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Prechemotherapy laparoscopic nephrectomy for Wilms' tumor
Journal of Pediatric Urology (2009) 5, 416e419
CASE REPORT
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor T.D. Barber a, J.E. Wickiser b, D.T. Wilcox a, L.A. Baker a,* a
Department of Urology, University of Texas Southwestern Medical Center, Children’s Medical Center, 2350 Stemmons Freeway #D-4300, Dallas, TX 75235, USA b Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, Children’s Medical Center, 1935 Motor Street, Dallas, TX 75235, USA Received 3 October 2008; accepted 5 January 2009 Available online 27 March 2009
KEYWORDS Wilms’ tumor; Pediatrics; Laparoscopy
Abstract Laparoscopic radical nephrectomy is emerging as the treatment of choice for localized renal malignancies in adults. Despite the widespread use of laparoscopic nephrectomy for benign renal disease in infants and children, the laparoscopic approach has not been employed for pediatric Wilms’ tumor except following systemic chemotherapy. We report the results of laparoscopic radical nephrectomy for removal of unilateral Wilms’ tumor prior to the administration of systemic chemotherapy in two patients. ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Wilms’ tumor is the most common primary malignant renal tumor in children. In the US, initial management is most often radical nephrectomy followed by adjuvant chemotherapy, and possibly external beam radiation, based on extent of disease and tumor histology. Where primary nephrectomy is not possible due to the extent of disease, neoadjuvant chemotherapy is administered with the hope of reducing tumor burden and making surgical resection possible. Traditionally, radical nephrectomy for Wilms’ tumor has been performed via an open approach, using either a chevron or transverse abdominal incision. * Corresponding author at: Department of Urology, University of Texas Southwestern Medical Center, 6300 Harry Hines Boulevard, Suite 1401, Dallas, TX 75390-9110, USA. Tel.: þ1 214 456 2480; fax: þ1 214 456 2497. E-mail address: [email protected] (L.A. Baker).
Abroad, the approach to Wilms’ tumor differs primarily by the administration of neoadjuvant chemotherapy followed by nephrectomy. With advancements in minimally invasive surgery, reports of laparoscopic post-chemotherapy radical nephrectomy in patients with Wilms’ tumor have emerged [1,2]. We report the successful laparoscopic removal of two unilateral Wilms’ tumors prior to the administration of chemotherapy.
Case reports Case 1 A 14-month-old African-American female (9.75 kg, 76.5 cm) presented with a palpable abdominal mass. CT imaging revealed an 8.0 6.8 6.6-cm left renal mass nearly
1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2009.01.011
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor replacing the kidney, composed of soft-tissue density with a few areas of cystic density, consistent with localized Wilms’ tumor (Fig. 1A). The contralateral kidney was free of tumor and the largest left hilar lymph node was 3 mm in diameter. No visceral metastases or involvement of adjacent organs was noted. Subsequently, the patient was taken for laparoscopic left radical nephrectomy. A transabdominal approach was utilized. Positioning was in a modified right lateral decubitus position, using a roll to elevate the left flank approximately 30 degrees. Three trocars were placed (two working and one camera). A 10-mm camera port was placed infra-umbilically; 5-mm trocars were placed in the left lower quadrant midaxillary line and midline epigastrium respectively. Following mobilization and reflection of the descending colon, the initial dissection was directed toward the left renal hilum but was challenging due to the tumor size. Therefore, attention was turned toward identification of the ureter and dissection of the lower pole of the kidney. Following dissection of the lower pole of the kidney, the renal hilum was visualized and the renal vessels were ligated with surgical clips. No tumor spillage occurred and the ipsilateral adrenal gland was left intact. Following completion of the nephrectomy and lymph node biopsy, the specimen was removed via a Pfannenstiel incision. Operative time was 252 min. Intraoperative blood loss was 25 cc. Postoperatively, the patient had an uneventful course and was discharged on postoperative day 2. Pathology revealed complete resection of a 12.4-cm-long, 284-g kidney containing a multifocal Wilms’ tumor of favorable histology. Review of the case by the Children’s Oncology Group Renal Tumor Pathology center identified extensive involvement of hilar fat by nephroblastomatosis thus upstaging the tumor to Stage II. The lymph node biopsy returned no nodes. Tumor cytogenetics were 46, XX, der(16)t(1;16)(q21;q12.1). Following recovery from surgery, the patient was started on adjuvant dactinomycin and vincristine per National Wilms’ Tumor Study Group (NWTSG) V protocol for Stage II disease [3]. Five months postoperatively, the patient continues to do well and has had no evidence of tumor recurrence.
