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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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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 donor...

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Related Experiment Video

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Nephron-Sparing Surgery for Patients With Wilms Tumor, a Surgical Delphi Study Consensus Statement.

Matthijs Fitski1, Guus M J Bökkerink1, Andrew M Davidoff2

  • 1Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.

Pediatric Blood & Cancer
|March 10, 2025
PubMed
Summary

Nephron-sparing surgery (NSS) for pediatric Wilms tumor (WT) is feasible for unilateral cases with specific criteria, including neoadjuvant chemotherapy and tumor size. This study defines surgical consensus to expand NSS utilization.

Keywords:
Delphi consensus statementWilms tumornephron‐sparing surgery

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Area of Science:

  • Pediatric Oncology
  • Surgical Oncology
  • Nephrology

Background:

  • Current pediatric renal tumor treatment guidelines restrict nephron-sparing surgery (NSS) for unilateral Wilms tumor (WT) under strict conditions.
  • Surgical feasibility is not adequately addressed in oncological guidelines, potentially limiting NSS use.
  • Defining surgical feasibility is crucial for optimizing NSS in WT management.

Purpose of the Study:

  • To establish surgical consensus statements for assessing Wilms tumor (WT) patients eligible for nephron-sparing surgery (NSS).
  • To develop criteria for surgical feasibility to potentially increase the utilization of NSS in pediatric WT cases.

Main Methods:

  • A Delphi study involving 34 potential surgical experts was conducted.
  • Experts responded to questionnaires on surgery, oncology, contraindications, technique, and organization for NSS in WT.
  • Follow-up questionnaires presented closed-ended statements derived from initial responses.

Main Results:

  • Eleven surgeons participated, completing three questionnaires with 72 statements.
  • Nephron-sparing surgery (NSS) for nonsyndromic unilateral WT is considered feasible after 4 weeks of neoadjuvant chemotherapy, with tumors <200 mL, and when partial nephrectomy with >5 mm margins is possible.
  • Despite feasibility, some COG surgeons did not advocate NSS for nonsyndromic unilateral WT.

Conclusions:

  • Surgical experts utilized the Delphi method to define consensus statements for NSS in Wilms tumor (WT).
  • These consensus statements aim to define surgical feasibility for WT, potentially expanding the use of oncologically appropriate NSS.
  • The findings support the integration of surgical feasibility into future WT treatment protocols to enhance NSS utilization.