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Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension
Journal article   Open access   Peer reviewed

Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension

Bindi Naik-Mathuria, Alan F. Utria, Peter F. Ehrlich, Jennifer H. Aldrink, Andrew J. Murphy, Timothy Lautz, Roshni Dasgupta, Scott S. Short, Harold N. Lovvorn, Eugene S. Kim, …
Annals of surgery, Vol.279(3), pp.528-535
03/01/2024
DOI: 10.1097/SLA.0000000000005921
PMCID: PMC10829895
PMID: 37264925
url
https://doi.org/10.1097/SLA.0000000000005921View
Published (Version of record) Open Access

Abstract

Objective:The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus.Background:The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported.Methods:Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed.Results:Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P=0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P=0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P=0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival.Conclusions:Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.
 Life Sciences & Biomedicine Science & Technology Surgery

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