weekly_question 16/7/2023

[Admin]

What surgical factors must be considered to decrease the risk of local recurrence in patients with unilateral Wilms Tumor?

A Plan for radical nephrectomy rather than nephron-sparing surgery

B Avoid intra-operative rupture and sample at least 5 regional lymph nodes

C Ensure complete excision of tumor and abnormal appearing lymph nodes

D Ensure complete excision of tumor

[Admin]

correct answer
B Avoid intra-operative rupture and sample at least 5 regional lymph nodes

Meier et al. assessed the rate of local recurrence (LR) in 2386 children and adolescents with unilateral nephroblastoma (Wilms Tumor). These patients were treated between 1989 and 2020. All patients received pre-operative chemotherapy as per the International Society of Paediatric Oncology (SIOP) rather than upfront resection as per the Children’s Oncology Group (COG).

LR occurred in 4.9% of patients. Children older than 48 months were significantly more likely to experience LR with an incidence more than double compared to children < 48 months. LR occurred twice as often in tumors whose volume was greater than 500 ml. High-risk histology and local stage were also important risk factors.

The surgical factors found to decrease LR included adequate lymph node sampling and prevention of intraoperative rupture. The risk of LR increased by 85% if no lymph nodes were sampled. The authors also showed that patients with less than 5 lymph nodes sampled had a significantly higher rate of LR. In comparison to preoperative rupture, intraoperative rupture was associated with increased risk of LR. Nephron-sparing surgery or incomplete resection was not associated with increased risk. These findings emphasize the importance of avoiding intraoperative rupture and obtaining accurate staging by sampling lymph nodes appropriately.

[Bilal]

B

[Ismailmohamed]

B as increased risk of local recurrence are spillage of tumor and unfavourable histology with failure to perform lymph node biopsy at time of resection not only grossly appeared lymph node.

[Admin]

correct answer
B Avoid intra-operative rupture and sample at least 5 regional lymph nodes

Meier et al. assessed the rate of local recurrence (LR) in 2386 children and adolescents with unilateral nephroblastoma (Wilms Tumor). These patients were treated between 1989 and 2020. All patients received pre-operative chemotherapy as per the International Society of Paediatric Oncology (SIOP) rather than upfront resection as per the Children’s Oncology Group (COG).

LR occurred in 4.9% of patients. Children older than 48 months were significantly more likely to experience LR with an incidence more than double compared to children < 48 months. LR occurred twice as often in tumors whose volume was greater than 500 ml. High-risk histology and local stage were also important risk factors.

The surgical factors found to decrease LR included adequate lymph node sampling and prevention of intraoperative rupture. The risk of LR increased by 85% if no lymph nodes were sampled. The authors also showed that patients with less than 5 lymph nodes sampled had a significantly higher rate of LR. In comparison to preoperative rupture, intraoperative rupture was associated with increased risk of LR. Nephron-sparing surgery or incomplete resection was not associated with increased risk. These findings emphasize the importance of avoiding intraoperative rupture and obtaining accurate staging by sampling lymph nodes appropriately.

[Admin]

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