Laparoscopic approach for Wilms tumor.
BACKGROUND
Traditionally, radical nephrectomy for Wilms tumor has been performed through an open approach. Advances in minimally invasive surgery have led to the application of these techniques to malignant lesions, including Wilms tumor. We aim to present our experience with laparoscopic nephrectomy (LN) for Wilms tumor.


METHODS
Four patients with Wilms tumor were treated preoperatively with chemotherapy and afterwards underwent an LN and lymph node sampling. Four ports were placed and the tumors were removed without morcellation in an endoscopic bag through an incision by extending the umbilical or the suprapubic port site.


RESULTS
The average age at the time of surgery was 3 years and 7 months (range, 23 mo to 6 y). There were no intraoperative complications and the blood loss was minimal in all cases. The mean operative time was 125 minutes (range, 90 to 160 min). Among our patients, we had 2 stage IV and 2 stage I cases. The mean time of hospitalization was 3 days (range, 2 to 4 d). There were no long-term complications at the mean follow-up of 3 years and 6 months.


CONCLUSIONS
LN for Wilms tumor may be considered as an option in selected patients. Minimally invasive surgery allows the surgeon to follow all the oncologic principles required for surgical treatment of this neoplasm and provides the advantages of these techniques for cancer patients. Preoperative chemotherapy is essential to decrease tumor size and facilitate the dissection avoiding tumor rupture.
*Division of Pediatric Urology †Department of Urology ‡Department of Pediatric Surgery, University Hospital, "12 de Octubre," Complutense University, Madrid, Spain.
Daniel
D
Cabezalí Barbancho
Felix
F
Guerrero Ramos
Francisco
F
López Vázquez
Adolfo
A
Aransay Bramtot
Andrés
A
Gómez Fraile
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy; D018579:Patient Selection; D009396:Wilms Tumor / Q000601:surgery*