title: Surgical aspects in the treatment of patients with unilateral wilms tumor: a report from the SIOP 93-01/German Society of Pediatric Oncology and Hematology.
abstract: OBJECTIVE
  To assess surgical aspects in the treatment of children with unilateral Wilms tumor based on data from the Cooperative Tumor Study SIOP 93-01 of the German Society of Pediatric Hematology and Oncology.
  
  
  BACKGROUND
  Although multiple international study trials exist for the treatment of nephroblastoma, the impact of surgical details and the outcome of the patients have not yet been described comparing different approaches of the trials.
  
  
  METHODS
  Treatment results of SIOP 93-01 of the German Society of Pediatric Hematology and Oncology were analyzed regarding frequencies of operations by surgeons and hospitals, surgical approaches, and operating subspecialties. Special attention was given to surgical complications, postoperative tumor stages and event-free survival.
  
  
  RESULTS
  Data sets from 757 of 1020 registered patients were received for evaluation. A unilateral Wilms tumor was observed in 512 of 757 children.Median follow-up was 4.8 years (1.2-10.7). Event-free survival rates were comparable for frequencies of operation by surgeons and hospitals, surgical approaches, and surgical specialties. Intraoperative tumor rupture rates were 12% in primarily operated patients (protocol violations) versus 3.2% inpatients after preoperative chemotherapy. There were 7% intraoperative ruptures for hospitals and surgeons performing 1 operation per year, and 3%when more than 4 operations per year were carried out. Sampling of hilar lymph nodes was often incomplete for all surgical subspecialties.
  
  
  CONCLUSIONS
  While the event-free survival for all groups is equal, there may be some long-term complications as a result of the more intensified therapy required for patients who suffer intraoperative ruptures. This will be defined only with longer term studies of late effects of the more intensified therapy. There is,however an increased rate of complications and ruptures associated with the use of midline laparotomy rather than a transverse or thoracoabdominal incision.
authors.affiliation: Department of Pediatric Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 03, 72076 Tuebingen, Germany. joerg.fuchs@med.uni-tuebingen.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Fuchs
authors.forename: Katarina
authors.initials: K
authors.lastname: Kienecker
authors.forename: Rhoikos
authors.initials: R
authors.lastname: Furtwängler
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
authors.forename: Dietrich
authors.initials: D
authors.lastname: Bürger
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thürhoff
authors.forename: Josef
authors.initials: J
authors.lastname: Hager
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D011336:Probability; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D012955:Societies, Medical; D016019:Survival Analysis; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*