title: Videolaparoscopic radical nephrectomy after chemotherapy in the treatment of Wilms' tumor: Long-term results of a pioneer group.
abstract: BACKGROUND
  A high cure rate for Wilms' tumor has been achieved using a multidisciplinary approach. The natural step forward is to offer the benefits of a minimally invasive technique for surgery, which is an obligatory part of treatment. Nevertheless, some authors resist using videolaparoscopic radical nephrectomy (VRN) because of concerns about reducing the cure index.
  
  
  METHODS
  The present study included children with unilateral Wilms' tumor treated from December 2003 to December 2015 with neoadjuvant chemotherapy followed by VRN. Patients were selected based on the size of their tumors compared with the contralateral kidney, and on their stature.
  
  
  RESULTS
  VRN was performed in 24 patients of age range 10-93 months, with an average of 38.04 ± 23.37 months. The tumoral kidney's largest diameter after chemotherapy averaged 10% of a patient's height. There was no tumor rupture or spillage and no patient presented intra or immediate postoperative complications, except for prolonged ileum in two patients. One patient required intraoperative transfusion because of preoperative anemia. Another developed a late herniation in the umbilical port that required surgical correction. After an average of 6.65 years of follow-up, two patients presented relapse: one with a stage IV disease had relapse in the lung and another with a stage III, involving the liver, had local relapse because of an unwanted delay in the adjuvant treatment.
  
  
  CONCLUSIONS
  VRN can be considered a feasible alternative to open surgery in selected cases of children with Wilms' tumor. The present experience shows that besides the benefits of minimally invasive procedures and better cosmetic results, there is no evidence of increased tumor rupture or spillage, peritoneal or port site metastasis, and the long-term oncological results are the same as open procedures.
authors.affiliation: Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ricardo Jordão
authors.initials: RJ
authors.lastname: Duarte
authors.affiliation: Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Cristofani
authors.affiliation: Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Vicente
authors.initials: V
authors.lastname: Odone Filho
authors.affiliation: Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Uropediatric Unit, Division of Urology, Hospital da Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: ftdenes@gmail.com.
authors.forename: Francisco Tibor
authors.initials: FT
authors.lastname: Dénes
mesh_terms: D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D020360:Neoadjuvant Therapy; D009392:Nephrectomy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery; D009396:Wilms Tumor / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
keywords: Children; Radical nephrectomy; Videolaparoscopy; Wilms' tumor