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Wilms' tumours with intracaval involvement

✍ Scribed by Martínez-Ibáñez, Vicente; de Toledo, José Sánchez; De Diego, Marta; Castellote, Amparo; Sábado, Constantino; Javier, Germán; Marqués, Alfredo; Boix-Ochoa, José

Publisher
John Wiley and Sons
Year
1996
Tongue
English
Weight
379 KB
Volume
26
Category
Article
ISSN
0098-1532

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✦ Synopsis

Since Gross established the basic rules for nephrectomy in Wilms' tumour (WT) in 1953, the management of nephroblastoma has been more straightforward. However, some cases with intravascular involvement, currently detected by ultrasound (US), may represent a daunting challenge for the surgeon. Inferior vena cava with tumour thrombus induced by W l can be asymptomatic and, if undetected, can contribute to poorer prognosis for two main reasons: possible neoplastic cells inside the thrombus and higher morbidity risk of surgery. From 1979 to 19!23,81 WT were studied by routine US. lntracaval thrombosis was diagnosed in four (5%), in one of which the thrombus extended to the right atrium. In our experience, the surgical strategy in each of the four cases (100% survival) depended on the length of the thrombus and whether or not it infiltrated the vena cava wall. If the thrombus can be easily removed: complete resection. However, in cases of atrial thrombus, and more particularly if the thrombus in- volves the intima, we suggest the thrombus not be touched since the problem may be solved by preoperative and postoperative chemotherapy. Thus the favourable prognosis would be maintained and superfluous risky surgery avoided.

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