Laparoscopic nephron-sparing surgery and laparoscopic nephrectomy for Wilms' tumor
Maciej Murawski1, Joanna Stefanowicz2,3,4, Marcin Łosin1
1Department of Surgery and Urology for Children and Adolescents, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
Summary
Laparoscopic nephrectomy (LN) is a feasible option for treating Wilms tumors in children, especially after neoadjuvant chemotherapy shrinks the tumor. Experienced surgeons can achieve good outcomes with this minimally invasive approach.
Area of Science:
- Pediatric Surgery
- Urologic Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic nephrectomy (LN) for Wilms tumors remains debated.
- Neoadjuvant chemotherapy facilitates tumor shrinkage, making LN a viable option.
- Laparoscopic nephron-sparing surgery (NSS) is technically demanding and requires surgeon expertise.
Purpose of the Study:
- To report on the feasibility and outcomes of laparoscopic surgery for Wilms tumors.
- To evaluate the effectiveness of neoadjuvant chemotherapy in reducing tumor size prior to laparoscopic resection.
Main Methods:
- Retrospective review of 8 pediatric patients with Wilms tumors undergoing laparoscopic surgery (7 nephrectomies, 1 heminephrectomy) between 2013-2020.
- All patients received neoadjuvant chemotherapy per SIOP protocol.
- Tumor volume was measured before and after chemotherapy.
Main Results:
- Seven laparoscopic nephrectomies and one laparoscopic heminephrectomy were successfully performed without intraoperative rupture.
- One case of urine leak occurred post-heminephrectomy; no other complications reported.
- All 8 patients remained disease-free with no local or distant relapses at a median follow-up of 71 months.
Conclusions:
- Laparoscopic nephrectomy is a feasible surgical option for pediatric Wilms tumors.
- Careful patient selection and specialized laparoscopic surgical training are crucial for successful outcomes.
- Laparoscopic heminephrectomy requires particular surgical skill and experience.
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