Wilms tumors (WTs) with intravascular extension... | 2012 - 2019 | Subgroup analysis of the IMPORT Trial: | Multicenter study UK and Ireland | Patients < 18 yrs | 69 PATIENTS | confirmed by surgeon & pathologist | tumor thrombus in renal vein (RV) or beyond | 46 patients (67%) | thrombus-related Stage III disease | 24% macroscopically incomplete resection | 43% piecemeal resection of thrombus | 33% microscopically positive margins at RV | EFS associated with complete surgical resection | p<0.05 | EFS & OS no association with tumor thrombus viability | p=0.19 | p=0.59 | EFS = event-free survival, OS = overall survival | Conclusion: Invasive WTs have a high risk of thrombus related disease. Complete thrombus removal should be the goal of surgery. | https://doi.org/10.1016/j.jpedsurg.2021.08.023 | Source: Dzhuma K et al. Department of Developmental Biology and Cancer Department University College of London, UK | @StayCurrentMD | @NikhilShah_MD | Cincinnati Children's | Journal of Pediatric Surgery
Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study
Infographic · Apr 2022 · 1 min read
In brief
In brief
This UK national study of 69 Wilms tumor patients with intravascular extension found that 67% had stage III disease due to incomplete thrombus resection. Complete surgical removal of tumor thrombus significantly improved event-free survival, emphasizing the importance of controlled complete resection including cavotomy when indicated.
- 11.8% of Wilms tumors present with intravascular extension, requiring specialized surgical approach for complete thrombus removal.
- 67% of cases with vascular extension are upstaged to stage III due to incomplete resection, piecemeal removal, or positive margins.
- Complete surgical resection of tumor thrombus significantly improves event-free survival compared to incomplete resection.
- Two-thirds of tumor thrombi contain viable tumor cells, emphasizing need for en bloc rather than piecemeal removal.
- Cavotomy should be performed when indicated; avoiding it contributed to incomplete resection in 8 cases with worse outcomes.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with three main sections. The top shows a calendar icon and kidney illustration. The middle section displays statistics with chevron arrows pointing to surgical outcomes. The bottom compares survival metrics (EFS and OS) with a yellow conclusion box on the right containing a checkmark.
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<0.05). OS and EFS were also significantly associated with histological risk group (P<0.05) but not with viability of tumour thrombus (P=0.19; P=0.59).
Conclusions
WTs with intravascular extension have a high risk of local stage III due to thrombus-related reasons. Controlled complete removal of the thrombus should be the aim of surgery.