Wilms肿瘤腹腔镜治疗：SIOP-UMBRELLA协议标准可能更新

Laparoscopic Treatment of Wilms' Tumor: Criteria of SIOP-UMBRELLA Protocol may be Updated

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

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

DOI: 10.1245/s10434-024-16057-3

摘要

尽管根据UMBRELLA指南的指征目前仍非常有限，但用于Wilms肿瘤（WT）治疗的全肾切除术正日益采用腹腔镜技术。本研究的目的是评估WT微创治疗符合UMBRELLA协议标准的程度。本回顾性多中心研究包括2020年前接受腹腔镜全肾切除术怀疑WT的儿童病例。影像资料由中心进行复审。共56名患者（50例WT和6例发生性肾样休克）在中位年龄3.3±2.6岁时接受手术。诊断时有13例（23%）存在转移。平均手术时间为213±84分钟。有8例（14.3%）中途转换手术，存在5例术中并发症。确认局部Stage III者7例（12.5%），其中2例因肿瘤破裂。只有1例（1.8%）的手术符合SIOP-UMBRELLA腹腔镜适应症。 “正常实质环”这一标准仅达成一次。保守手术在10例（17.9%）中似乎是可行的。化疗后肿瘤超出同侧椎骨边缘以及肿瘤体积超过200 mL与转换风险增加有关（p=0.0004和p=0.001）。平均随访5.2±4.0年后，尽管未见局部复发，但仍有1例因转移进展在术后15个月死亡。WT的腹腔镜治疗在超出UMBRELLA建议的情况下仍具有可行性，且复发风险较低。其适应症可能会被更新和验证。

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.