Predictive factor for intraoperative tumor rupture of Wilms tumor.
OBJECTIVE
For Wilms tumor, intraoperative tumor rupture with wide tumor spillage during surgical manipulation raises the classification to stage 3. Then, postoperative chemotherapy must be more intensive, and abdominal radiotherapy is added. Therefore, intraoperative tumor rupture should be avoided if possible. However, predictive factors for intraoperative tumor rupture have not been sufficiently described. Here we examined the risk factors for intraoperative tumor rupture.


METHODS
Patients with Wilms tumor who underwent treatment according to the National Wilms Tumor Study or the Japanese Wilms Tumor Study protocol at our institution were reviewed retrospectively. Collected cases were categorized into two groups: the ruptured group and the non-ruptured group. Risk factors for intraoperative tumor rupture, including the ratio of the tumor area to the abdominal area in a preoperative single horizontal computed tomography slice (T/A ratio), were investigated in both groups.


RESULTS
The two groups were not different in age, body weight, tumor laterality, sex, or histological distribution. The T/A ratio in the ruptured group was significantly higher than that in the non-ruptured group. Receiver operating characteristic curve analysis identified a discriminative value for a T/A ratio >0.5.


CONCLUSIONS
The T/A ratio can be a predictive factor for intraoperative tumor rupture of Wilms tumor.
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan. fukuzawa_kch@hp.pref.hyogo.jp.
Hiroaki
H
Fukuzawa
Department of Pediatric Intensive Care Medicine, Kobe Children's Hospital, Kobe, Japan.
Yuko
Y
Shiima
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Yasuhiko
Y
Mishima
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Sachi
S
Sekine
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Shizu
S
Miura
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Kiyoaki
K
Yabe
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Satoshi
S
Yamaki
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Keiichi
K
Morita
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Yuichi
Y
Okata
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Chieko
C
Hisamatsu
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Makoto
M
Nakao
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Akiko
A
Yokoi
Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojima-cho, Chuo-ku, Kobe, 650-0047, Japan.
Kosaku
K
Maeda
Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Japan.
Yoshiyuki
Y
Kosaka
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D009396:Wilms Tumor / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult
Nephroblastoma; Risk factor; Rupture; Wilms tumor