Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study
Topic overview
This UK national study of 69 Wilms tumor patients with intravascular extension found that 67% had stage III disease due to incomplete thrombus resection. Complete surgical removal of tumor thrombus significantly improved event-free survival, emphasizing the importance of controlled complete resection including cavotomy when indicated.
Key takeaways
- 11.8% of Wilms tumors present with intravascular extension, requiring specialized surgical approach for complete thrombus removal.
- 67% of cases with vascular extension are upstaged to stage III due to incomplete resection, piecemeal removal, or positive margins.
- Complete surgical resection of tumor thrombus significantly improves event-free survival compared to incomplete resection.
- Two-thirds of tumor thrombi contain viable tumor cells, emphasizing need for en bloc rather than piecemeal removal.
- Cavotomy should be performed when indicated; avoiding it contributed to incomplete resection in 8 cases with worse outcomes.
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