Wilms肿瘤的腹腔镜治疗：SIOP-umbrella方案的标准可能会更新
Laparoscopic Treatment of Wilms' Tumor: Criteria of SIOP-UMBRELLA Protocol may be Updated
影响因子:3.50000
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 Dec
作者:
Morgan Pradier, Sabine Irtan, Hubert Ducou Le Pointe, François Becmeur, Raphaël Moog, Julien Rod, Aurore Haffreingue, Marc-David Leclair, Hubert Lardy, Aurélien Binet, Frédéric Lavrand, Pascale Philippe-Chomette, Matthieu Peycelon, Florent Guerin, Aurore Bouty, Arnauld Verschuur, François Varlet, Aurélien Scalabre
摘要
腹腔镜检查越来越多地执行Wilms肿瘤（WT）治疗的总肾切除术，尽管该方法遵循伞准则的适应症目前非常有限。 The purpose of this study was to assess the compliance to the criteria of the UMBRELLA protocol for minimally invasive approach of WT.This retrospective multicenter study included children operated on by laparoscopic total nephrectomy for suspected WT before 2020. Imaging was reviewed centrally.Fifty-six patients (50 WT and 6 nephrogenic rests) were operated on at a median age of 3.3 ± 2.6 年。诊断时有13名（23％）患者发生转移。平均手术时间为213±84分钟。有八个（14.3％）的转化率和五种可变性并发症。在7例（12.5％）病例中证实了局部III，其中两例肿瘤破裂。只有一个（1.8％）的手术遵循了腹腔镜检查的SIOP-umbrella指示。仅满足一次标准“正常实质环”。在十个（17.9％）病例中，保守手术似乎是可能的。化学疗法后的肿瘤延伸超出椎骨的同侧边缘，体积超过200 mL与转化率的风险增加有关（分别为p = 0.0004和p = 0.001）。在平均随访为5。2.2±4。0年后，尽管没有局部复发，但术后15个月时转移性进展导致一场死亡。它的指示可以更新和验证。
Abstract
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.This retrospective multicenter study included children operated on by laparoscopic total nephrectomy for suspected WT before 2020. Imaging was reviewed centrally.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.The laparoscopic approach of WT beyond the UMBRELLA recommendations was feasible with low risk of local recurrence. Its indications may be updated and validated.