Current Surgical Role in The Management of Pediatric Renal Tumors
Keywords:
Wilms tumor, Renal tumor, Nephrectomy, Nephron-sparing surgeryAbstract
Pediatric renal tumors (PRT) belong to a group of cancers arising in early human life called the embryonal tumors. Wilms tumor is the predominant pathologic type, followed by rare entities including clear cell sarcoma of the kidney, malignant rhabdoid tumor of the kidney and pediatric renal cell carcinoma. Although there is some controversy regarding the optimal treatment sequence, surgery is usually the definitive treatment and radical nephrectomy remains the standard surgical option for unilateral tumors. Apart from tumor removal, data from lymph node sampling and recording of intraoperative spills are important for surgical staging. Bilateral PRT and complicated situations such as tumors in young infants, tumors with intravenous thrombus and concomitant intraabdominal metastases indicate upfront chemotherapy should be applied first followed by surgery. Nephronsparing surgery in bilateral PRT is a surgically challenging situation requiring anatomical planning and meticulous care. In general, PRT has a good outcome unless there is metastasis, intraoperative rupture or unfavorable histopathological features at the diagnosis. The five-year overall survival in cases of non-metastatic Wilms tumor has reached 100% in large trial reports. However, outcomes in low-income countries remain poor because of late diagnosis and toxicity from treatment. Good surgical technique potentially reduces operative complications, especially spills. This review focuses on the current surgical role in the treatment of PRC.
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