SURGICAL MANAGEMENT, STAGING, AND OUTCOMES OF WILMS TUMOURS WITH INTRAVASCULAR EXTENSION: RESULTS OF THE IMPORT STUDY
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In brief
In brief
National study of 69 children with Wilms tumors and intravascular extension found 67% had stage III disease due to thrombus-related factors. Incomplete surgical resection significantly impacted event-free survival, with 66% of thrombi containing viable tumor. Eight patients avoided cavotomy despite indication, highlighting critical surgical decision-making in complex cases.
Written by the GCMD Library team from the article.
Purpose
to review surgical management, tumour stage and clinical outcomes in children with intravascular extension of Wilms tumour (WT) registered in a national clinical study (2012-19).
Methods
WTs with presence/suspicion of tumour thrombus in the renal vein (RV) or beyond on radiology, surgery or pathology case report forms were identified. Only cases where thrombus was confirmed by surgeon and/or reference pathologist were included. Surgical management, disease stage, overall (OS) and event free survival (EFS) were investigated.
Results
69/583 (11.8%) patients met the inclusion criteria. Forty-six (67%) had abdominal stage III due to thrombus-related reasons: 11 had macroscopically incomplete resection, including 8 cases where cavotomy was not performed; 20 had piecemeal complete resection of thrombus; 15 had microscopically positive resection margins at the RV. 66% of tumour thrombi contained viable tumour. There were eight relapses and five deaths. EFS, but not OS, was significantly associated with completeness of surgical resection (P