840 CAN IT BE POSSIBLE TO SPARE THE ADRENAL GLAND AT RADICAL NEPHRECTOMY IN CHILDREN DIAGNOSED OF WILMS' TUMOR?

Abstract

You have accessJournal of UrologyPediatrics: Stones/Tumors1 Apr 2012840 CAN IT BE POSSIBLE TO SPARE THE ADRENAL GLAND AT RADICAL NEPHRECTOMY IN CHILDREN DIAGNOSED OF WILMS' TUMOR? Jeman Ryu, Jongwon Kim, Sungchan Park, and Kun Suk Kim Jeman RyuJeman Ryu Seoul, Korea, Republic of More articles by this author , Jongwon KimJongwon Kim Seoul, Korea, Republic of More articles by this author , Sungchan ParkSungchan Park Ulsan, Korea, Republic of More articles by this author , and Kun Suk KimKun Suk Kim Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.931AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Wilms' tumor is most common renal neoplasm in children. Radical nephrectomy is the generally recommended treatment of choice as a part of multi-disciplinary therapy. However, there is no definite clinical guideline for ipsilateral adrenalectomy when performing radical nephrectomy for the treatment of Wilms' tumor. Therefore we aimed to confirm whether patients with Wilms' tumor could be treated with ipsilateral adrenal sparing nephrectomy. METHODS Between 1992 and 2010, 51 patients with histologically confirmed Wilms' tumor undergoing radical nephrectomy were analyzed in this study. Patient age, clinical symptom, size and laterality of tumor, and adrenal invasion of tumor on abdominal computed tomography (CT) or ultrasound were reviewed as preoperative data and pathologic stage, renal capsule invasion, adrenal invasion, lymphovascular invasion, and complete resection were reviewed postoperatively. RESULTS Of the 51 patients, 27 (53%) were male and 24 (47%) were female. The mean age was 39 months and the mean follow up duration was 73.7 months. Preoperative clinical symptoms included abdominal palpable mass (62.7%), abdominal discomfort (9.8%), and gross hematuria (27.5%). Tumor involved unilaterally in 49 and bilaterally in 2. The mean size of renal mass was 10.1cm on preoperative CT (74.5%) or ultrasound (25.5%). Six patients (11.8%) who had pulmonary metastasis received neoadjuvant chemotherapy (Vincristine, Dactinomycin, and Cyclophosphamide). Pathologic stage was: I-25 (49%), II-8 (15.7%), III-7 (13.7%), IV-9 (17.6%), and V-2 (4%). Renal capsule invasion in 13 and lymphovascular invasion in 4 were observed, but adrenal invasion was not identified in all nephrectomy specimens. Complete resection rate was 80% and adjuvant chemotherapy was performed following radical nephrectomy in all 51 patients. CONCLUSIONS Adrenal involvement is not likely in patients with Wilms' tumor, and adrenalectomy is unnecessary in all cases eventually. These results suggest that unconditional ipsilateral adrenalectomy during radical nephrectomy for the treatment of Wilms' tumor could be avoided. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e342-e343 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeman Ryu Seoul, Korea, Republic of More articles by this author Jongwon Kim Seoul, Korea, Republic of More articles by this author Sungchan Park Ulsan, Korea, Republic of More articles by this author Kun Suk Kim Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...