Wilms' tumour: a comparison of surgical aspects in patients with or without pre-operative chemotherapy.
OBJECTIVE
To compare the technical aspects of Wilms' tumour (WT) surgery in patients with and without pre-operative chemotherapy.


METHODS
Quasi-experimental.


METHODS
Military Hospital (MH) and Combined Military Hospital (CMH), Rawalpindi, from January 1999 to December 2004.


METHODS
Patients of WT, presenting between January 1999 and December 2001, were treated, using the NWTSG protocol, with primary surgery (group I). Between January 2001 and December 2004, WT patients were treated according to SIOP protocol, with pre-operative chemotherapy followed by surgery (group II). Volume reduction with chemotherapy, duration of surgery, rupture of tumour, extent of excision, adherence and damage to surrounding structures, blood loss, complications, stay in hospital and event-free survival (EFS) were compared in the two groups.


RESULTS
Out of 22 patients in group I, 19 (86.4%) underwent primary surgery. Of the 23 patients in group II, 21 (91.3%) received pre-operative chemotherapy followed by surgery. Average volume reduction in this group was 54% with chemotherapy. Difference in duration of surgery and blood loss was significantly low in group II (p=0.003 and p < 0.001, respectively). In group I, rupture (6 vs 2), adherence (14 vs 10) and damage to surrounding structures (5 vs 2) were more. Complete macroscopic excision was possible in 90.5% of WT in group II as compared to 73.7% in group I. Immediate postoperative complications and length of hospital stay were similar in both groups. There was no difference in EFS.


CONCLUSIONS
Pre-operative chemotherapy makes it technically easier and safer to operate, without jeopardizing the final outcome.
Safdar
C Aqeel
CA
Department of Paediatric Surgery, Military Hospital, The Mall, Rawalpindi, Pakistan. aqeel.safdar@hotmail.com
Aslam
Mushahid
M
Awan
Safdar Hussain
SH
Ahmed
Iftikhar
I
Badshah
Shahida
S
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010154:Pakistan; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
D000970:Antineoplastic Agents