Laparoscopic Radical Nephrectomy of Wilms' Tumor and Renal Cancer in Children: Preliminary Experience from a Two-Center Study in China

Abstract

BACKGROUND: To report the preliminary experience of laparoscopic radical nephrectomy (LRN) in children with Wilms' tumor (WT) and renal cancer. PATIENTS AND METHODS: From January 2010 to October 2013, the medical records of 7 cases of WT or renal cancer in children treated by LRN at two medical centers in China were reviewed. RESULTS: All the patients were treated by LRN, and 3 of them underwent preoperative chemotherapy before surgery. The biggest tumor size was 10 cm without crossing the lateral edge of the vertebra at the time of operation. The median hospital stay was 8.5 days (range, 6-11 days). The pathologic investigation showed 5 cases of WT, 1 case of rhabdoid tumor, and 1 case of renal cell carcinoma. With a median follow-up of 1.9±1.5 years (range, 0.3-2.9 years), six children were in complete remission, and the remaining one was lost to follow-up. None of these patients presented evidence of oncological complications (tumoral recurrences, port-site implantation, or secondary lung metastases), and no small bowel obstruction occurred. CONCLUSIONS: LRN for WT and renal cancer may be considered as an option in selected children. Preoperative chemotherapy is to decrease tumor size and to facilitate the dissection, avoiding tumor rupture. For trained laparoscopic surgeons, the eventual indication of LRN is the tumor not crossing the midline. A long follow-up and more cases are necessary to evaluate the results of the laparoscopic approach.