Citations 1
Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension
Naik‐Mathuria, Bindi , Dasgupta, Roshni , Short, Scott S. , Lovvorn, Harold N. , Newman, Erica, Rich, Barrie S. , Piché, Nelson , Glick, Richard D. , Petroze, Robin T. , Polites, Stephanie F. , Alore, Elizabeth , Sutthatarn, Pattamon , Wong‐Michalak, Shannon , Romao, Rodrigo , Al‐Hadidi, Ameer , Marquart, John , Gainer, Hailey, Johnson, Mike, Boehmer, Chloé , Rinehardt, Hannah , Seemann, Natashia M. , Davidson, Jacob , Polcz, Valerie E., Lund, Sarah , McKay, Katlyn G. , Correa, Hernán , Lund, Sarah B, Dasgupta, Roshni , Utria, Alan Fremder , Ehrlich, Peter F. , Aldrink, Jennifer H. , Murphy, Andrew J. , Lautz, Timothy B. , Kim, Eugene S. , Lal, Dave R. , Kastenberg, Zachary J. , Malek, Marcus M. , Whitlock, Richard S. , Chen, Stephanie , Rubalcava, Nathan S. , Gainer, Hailey, Rothstein, David H.
Annals of Surgery | June 2, 2023 | Volume: 279 | Issue: 3 | Pages: 528-535
Objective: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. Background: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. Methods: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. Results: Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P=0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P=0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P=0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. Conclusions: Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.