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

153 / 492

S11-7 (P)
HOW MANY WILMS TUMORS ARE AMENABLE TO SAFE LAPAROSCOPIC TOTAL
NEPHRECTOMY ?
Marc-David LECLAIR1, Alexis FLORET2, Isabelle PELLIER3, Karine RENAUDIN-AUTAIN4, Thomas LEFRANCOIS2 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 has defined criteria, which potentially allow to perform
laparoscopic total nephrectomy (MIS) in Wilms’ tumours (WT).
We aimed to investigate in what proportion of renal tumours these criteria were present.
MATERIAL AND METHODS
Inclusion criteria: All consecutive WT referred to a single institution from 2005 to 2014. All children received
neoadjuvant chemotherapy according to SIOP protocols.
Methods : Retrospective blind reviews of preoperative post-chemo abdominal CT-scans, and pathology reports, to
determine the prevalence of the following criteria : tumour volume and location, predictable invasion of surrounding
organs/main vessels, vascular thrombus, extension beyond the ipsilateral edge of the vertebral body.
RESULTS
Among 86 consecutive tumours (79 patients), one or more criteria excluding potential feasibility of MIS were present in
60% of cases.
Among 34 tumours (40%) potentially eligible for MIS, 22 also met criteria for partial nephrectomy (NSS) : either
mandatory NSS in predisposed syndromic patients (n=10), or children with unilateral WT meeting the new SIOP criteria
allowing elective NSS (n=12).
Analysing pathology reports of the 24 cases (28%) eligible for total nephrectomy by MIS (without SIOP mandatory
indication for NSS), 25% had open incomplete microscopic resection after open nephrectomy, 25% had positive lymph
nodes and 20% were high-stage histology. The overall rate of stage III in this subgroup was 37%.
CONCLUSIONS
Among a population of 86 consecutive WT, the proportion of tumours potentially amenable to MIS was 40%.
After exclusion of tumours eligible for NSS (either mandatory or elective), there remained a subset of 12/86 tumours
(14%) with no contra-indication to laparoscopic total nephrectomy. Considered together with the low overall incidence of
WT and the increased oncological risk, this finding suggests that these cases should be centrally reviewed, and the
procedures be performed in a limited number of institutions.