Cargando…

Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy

BACKGROUND: Unilateral Wilms' tumor (uWT) is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy (RN) has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative...

Descripción completa

Detalles Bibliográficos
Autor principal: Sarin, Yogesh Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853590/
https://www.ncbi.nlm.nih.gov/pubmed/35261509
http://dx.doi.org/10.4103/jiaps.jiaps_205_21
_version_ 1784653264764010496
author Sarin, Yogesh Kumar
author_facet Sarin, Yogesh Kumar
author_sort Sarin, Yogesh Kumar
collection PubMed
description BACKGROUND: Unilateral Wilms' tumor (uWT) is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy (RN) has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative complications associated with this procedure. Nephron-sparing surgery (NSS) has been reported to avoid such postoperative complications and have high technical success rate. However, not much literature is available comparing the efficacy of RN and NSS for managing nonsyndromic uWT, which makes it less acceptable globally. MATERIALS AND METHODS AND RESULTS: A systematic identification of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. Out of 1017 records, 20 manuscripts including 312 patients were included in the review; 4 patients treated by the author (unpublished data) have also been included. The studies included 7 retrospective case series with no comparison group, 4 retrospective case series with comparison group, 4 retrospective series with a cursory mention of NSS in uWT, 2 case reports, 1 protocolized prospective trial with comparison group, 1 administrative database analysis with comparison group, and 1 randomized controlled study. In all, 316 patients with nonsyndromic uWT were studied. The pretherapy volumes of the WT ranged from 2.4 to 640 ml. Majority of them were administered preoperative chemotherapy. About half of the patients (n = 159) (50.3%) were Stage I tumors. Stage II, III, and IV tumors were seen in 23 (7.3%), 20 (6.3%), and 3 (1%) patients. Stage was not specified in 111 (35.1%) patients. Majority of them were “intermediate risk” WT. All these tumors were nonanaplastic. Surgical margins were reported positive in 13 (4%) patients. Overall and event-free survivals were 100% in most of the studies; only handful of relapses were noted in this systematic review. CONCLUSIONS: This qualitative systematic review recommends the use of NSS for nonsyndromic uWT. The procedure accounts for higher postoperative renal function and lesser incidence of hypertension as compared to the radical nephrectomy. Overall and event-free survivals are comparable or even better with NSS.
format Online
Article
Text
id pubmed-8853590
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-88535902022-03-07 Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy Sarin, Yogesh Kumar J Indian Assoc Pediatr Surg Review Article BACKGROUND: Unilateral Wilms' tumor (uWT) is the most common renal malignancy in the pediatric population. Although the onset of surgical intervention like radical nephrectomy (RN) has substantially reduced the mortality rate, recent evidence has raised concerns regarding several postoperative complications associated with this procedure. Nephron-sparing surgery (NSS) has been reported to avoid such postoperative complications and have high technical success rate. However, not much literature is available comparing the efficacy of RN and NSS for managing nonsyndromic uWT, which makes it less acceptable globally. MATERIALS AND METHODS AND RESULTS: A systematic identification of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. Out of 1017 records, 20 manuscripts including 312 patients were included in the review; 4 patients treated by the author (unpublished data) have also been included. The studies included 7 retrospective case series with no comparison group, 4 retrospective case series with comparison group, 4 retrospective series with a cursory mention of NSS in uWT, 2 case reports, 1 protocolized prospective trial with comparison group, 1 administrative database analysis with comparison group, and 1 randomized controlled study. In all, 316 patients with nonsyndromic uWT were studied. The pretherapy volumes of the WT ranged from 2.4 to 640 ml. Majority of them were administered preoperative chemotherapy. About half of the patients (n = 159) (50.3%) were Stage I tumors. Stage II, III, and IV tumors were seen in 23 (7.3%), 20 (6.3%), and 3 (1%) patients. Stage was not specified in 111 (35.1%) patients. Majority of them were “intermediate risk” WT. All these tumors were nonanaplastic. Surgical margins were reported positive in 13 (4%) patients. Overall and event-free survivals were 100% in most of the studies; only handful of relapses were noted in this systematic review. CONCLUSIONS: This qualitative systematic review recommends the use of NSS for nonsyndromic uWT. The procedure accounts for higher postoperative renal function and lesser incidence of hypertension as compared to the radical nephrectomy. Overall and event-free survivals are comparable or even better with NSS. Wolters Kluwer - Medknow 2022 2022-01-11 /pmc/articles/PMC8853590/ /pubmed/35261509 http://dx.doi.org/10.4103/jiaps.jiaps_205_21 Text en Copyright: © 2022 Journal of Indian Association of Pediatric Surgeons https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Sarin, Yogesh Kumar
Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title_full Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title_fullStr Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title_full_unstemmed Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title_short Nephron-Sparing Surgery in Nonsyndromic Unilateral Wilms' tumor: An Insight into the Ongoing Surgical Controversy
title_sort nephron-sparing surgery in nonsyndromic unilateral wilms' tumor: an insight into the ongoing surgical controversy
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853590/
https://www.ncbi.nlm.nih.gov/pubmed/35261509
http://dx.doi.org/10.4103/jiaps.jiaps_205_21
work_keys_str_mv AT sarinyogeshkumar nephronsparingsurgeryinnonsyndromicunilateralwilmstumoraninsightintotheongoingsurgicalcontroversy