptured Wilms tumors.
Main Methods:
- Retrospective review of Wilms tumor patients treated under NWTS or SIOP protocols (2008-2017).
- Identification of preoperative tumor rupture based on clinical (abdominal pain, hemoglobin fall) and radiologic signs (effusion, hemorrhage, fracture, ascites).
- Comparison of outcomes between ruptured and non-ruptured Wilms tumor groups, including immediate vs. delayed surgery for ruptured cases.
Main Results:
- 45 of 565 Wilms tumor patients had preoperative rupture, confirmed at surgery.
- Stage III ruptured tumors showed varied presentations; immediate surgery (13 patients) had 2 recurrences/metastases, while delayed surgery (28 patients) had 8 recurrences/metastases and 7 deaths.
- Ruptured Wilms tumors had a significantly higher recurrence/metastasis rate (24.4%) compared to non-ruptured tumors (7.3%), though overall survival showed no statistical difference.
Conclusions:
- Contrast-enhanced CT and US are valuable for diagnosing preoperative Wilms tumor rupture.
- Both immediate and delayed surgery are viable therapeutic options, with treatment selection based on patient condition, tumor characteristics, and multidisciplinary team expertise.
- Preoperative Wilms tumor rupture is associated with an increased risk of postoperative recurrence or metastasis.
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