Wilms' tumor--single-center experience with renal surgery

Abstract

Objective: To analyze the perioperative complications of renal surgery in a sample of patients with Wilms' tumor (WT), especially with regard to the effects of preoperative chemotherapy.

Material and methods: The case histories of 34 patients (mean age 4 years) who underwent renal surgery for suspicion of WT between 1989 and 2002 were retrospectively analyzed with special regard to intra- or postoperative complications. In total, 32 patients had undergone a radical nephrectomy and two had undergone organ-sparing renal surgery because of bilateral involvement. The median maximal tumor diameter was 9.6 cm. In 10 patients preoperative chemotherapy was completely renounced or had to be stopped early. All other patients were treated according to the protocols of the Société Internationale d'Oncologie Pédiatrique (SIOP)-9 or 93/01 studies.

Results: A total of 5/34 patients (14.7%) had perioperative complications. There was one intraoperative tumor rupture in a patient who had undergone an emergency radical nephrectomy before completing preoperative chemotherapy. Furthermore, three patients had to be reoperated on because of small bowel obstruction during the first 12 months after renal surgery. Another patient developed pancreatitis postoperatively due to delayed drainage of pancreatic secretion. These four patients had completed preoperative chemotherapy. All postoperative complications occurred in patients with tumors > 10 cm in diameter or after extended surgery for vascular or extrarenal tumor involvement.

Conclusions: The presented incidence of surgical complications associated with the operative treatment of WT is most probably due to the local extent of the primary tumor leading to more extensive surgical intervention. It remains unclear whether the extent of preoperative chemotherapy influences the complication rate.