Case 2 A 16-year-old female was found to have an incidental 8 6.8 6.4-cm central right renal mass with hydronephrosis on an
417 abdominal CT scan following a motor vehicle collision (Fig. 1B). There was no contralateral kidney tumor, metastasis or lymphadenopathy noted. A transperitoneal laparoscopic nephrectomy was performed. The patient was positioned over the kidney rest in a right modified lateral decubitus position elevating the right flank on a roll. Trocar positioning was performed in an identical fashion to the first case. The ascending colon and hepatic flexure were mobilized medially. With the increased intra-abdominal space in this older child, the right renal hilar dissection was achieved with some minimal blood loss. The right renal artery and vein were ligated with surgical clips and polyglactin ties. No intraoperative tumor spill was noted. The adrenal was left in situ and the kidney specimen was withdrawn via a Pfannenstiel incision. Operative time was 304 min. Blood loss was 300 cc. No intraoperative or postoperative blood transfusion was needed. The patient was discharged home on postoperative day 3. Final pathology revealed anaplastic histology with extracapsular tumor extension and invasion of the hilar lymphatics, but negative surgical margins. Thus, this tumor was NWTSG Stage II. The patient subsequently underwent local external beam radiation therapy and two-agent systemic chemotherapy with vincristine and dactinomycin. Sixteen months postoperatively, the patient remains recurrence free.
Discussion With the development of multimodal treatment for Wilms’ tumor, survival rates are now in excess of 90% for those patients with low-stage (Stage I and II), favorable histology tumors [4e6]. As survival rates have increased, attention has begun to focus on minimizing patient morbidity without negatively impacting event-free survival. In the last 15 years, laparoscopy has been introduced into the treatment armamentarium for pediatric benign renal disease. Unlike adult urology, which rapidly transitioned to laparoscopic radical nephrectomy as standard of care for malignancies of the kidney, pediatric laparoscopic nephrectomy for malignancy has rarely been reported. Concerns raised over the laparoscopic treatment of Wilms’ tumor have included: (1) an increased risk of tumor rupture due to decreased tactile feedback and the fragile nature of the tumor capsule, and (2) inadequate abdominal exploration for complete staging. While these are certainly
Figure 1 A. Preoperative CT image from case 1 showing a large left renal mass involving the entire kidney. B. Preoperative CT image from case 2 showing right renal mass.
418 valid concerns, in two recent reports, eight successful laparoscopic nephrectomies for pediatric Wilms’ tumor were performed following neoadjuvant chemotherapy according to the Society of Pediatric Oncology protocol utilized at the institution [1,2]. At surgery, the mean age was 44.3 months, mean weight 14.6 kg, mean height 94.6 cm, mean specimen size 9.7 5.4 cm, and mean specimen weight 129.2 g. In each case, there was noted to be a significant reduction in tumor size following a 4-week course of chemotherapy utilizing vincristine þ actinomycin D. As it is well reported that intraoperative tumor spillage is associated with an increased risk of local relapse [7], this invites the question of whether the favorable post-chemotherapy laparoscopic nephrectomy outcomes are in part due to a decreased likelihood of the shrunken tumor to rupture. While a lower likelihood of intraoperative tumor rupture may have been due to the administration of neoadjuvant chemotherapy, in the case of our patients (who were theoretically at a higher risk of tumor rupture) the operations were completed with no disruption of the tumor capsule in either patient. In the case of our first patient, this was despite being 14 months old, weighing 9.75 kg, measuring 76.5 cm in height, and having an 8.0-cm tumor in a 12.4-cm, 284-g specimen. However, her tumor was primarily solid. Regarding the possibility of laparoscopy limiting the surgeon’s ability to perform an adequate assessment of the abdominal cavity for the presence of metastatic disease, in both our case and the previously reported cases, laparoscopy, which can magnify up to 40, did allow for excellent visual assessment of the abdominal cavity. Lymph node sampling can be easily performed laparoscopically as in the case of our second patient. While the biopsy in our first patient surprisingly found no nodes, she was upstaged due to the hilar fat nephroblastomatosis. Furthermore, palpation of the contralateral kidney in the setting of a preoperative CT or MRI showing a normal contralateral kidney is no longer recommended by NWTSG/Children’s Oncology Group [8]. While our follow up is short, no evidence of tumor recurrence was noted at up to 23 months postoperatively in the post-chemotherapy laparoscopic nephrectomy series for Wilms’ tumor [2]. Finally, while event-free survival is certainly the most important outcome measure in these patients, perhaps the greatest potential benefit of laparoscopic surgery is decreased patient morbidity. Classically, radical nephrectomy for Wilms’ tumor is performed via either a chevron, transverse abdominal or flank incision. The large incision size and extensive mobilization of the contents of the peritoneal cavity with these approaches are associated with increased length of hospitalization, increased analgesic use, and perhaps even an increased cost when compared to a laparoscopic approach [9,10]. In addition, by performing the nephrectomy portion of the operation via three 10-mm or less abdominal incisions, the mobilized specimen is able to be removed via a smaller Pfannenstiel incision made along a skin crease in the lower abdomen which is more cosmetically pleasing, concealable, and may be associated with a more rapid return of bowel function and decreased postoperative pain when compared to other abdominal incisions [11e13].
T.D. Barber et al.
Conclusion As the role of laparoscopy in the treatment of pediatric malignancies is increasing, prechemotherapy laparoscopic radical nephrectomy for Wilms’ tumor may be considered a potential treatment option for the experienced endoscopic surgeon in the properly selected patient. While our two cases suggest the feasibility of laparoscopic nephrectomy, this approach should not yet be considered the ‘gold standard’ in the surgical management of Wilms’ tumor. Challenges will lie in preoperatively identifying the proper candidates for this approach and in performing multiinstitutional, prospective trials in a larger cohort of select patients to establish the safety and efficacy of laparoscopic nephrectomy in Wilms’ tumor.
