Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Ante Situ Tumor Resection and Orthotopic Renal Autotransplantation for Bilateral Nephroblastoma
2.3. Renal Autotransplantation in Neuroblastoma Resection
2.4. Demographic and Clinical Characteristics
2.5. Study Outcome
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CT | Computed tomography |
GFR | Glomerulofiltration rate |
HTK | Histidine–tryptophan-–ketoglutarate |
MAG | Mercaptoace–tyltriglycine |
MIP | Maximum intensity projection |
MRU | Magnetic resonance urography |
NED | No evidence of disease |
NSS | Nephron-sparing surgery |
PICU | Pediatric intensive care unit |
RATX | Renal autotransplantation |
WAGR | Wilms tumor–aniridia–genitourinary abnormalities–mental retardation syndrome |
WT1 | Wilms tumor protein 1 |
References
- Kaatsch, P.; Grabow, D.; Spix, C. German Childhood Cancer Registry—Annual Report 2018 (1980–2017); Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz: Mainz, Germany, 2019. [Google Scholar]
- La Quaglia, M.P.; Kushner, B.H.; Su, W.; Heller, G.; Kramer, K.; Abramson, S.; Rosen, N.; Wolden, S.; Cheung, N.-K.V. The Impact of Gross Total Resection on Local Control and Survival in High-Risk Neuroblastoma. J. Pediatr. Surg. 2004, 39, 412–417, discussion 412–417. [Google Scholar] [CrossRef] [PubMed]
- Godzinski, J.; Graf, N.; Audry, G. Current Concepts in Surgery for Wilms Tumor—The Risk and Function-Adapted Strategy. Eur. J. Pediatr. Surg. 2014, 24, 457–460. [Google Scholar] [CrossRef]
- Breslow, N.E.; Collins, A.J.; Ritchey, M.L.; Grigoriev, Y.A.; Peterson, S.M.; Green, D.M. End Stage Renal Disease in Patients with Wilms Tumor: Results from the National Wilms Tumor Study Group and the United States Renal Data System. J. Urol. 2005, 174, 1972–1975. [Google Scholar] [CrossRef] [PubMed]
- Perwein, T.; Lackner, H.; Sovinz, P.; Benesch, M.; Schmidt, S.; Schwinger, W.; Urban, C. Survival and Late Effects in Children with Stage 4 Neuroblastoma. Pediatr. Blood Cancer 2011, 57, 629–635. [Google Scholar] [CrossRef]
- Davidoff, A.M.; Giel, D.W.; Jones, D.P.; Jenkins, J.J.; Krasin, M.J.; Hoffer, F.A.; Williams, M.A.; Dome, J.S. The Feasibility and Outcome of Nephron-Sparing Surgery for Children with Bilateral Wilms Tumor. Cancer 2008, 112, 2060–2070. [Google Scholar] [CrossRef]
- Shamberger, R.C.; Haase, G.M.; Argani, P.; Perlman, E.J.; Cotton, C.A.; Takashima, J.; Green, D.M.; Ritchey, M.L. Bilateral Wilms’ Tumors with Progressive or Nonresponsive Disease. J. Pediatr. Surg. 2006, 41, 652–657. [Google Scholar] [CrossRef] [PubMed]
- Cozzi, D.A.; Zani, A. Nephron-Sparing Surgery in Children with Primary Renal Tumor: Indications and Results. Semin. Pediatr. Surg. 2006, 15, 3–9. [Google Scholar] [CrossRef]
- Ginsburg, K.B.; Schober, J.P.; Kutikov, A. Ischemia Time Has Little Influence on Renal Function Following Partial Nephrectomy: Is It Time for Urology to Stop the Tick-Tock Dance? Eur. Urol. 2022, 81, 501–502. [Google Scholar] [CrossRef]
- Thompson, R.H.; Lane, B.R.; Lohse, C.M.; Leibovich, B.C.; Fergany, A.; Frank, I.; Gill, I.S.; Blute, M.L.; Campbell, S.C. Every Minute Counts When the Renal Hilum Is Clamped During Partial Nephrectomy. Eur. Urol. 2010, 58, 340–345. [Google Scholar] [CrossRef]
- Holmes, K.; Pötschger, U.; Pearson, A.D.J.; Sarnacki, S.; Cecchetto, G.; Gomez-Chacon, J.; Squire, R.; Freud, E.; Bysiek, A.; Matthyssens, L.E.; et al. Influence of Surgical Excision on the Survival of Patients with Stage 4 High-Risk Neuroblastoma: A Report from the HR-NBL1/SIOPEN Study. J. Clin. Oncol. 2020, 38, 2902–2915. [Google Scholar] [CrossRef]
