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Multicenter Study
. 2024 Dec;31(13):9248-9255.
doi: 10.1245/s10434-024-16057-3. Epub 2024 Sep 2.

Laparoscopic Treatment of Wilms' Tumor: Criteria of SIOP-UMBRELLA Protocol may be Updated

Morgan Pradier  1 , Sabine Irtan  2 , Hubert Ducou Le Pointe  3 , François Becmeur  4 , Raphaël Moog  4 , Julien Rod  5 , Aurore Haffreingue  5 , Marc-David Leclair  6 , Hubert Lardy  7 , Aurélien Binet  7 , Frédéric Lavrand  8 , Pascale Philippe-Chomette  9 , Matthieu Peycelon  9 , Florent Guerin  10 , Aurore Bouty  11 , Arnauld Verschuur  12 , François Varlet  13 , Aurélien Scalabre  13
Affiliations
Multicenter Study

Laparoscopic Treatment of Wilms' Tumor: Criteria of SIOP-UMBRELLA Protocol may be Updated

Morgan Pradier et al. Ann Surg Oncol. 2024 Dec.

Abstract

Introduction: Total nephrectomies for the treatment of Wilms' tumor (WT) are more and more performed by laparoscopy, although indications for this approach following the UMBRELLA guidelines are currently very restrictive. The purpose of this study was to assess the compliance to the criteria of the UMBRELLA protocol for minimally invasive approach of WT.

Methods: This retrospective multicenter study included children operated on by laparoscopic total nephrectomy for suspected WT before 2020. Imaging was reviewed centrally.

Results: Fifty-six patients (50 WT and 6 nephrogenic rests) were operated on at a median age of 3.3 ± 2.6 years. Thirteen (23%) patients had metastasis at diagnosis. The mean operative time was 213 ± 84 min. There were eight (14.3%) conversions and five peroperative complications. A local stage III was confirmed in seven (12.5%) cases, including two for tumor rupture. Only one (1.8%) of the procedures followed the SIOP-UMBRELLA indications for laparoscopy. The criterion "ring of normal parenchyma" was met only once. Conservative surgery seemed possible in ten (17.9%) cases. The extension of the tumor beyond the ipsilateral edge of the vertebra after chemotherapy and a volume over 200 mL were associated with an increased risk of conversion (p = 0.0004 and p = 0.001 respectively). After a mean follow-up of 5.2 ± 4.0 years, although there was no local recurrence, one death occurred due to metastatic progression at 15 months postoperatively.

Conclusions: The laparoscopic approach of WT beyond the UMBRELLA recommendations was feasible with low risk of local recurrence. Its indications may be updated and validated.

Keywords: Child; Laparoscopy; Nephroblastoma; Radical nephrectomy; SIOP-UMBRELLA protocol; Wilms’ tumor.

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References

    1. Duarte RJ, Dénes FT, Cristofani LM, Odone-Filho V, Srougi M. Further experience with laparoscopic nephrectomy for Wilms’ tumour after chemotherapy. BJU Int. 2006;98(1):155–9. https://doi.org/10.1111/j.1464-410X.2006.06214.x . - DOI - PubMed
    1. Varlet F, Stephan JL, Guye E, Allary R, Berger C, Lopez M. Laparoscopic radical nephrectomy for unilateral renal cancer in children. Surg Laparosc Endosc Percutan Tech. 2009;19(2):148–52. https://doi.org/10.1097/SLE.0b013e31819f204d . - DOI - PubMed
    1. Duarte RJ, Dénes FT, Cristofani LM, Giron AM, Filho VO, Arap S. Laparoscopic nephrectomy for wilms tumor after chemotherapy: initial experience. J Urol. 2004;172(4 Pt 1):1438–40. https://doi.org/10.1097/01.ju.0000138230.51134.65 . - DOI - PubMed
    1. van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K, et al. Position paper: rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol. 2017;14(12):743–52. https://doi.org/10.1038/nrurol.2017.163 . - DOI - PubMed
    1. Varlet F, Petit T, Leclair MD, et al. Laparoscopic treatment of renal cancer in children: a multicentric study and review of oncologic and surgical complications. J Pediatr Urol. 2014;10(3):500–5. https://doi.org/10.1016/j.jpurol.2013.11.005 . - DOI - PubMed

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