Management of Wilms tumor with intravenous thrombus in children: a single center experience

Abstract

Background: Wilms tumor tends to grow into vena cava, even invade atrium, which increased operating difficulty and frequency of surgical complications.

Methods: Forty-two patients of Wilms tumor with intravenous thrombus were retrospective studied. The diagnosis and therapy were discussed according to the medical records and interrelated literatures.

Results: Forty-two children with thrombus were diagnosed by computed tomography and 41 cases by ultrasound simultaneously. 36 children had received preoperative chemotherapy. Surgical resection was performed in all patients. Cardiopulmonary bypass was used for the removal of the intra-atrial thrombus in 5 patients. There were no surgical complications occurred. The patients received chemotherapy and radiotherapy according to clinical staging by National Wilms' Tumor Study (NWTS)-4 or NWTS-5. 34 patients were successfully followed up, 32 patients survive at present, including one who has been followed up more than 20 years since operation.

Conclusion: Standardized sequential treatment, including preoperative chemotherapy and radiotherapy, nephrectomy combining resection of thrombus, postoperative adjuvant therapy, is the mainstay of treatment of Wilms tumor with intravenous thrombus.

Keywords: Experience; Intravenous thrombus; Management; Wilms tumor.

Fig. 1

The patient (no. 8 in Table 1), female, was 4.8 years old, with right renal Wilms tumor combined with atrial tumor thrombus. She underwent deep hypothermic cardiopulmonary bypass to remove intra-cardiac tumor thrombus. a, b computed tomography showed right renal tumor and atrial tumor thrombus before preoperative chemotherapy. The tumor shrank after chemotherapy, but the intra-atrial tumor thrombus did not shrink significantly; c, d intra-atrial tumor thrombus was removed under cardiopulmonary bypass in the operation

Fig. 2

The patient (no. 4 in Table 1), male, was 3.6 years old, with left renal wilms tumor combined with atrial tumor thrombus. After preoperative chemotherapy, the tumor thrombus was significantly reduced to the atrial entrance. Preoperative ultrasound showed that there was blood flow between the thrombus and the atrial entrance or the vena cava wall. a, b during the nephrectomy, vena cava was opened carefully, tumor with the whole thrombus was completely dragged out and removed; c abdominal computed tomography showed left renal tumor and atrial tumor thrombus before preoperative chemotherapy; d specimen of the whole renal with tumor and thrombus removed by operation