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Related Experiment Videos

Wilms' tumours with intracaval involvement

V Martínez-Ibáñez1, J Sánchez de Toledo, M De Diego

  • 1Hospital Infantil Valle Hebrón, Department of Paediatric Surgery, Barcelona, Spain.

Medical and Pediatric Oncology
|April 1, 1996
PubMed
Summary

Wilms

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Area of Science:

  • Pediatric Oncology
  • Surgical Oncology
  • Diagnostic Imaging

Background:

  • Wilms' tumour (WT) management has improved since 1953.
  • Intravascular involvement, particularly in the inferior vena cava (IVC), presents surgical challenges.
  • Undetected IVC tumor thrombus in WT can lead to poor prognosis due to potential metastasis and surgical morbidity.

Purpose of the Study:

  • To evaluate the incidence and management of IVC tumor thrombus in pediatric patients with WT.
  • To determine optimal surgical strategies based on thrombus characteristics and location.

Main Methods:

  • Retrospective review of 81 WT cases managed between 1979 and 1993.
  • Routine ultrasound (US) used for diagnosis of IVC involvement.
  • Surgical strategy tailored to thrombus length and IVC wall infiltration.

Main Results:

  • Intracaval thrombosis was diagnosed in 4 (5%) of 81 WT patients.
  • One case involved thrombus extension into the right atrium.
  • All four patients with IVC thrombus achieved 100% survival with tailored surgical or chemotherapeutic approaches.

Conclusions:

  • Ultrasound is effective in detecting IVC tumor thrombus in WT.
  • Surgical strategy for IVC thrombus should consider thrombus length and intimal involvement.
  • Non-operative management with chemotherapy may be preferred for extensive or atrial thrombi to minimize surgical risk and maintain favorable prognosis.

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