[The role of surgery in the treatment of Wilms tumor: analysis of cooperative study].
OBJECTIVE
To detect the effects of the surgical treatment and staging on the obtained results and to check the possible relationship between these results and the compliance, or not, with the preset surgical approach protocol (in accordance with the National Wilms Tumor Study--NWTS). MATERIAL AN METHOD: One hundred and sixty six operated on patients entered between October 1986 and December 1988, with the data updated until February 1992 were studied. The minimum follow-up period was 24 months for 147 patients (average 36 months). The remaining 19 patients were followed in the outpatient clinic for three to 18 months.


RESULTS
After submitting these data to statistical analysis and the obtained results compared to those in the literature we observed that: previous ligature of the renal vessels had no discernible effect on the ultimate outcome (relapses and mortality); intra-operative tumoral rupture with contamination of the peritoneal cavity unfavorably interferes with the mortality rate; even when the adrenal and the perirenal fat are normal from the surgeon's point of view, the histological findings showed tumor contamination in a number of cases; there is a worse prognosis when the tumor weight exceeds 500 g; according to the lympho-node evaluation, surgeon's performance was not in accordance with the protocol recommendations, considering that the node evaluation was neglected in 56.6% of the patients. This led to a surgical staging error and has contributed to some unexpected results like: lower relapses rate in the patients with affected lymph nodes; higher incidence of lung metastases in patients without lymph nodes analysis; stage II patients with better prognosis, compared to stage I patients and patients with stage I and III having similar relapse rates.


CONCLUSIONS
From the above-referred results, we concluded that some omissions have happened jeopardizing accuracy of the surgical staging in a significant way. In this way, in our environment the oncologist in charge of the treatment of Wilms tumor bearers, must establish a close integration with a surgical team, whose members have a precise understanding of the surgeon's importance and his fundamental role, not only of the surgical treatment itself, but who are aware on the minimal details on the surgical staging of this neoplasm, and of its importance in relation to the multidisplinary approach.
Schettini
S T
ST
Departamento de Cirurgia, UNIFESP-Escola Paulista de Medicina.
D002985:Clinical Protocols; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010348:Patient Care Team; D010819:Physician's Role; D009396:Wilms Tumor / Q000601:surgery*