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108
29
th
CONGRESS OF THE ESPU
08:06–08:09
S13-3 (PP)
INFERIOR VENA CAVECTOMY FOR COMPLETE EXCISION
OF WILMS' TUMOUR
Sadaf ABA UMER KODWAVWALA
1
, Sajid SULTAN
1
, Bashir AHMED
1
, Shamvil
ASHRAF
1
, Muhammad MUBARAK
2
, Abdaal WASIM KHAN
3
, Zaid SUFI
4
, Philip
G RANSLEY
1
and Adeeb Ul Hasan RIZVI
1
1) Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN
- 2) Sindh Institute of Urology & Transplantation, Department of Pathology, Karachi, PAKISTAN - 3) Sindh Institute
of Urology & Transplantation, Department of General Surgery, Karachi, PAKISTAN - 4) Sindh Institute of Urology &
Transplantation, Department of Vascular surgery, Karachi, PAKISTAN
PURPOSE
To evaluate the outcome of patients who underwent “enbloc” inferior venacavectomy with tumour
nephrectomy for Wilms’ tumour.
MATERIAL AND METHODS
Of the 194 patients of Wilms’ tumour managed during 2001–2017, we retrospectively reviewed the
prospectively collected data of Six patients who underwent “en bloc“ inferior venacavectomy and
tumour nephrectomy. Data was reviewed with regard to the findings, treatment and event free and
overall survival. Statistical analysis was done on SPSS v.20 using Paired samples T- Test.
RESULTS
Mean age was 4.3 +/- 1y. Five (83 %) were right sided. All presented with abdominal mass. The
mean tumour volume was 803 +/- 748 cm
3
and three had pulmonary metastases. The IVC thrombus
was infrahepatic in two and intrahepatic in four with distal extension to the bifurcation.
Neoadjuvant chemotherapy reduced the mass to a mean volume of 305 +/- 185.9 cm
3
(p = 0.09)
and all pulmonary metastases resolved with no significant change in IVC thrombus. Enbloc inferior
venacavectomy and nephrectomy was performed in all patients, sparing the hepatic veins. The
contralateral renal vein was ligated beyond the thrombus. The postoperative complications included
deranged LFT’s with subacute intestinal obstruction in one and one patient needed postoperative
ventilatory support for 2 days. Histopathology showed 100 % necrosis in 3 patients. Of the six pa-
tients, 4 needed abdominal radiotherapy along with chemotherapy. Overall and event free survival
is 83 % with mean follow up period of 25 +/- 14 months.
CONCLUSIONS
Our results show Enbloc inferior venacavectomy and tumour nephrectomy is safe and effective
management for Wilms’ tumour with subdiaphragmatic IVC thrombus not amenable to intravascular
retrieval.