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Modified radical nephrectomy in the treatment of pediatric unilateral Wilms' tumor: Emphasizing a template-based
Xiaofeng Chang1, Shan Liu1, Qinghua Ren1
1Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Background:
The surgical management of pediatric unilateral Wilms' tumor (uWT) continues to be a subject of ongoing debate, particularly regarding the criteria for lymph node (LN) sampling. To address this concern, we implemented a modified radical nephrectomy (MRN) technique that includes ipsilateral perivascular regional LN dissection following nephrectomy to enhance the surgical approach. This study evaluates the safety and feasibility of MRN in treating uWT.
Methods:
We conducted a retrospective analysis of 105 uWT cases treated with MRN from January 2016 to June 2023. Clinical characteristics, treatment regimens, and patient outcomes were evaluated.
Results:
All 105 patients underwent MRN successfully. Among these, 48 received upfront surgery, while 57 were treated with neoadjuvant chemotherapy. After nephrectomy, regional LN dissection was performed, with a median of 9 nodes excised. LN metastasis was found in 6 patients (5.7 %). Tumor spillage was reported in 6 cases (5.7 %), mainly during upfront surgery. Surgical complications occurred in 6 patients (5.7 %), consisting of 4 cases of chylous ascites and 2 cases of intestinal obstruction. All were successfully treated. Recurrence was seen in 8 patients (7.6 %), including two cases of local recurrence. The 3-year event-free survival and overall survival rates were 91.3 % and 95.6 %, respectively.
Conclusion:
The MRN demonstrated safety and feasibility in the surgical treatment of pediatric uWT. It enables LN sampling from all relevant draining stations and avoids the limitations of random sampling. However, these findings require validation in larger, prospective, multicenter studies to determine whether this approach is superior to current practice in improving staging accuracy and patient outcomes.
