Chapter 85 Wilms’ Tumor and Neuroblastoma
Wilms’ Tumor
INTRODUCTION
Nephroblastoma, also known as Wilms’ tumor after Max Wilms who described seven cases in 1899, is the most common intra-abdominal cancer in children. Wilms’ tumor represents 6% of all pediatric cancers and the incidence is 8 cases per 1 million children younger than 15 years of age or 1 in 10,000 infants.1 Seventy-five percent of cases occur in children under 5 years of age, and the peak incidence is 2 to 3 years of age.2
Surgical therapy for Wilms’ tumor was first described in 1877, with poor outcomes. Over the next 100 years, the operative strategy for Wilms’ tumor was modified to include the addition of chemotherapy and, occasionally, radiation. Furthermore, a cooperative study of several groups called the National Wilms’ Tumor Study (NWTS) developed treatment standards that have improved overall survival to approximately 95.6% for stage 1 tumors.3
OPERATIVE PROCEDURE
Incision
Poor Exposure/Tumor Spillage
• Consequence
Exploration of the Contralateral Kidney
Renal Hilum Ligation
Ligation of the Contralateral Vessels
Sometimes, the large renal mass encroaches on the hilum so much that it thins out the inferior vena cava (IVC) and the ipsilateral renal artery and vein and lifts the contralateral renal vessels up, making them susceptible to injury or ligation (Fig. 85-1).
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