- Lim, I.I.P.; Goldman, D.A.; Farber, B.A.; Murphy, J.M.; Abramson, S.J.; Basu, E.; Roberts, S.; LaQuaglia, M.P.; Price, A.P. Image-Defined Risk Factors for Nephrectomy in Patients Undergoing Neuroblastoma Resection. J. Pediatr. Surg. 2016, 51, 975–980. [Google Scholar] [CrossRef] [PubMed]
- Fahy, A.S.; Roberts, A.; Nasr, A.; Irwin, M.S.; Gerstle, J.T. Long Term Outcomes after Concurrent Ipsilateral Nephrectomy versus Kidney-Sparing Surgery for High-Risk, Intraabdominal Neuroblastoma. J. Pediatr. Surg. 2019, 54, 1632–1637. [Google Scholar] [CrossRef]
- Warmann, S.W.; Seitz, G.; Fuchs, J. Surgical Complications in Pediatric Surgical Oncology. Pediatr. Blood Cancer 2012, 59, 398–404. [Google Scholar] [CrossRef]
- Desai, D.; Nicholls, G.; Duffy, P.G. Bench Surgery with Autotransplantation for Bilateral Synchronous Wilms’ Tumor: A Report of Three Cases. J. Pediatr. Surg. 1999, 34, 632–634. [Google Scholar] [CrossRef] [PubMed]
- Zhong, Z.; Jiang, H.; Chen, H.; Wu, C.; Wang, Y.; Zhang, Z.; Li, J.; Liu, J. Ex Vivo Tumor Dissection Followed by Kidney Autotransplantation in Bilateral Wilms Tumor. Front. Pediatr. 2023, 11, 1120797. [Google Scholar] [CrossRef] [PubMed]
- Longaker, M.T.; Harrison, M.R.; Scott Adzick, N.; Crombleholme, T.M.; Langer, J.C.; Duncan, B.W.; Halberg, F.E.; Salvatierra, O. Nephron-Sparing Approach to Bilateral Wilms’ Tumor: In Situ or Ex Vivo Surgery and Radiation Therapy. J. Pediatr. Surg. 1990, 25, 411–414. [Google Scholar] [CrossRef]
- Akhaladze, D.G.; Minnullin, M.M.; Krivonosov, A.A.; Kachanov, D.Y.; Grachev, N.S. Autologous kidney transplantation in a high-risk patient with locally advanced retroperitoneal neuroblastoma. Khirurgiia 2024, 3, 63–69. [Google Scholar] [CrossRef]
- Berthold, F.; Faldum, A.; Ernst, A.; Boos, J.; Dilloo, D.; Eggert, A.; Fischer, M.; Frühwald, M.; Henze, G.; Klingebiel, T.; et al. Extended Induction Chemotherapy Does Not Improve the Outcome for High-Risk Neuroblastoma Patients: Results of the Randomized Open-Label GPOH Trial NB2004-HR. Ann. Oncol. 2020, 31, 422–429. [Google Scholar] [CrossRef]
- van den Heuvel-Eibrink, M.M.; Hol, J.A.; Pritchard-Jones, K.; van Tinteren, H.; Furtwängler, R.; Verschuur, A.C.; Vujanic, G.M.; Leuschner, I.; Brok, J.; Rübe, C.; et al. Rationale for the Treatment of Wilms Tumour in the UMBRELLA SIOP–RTSG 2016 Protocol. Nat. Rev. Urol. 2017, 14, 743–752. [Google Scholar] [CrossRef]
- Gołuch, M.; Pytlewska, A.; Sarnecki, J.; Chodnicka, P.; Śliwińska, A.; Obrycki, Ł.; Jurkiewicz, E. Evaluation of Differential Renal Function in Children—A Comparative Study between Magnetic Resonance Urography and Dynamic Renal Scintigraphy. BMC Pediatr. 2024, 24, 213. [Google Scholar] [CrossRef]
- Warmann, S.W.; Fuchs, J. Technical Aspects of Nephron-Sparing Surgery (NSS) in Children with Bilateral Centrally Located Renal Tumors. Semin. Pediatr. Surg. 2019, 28, 150865. [Google Scholar] [CrossRef] [PubMed]
- Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann. Surg. 2004, 240, 205. [Google Scholar] [CrossRef] [PubMed]
- Pierce, C.B.; Muñoz, A.; Ng, D.K.; Warady, B.A.; Furth, S.L.; Schwartz, G.J. Age- and Sex-Dependent Clinical Equations to Estimate Glomerular Filtration Rates in Children and Young Adults with Chronic Kidney Disease. Kidney Int. 2021, 99, 948–956. [Google Scholar] [CrossRef] [PubMed]
- Vujanić, G.M.; Sandstedt, B.; Harms, D.; Kelsey, A.; Leuschner, I.; de Kraker, J.; on behalf of the SIOP Nephroblastoma Scientific Committee. Revised International Society of Paediatric Oncology (SIOP) Working Classification of Renal Tumors of Childhood. Med. Pediatr. Oncol. 2002, 38, 79–82. [Google Scholar] [CrossRef]
