Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study
Topic overview
National study of 69 Wilms tumor patients with intravascular extension found 67% had stage III disease due to thrombus-related surgical factors, including incomplete resection or positive margins. Event-free survival correlated with complete surgical resection and histological risk, though not with thrombus viability.
Key takeaways
- 11.8% of Wilms tumours present with intravascular extension; 67% are upstaged to stage III due to thrombus-related surgical factors.
- Complete en-bloc thrombus resection significantly improves event-free survival; piecemeal removal or incomplete cavotomy increases stage III risk.
- Two-thirds of tumour thrombi contain viable tumour cells, emphasizing need for complete surgical excision rather than fragmented removal.
- Histological risk group predicts outcomes; thrombus viability itself does not independently affect survival when resection is complete.
- Surgical technique matters: 8 cases avoided cavotomy when indicated, resulting in macroscopically incomplete resection and stage III disease.
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