Virtual Resection: A New Tool for Preparing for Nephron-Sparing Surgery in Wilms Tumor Patients.

Jasper M Van Der Zee,Matthijs Fitski,Frank F J Simonis,Cornelis P Van De Ven,Alida F W Van Der Steeg,Marc H W A Wijnen,Aart J Klijn

doi:10.3390/curroncol29020066

Abstract

Nephron-sparing surgery (NSS) in Wilms tumor (WT) patients is a surgically challenging procedure used in highly selective cases only. Virtual resections can be used for preoperative planning of NSS to estimate the remnant renal volume (RRV) and to virtually mimic radical tumor resection. In this single-center evaluation study, virtual resection for NSS planning and the user experience were evaluated. Virtual resection was performed in nine WT patient cases by two pediatric surgeons and one pediatric urologist. Pre- and postoperative MRI scans were used for 3D visualization. The virtual RRV was acquired after performing virtual resection and a questionnaire was used to assess the ease of use. The actual RRV was derived from the postoperative 3D visualization and compared with the derived virtual RRV. Virtual resection resulted in virtual RRVs that matched nearly perfectly with the actual RRVs. According to the questionnaire, virtual resection appeared to be straightforward and was not considered to be difficult. This study demonstrated the potential of virtual resection as a new planning tool to estimate the RRV after NSS in WT patients. Future research should further evaluate the clinical relevance of virtual resection by relating it to surgical outcome.

Highlights

Wilms tumor (WT), known as nephroblastoma, is the most frequently occurring renal tumor in children, with a five-year survival rate of ~90% [1,2,3]
The complete preoperative 3D visualization was successfully obtained with magnetic resonance imaging (MRI) data only in 7 of the 9 cases
In cases eight and nine, 3D visualization of the kidney and tumor were obtained from preoperative MRI

Summary

Introduction

Wilms tumor (WT), known as nephroblastoma, is the most frequently occurring renal tumor in children, with a five-year survival rate of ~90% [1,2,3]. In 5–10% of WT patients, the disease is bilateral with an increased likelihood for end-stage renal disease and secondary morbidity [4]. Treatment of WT is in accordance with the UMBRELLA treatment protocol prescribed by the Renal Tumor Study Group of the International Society of Pediatric Oncology (SIOP-RTSG) [5]. This treatment protocol describes neoadjuvant chemotherapy, followed by open radical or partial nephrectomy, known as nephron-sparing surgery (NSS), and adjuvant chemotherapy. The preferred surgical treatment in bilateral and syndromic unilateral patients is NSS with radical resection of the tumor to preserve as much functional remnant renal volume (RRV) as possible

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Conclusion