Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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16:18 - 16:21
S11-3 (PP)
NEPHRON-SPARING SURGERY FOR UNILATERAL UNSCREENED WILMS TUMOUR :
HOW OFTEN IS IT FEASIBLE ?
Marc-David LECLAIR1, Alexis FLORET2, Isabelle PELLIER3, Karine RENAUDIN-AUTAIN4, Marie-Pierre QUERE2 and Estelle
THEBAUD5
1) Children University Hospital, Pediatric Surgery, Nantes, FRANCE - 2) Children University Hospital, Pediatric Radiology,
Nantes, FRANCE - 3) University Hospital, Pediatric Oncology, Angers, FRANCE - 4) Children University Hospital,
Pathology, Nantes, FRANCE - 5) Children University Hospital, Pediatric Oncology, Nantes, FRANCE
PURPOSE
In the process of writing future protocols guidelines, the SIOP-Renal-Tumour-Study-Group has defined criteria, allowing
to perform partial nephrectomy (NSS) in Wilms’ tumours (WT).
We aimed to investigate in what proportion of unscreened renal tumours these criteria were present.
METHODS
Inclusion criteria: Consecutive unscreened paediatric WT referred to a single institution. All children received
preoperative chemotherapy (SIOP protocols). Predisposed syndromic children, and bilateral WT with diffuse
nephroblastomatosis were excluded.
Retrospective blind reviews of preoperative postchemotherapy CT-scans, and postoperative pathology reports, to
determine the prevalence of the following criteria : potential for sparing healthy kidney, peripheral location, invasion of
calyces, surrounding organs, main vessels, or renal sinus. In potentially eligible cases, 3D-volume rendering analyses
calculated tumour and renal parenchyma volumes, preservable parenchyma volume being expressed as percentage of
contralateral healthy kidney volume.
RESULTS
Among 75 consecutive patients, one or more criteria excluding potential feasibility of NSS were present in 85% of
cases. The main reason for ruling out NSS was central tumour location (77%), extension to surrounding organs (5.5%),
or vascular thrombus (3%).
NSS was deemed feasible in 11/75 children (15%), with a volume of potentially preservable parenchyma representing
63% [34-113] of contralateral kidney volume.
Histopathology review showed perilobar and/or intralobar nephrogenic rests in 5/11 specimens (including 2/5 in distant
healthy parenchyma), microscopic incomplete resection (n=1), and high risk histology (n=2).
Had NSS been performed, secondary total nephrectomy would have been recommended in at least 3/11 cases.
CONCLUSIONS
Among the population of unscreened sporadic WT, the proportion of tumours potentially amenable to NSS is <15%.
Considered together with the low incidence of WT and the potential oncological risk of local relapse after NSS, this
finding suggests that these cases should be centrally reviewed and discussed to determine adequate strategy.