- Brisse, H.J.; McCarville, M.B.; Granata, C.; Krug, K.B.; Wootton-Gorges, S.L.; Kanegawa, K.; Giammarile, F.; Schmidt, M.; Shulkin, B.L.; Matthay, K.K.; et al. Guidelines for Imaging and Staging of Neuroblastic Tumors: Consensus Report from the International Neuroblastoma Risk Group Project. Radiology 2011, 261, 243–257. [Google Scholar] [CrossRef]
- Maas, M.H.; Cransberg, K.; van Grotel, M.; Pieters, R.; van den Heuvel-Eibrink, M.M. Renin-Induced Hypertension in Wilms Tumor Patients. Pediatr. Blood Cancer 2007, 48, 500–503. [Google Scholar] [CrossRef]
- Fuchs, J.; Wünsch, L.; Flemming, P.; Weinel, P.; Mildenberger, H. Nephron-Sparing Surgery in Synchronous Bilateral Wilms’ Tumors. J. Pediatr. Surg. 1999, 34, 1505–1509. [Google Scholar] [CrossRef]
- Secin, F.P. Importance and Limits of Ischemia in Renal Partial Surgery: Experimental and Clinical Research. Adv. Urol. 2008, 2008, 102461. [Google Scholar] [CrossRef]
- Fuchs, J.; Schunn, M.C.; Schäfer, J.F.; Ebinger, M.; Graf, N.; Furtwängler, R.; Warmann, S.W. Redo Nephron-Sparing Surgery in Stage V Pediatric Renal Tumors—A Report from the SIOP/GPOH Study Group for Renal Tumors. Eur. J. Surg. Oncol. 2024, 50, 107265. [Google Scholar] [CrossRef]
ID | Tumor Entity | Age Dx [mon] | Sex | Disease Stage * | Tumor Genetics | Risk Group * | Preoperative Imaging | Renal function [Left:Right] | Age TR [mon] |
---|---|---|---|---|---|---|---|---|---|
1 | BN | 36 | M | V | - | Intermediate | MRI + CT + MAG | 98:2 | 41 |
2 | BN | 17 | F | V | - | Intermediate | MRI + MAG | 55:45 | 20 |
3 | BN | 8 | F | V | - | Intermediate | MRI + CT + MAG | 47:53 | 13 |
4 | BN | 58 | M | V | - | Intermediate | CT + MRU | 17:83 | 62 |
5 | HN | 23 | M | III | N-MYC+ | High-risk | MRI + CT | - | 40 |
6 | HN | 55 | F | IV | - | High-risk | MRI | - | 62 |
7 | HN | 22 | F | IV | N-MYC+ | High-risk | MRI + CT | - | 29 |
8 | HN | 12 | F | IV | N-MYC+ | High-risk | MRI + CT | - | 32 |
ID | Operative Time [min] | Ischemia Time [min] | Contralat. Nx | Resection Status | Ventilation [d] | LPICU [d] | LOHS [d] | Complications * | Follow-Up [m] | Oncologic Outcome |
---|---|---|---|---|---|---|---|---|---|---|
1 | 389 | 120 | yes | R0 | 2 | 3 | 14 | I | 27 | CR |
2 | 423 | 90 | yes | R0 | 2 | 2 | 36 | IIIb | 17 | CR |
3 | 314 | 120 | no | R0 | 2 | 3 | 21 | I | 7 | CR |
4 | 444 | 110 | yes | R0 | 0 | 1 | 27 | IIIb | 3 | CR |
5 | 590 | - | secondary | GTR | 2 | 7 | 88 | IVa | 155 | CR |
6 | 450 | 240 | no | GTR | 2 | 7 | 18 | IIIb | 20 | LC |
7 | 585 | - | yes | GTR | 14 | 14 | 14 | V ** | - | Death |
8 | 659 | - | no | GTR | 4 | 7 | 19 | I | 3 | LC |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Mayer, B.F.B.; Schunn, M.C.; Urla, C.; Weinpert, L.; Tsiflikas, I.; Ebinger, M.; Fideler, F.; Neunhoeffer, F.; Weitz, M.; Nadalin, S.; et al. Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children. Cancers 2025, 17, 989. https://doi.org/10.3390/cancers17060989
Mayer BFB, Schunn MC, Urla C, Weinpert L, Tsiflikas I, Ebinger M, Fideler F, Neunhoeffer F, Weitz M, Nadalin S, et al. Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children. Cancers. 2025; 17(6):989. https://doi.org/10.3390/cancers17060989
Chicago/Turabian StyleMayer, Benjamin F. B., Matthias C. Schunn, Cristian Urla, Lea Weinpert, Ilias Tsiflikas, Martin Ebinger, Frank Fideler, Felix Neunhoeffer, Marcus Weitz, Silvio Nadalin, and et al. 2025. "Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children" Cancers 17, no. 6: 989. https://doi.org/10.3390/cancers17060989
APA StyleMayer, B. F. B., Schunn, M. C., Urla, C., Weinpert, L., Tsiflikas, I., Ebinger, M., Fideler, F., Neunhoeffer, F., Weitz, M., Nadalin, S., Warmann, S. W., & Fuchs, J. (2025). Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children. Cancers, 17(6), 989. https://doi.org/10.3390/cancers17060989