Conflict of interest statement None of the authors have financial or personal relationships with persons or organizations that could inappropriately bias the work described. No funding was received for this work.
References [1] Duarte RJ, Denes FT, Cristofani LM, Giron AM, Filho VO, Arap S. Laparoscopic nephrectomy for Wilms tumor after chemotherapy: initial experience. J Urol 2004;172: 1438e40. [2] Duarte RJ, Denes FT, Cristofani LM, Odone-Filho V, Srougi M. Further experience with laparoscopic nephrectomy for Wilms’ tumour after chemotherapy. BJU Int 2006; 98:155e9. [3] Dome JS, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey ML, et al. Treatment of anaplastic histology Wilms’ tumor: results from the fifth National Wilms’ Tumor Study. J Clin Oncol 2006;24:2352e8. [4] Pritchard J, Imeson J, Barnes J, Cotterill S, Gough D, Marsden HB, et al. Results of the United Kingdom Children’s Cancer Study Group first Wilms’ Tumor Study. J Clin Oncol 1995;13:124e33. [5] Suita S, Kinoshita Y, Tajiri T, Hara T, Tsuneyoshi M, Mizote H, et al. Clinical characteristics and outcome of Wilms tumors with a favorable histology in Japan: a report from the Study Group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan. J Pediatr Surg 2006;41:1501e5. [6] Green DM, Breslow NE, Beckwith JB, Finklestein JZ, Grundy PE, Thomas PR, et al. Comparison between single-dose and divided-dose administration of dactinomycin and doxorubicin for patients with Wilms’ tumor: a report from the National Wilms’ Tumor Study Group. J Clin Oncol 1998;16: 237e45. [7] Shamberger RC, Guthrie KA, Ritchey ML, Haase GM, Takashima J, Beckwith JB, et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg 1999;229:292e7. [8] Ritchey ML, Shamberger RC, Hamilton T, Haase G, Argani P, Peterson S. Fate of bilateral renal lesions missed on preoperative imaging: a report from the National Wilms Tumor Study Group. J Urol 2005;174:1519e21. [9] Wolf Jr JS, Merion RM, Leichtman AB, Campbell Jr DA, Magee JC, Punch JD, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation 2001;72:284e90.
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor [10] Cervellione RM, Gordon M, Hennayake S. Financial analysis of laparoscopic versus open nephrectomy in the pediatric age group. J Laparoendosc Adv Surg Tech A 2007;17:690e2. [11] Orr Jr JW, Orr PJ, Bolen DD, Holimon JL. Radical hysterectomy: does the type of incision matter? Am J Obstet Gynecol 1995;173:399e405.
419 [12] Redman JF, Barthold JS. Experience with ileal augmentation cystoplasty using a short Pfannenstiel incision. J Urol 1996; 155:1726e7. [13] Tisdale BE, Kapoor A, Hussain A, Piercey K, Whelan JP. Intact specimen extraction in laparoscopic nephrectomy procedures: Pfannenstiel versus expanded port site incisions. Urology 2007;69:241e4.
CASE REPORT
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor T.D. Barber a, J.E. Wickiser b, D.T. Wilcox a, L.A. Baker a,* a
Department of Urology, University of Texas Southwestern Medical Center, Children’s Medical Center, 2350 Stemmons Freeway #D-4300, Dallas, TX 75235, USA b Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, Children’s Medical Center, 1935 Motor Street, Dallas, TX 75235, USA Received 3 October 2008; accepted 5 January 2009 Available online 27 March 2009
KEYWORDS Wilms’ tumor; Pediatrics; Laparoscopy
Abstract Laparoscopic radical nephrectomy is emerging as the treatment of choice for localized renal malignancies in adults. Despite the widespread use of laparoscopic nephrectomy for benign renal disease in infants and children, the laparoscopic approach has not been employed for pediatric Wilms’ tumor except following systemic chemotherapy. We report the results of laparoscopic radical nephrectomy for removal of unilateral Wilms’ tumor prior to the administration of systemic chemotherapy in two patients. ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Wilms’ tumor is the most common primary malignant renal tumor in children. In the US, initial management is most often radical nephrectomy followed by adjuvant chemotherapy, and possibly external beam radiation, based on extent of disease and tumor histology. Where primary nephrectomy is not possible due to the extent of disease, neoadjuvant chemotherapy is administered with the hope of reducing tumor burden and making surgical resection possible. Traditionally, radical nephrectomy for Wilms’ tumor has been performed via an open approach, using either a chevron or transverse abdominal incision. * Corresponding author at: Department of Urology, University of Texas Southwestern Medical Center, 6300 Harry Hines Boulevard, Suite 1401, Dallas, TX 75390-9110, USA. Tel.: þ1 214 456 2480; fax: þ1 214 456 2497. E-mail address: [email protected] (L.A. Baker).
Abroad, the approach to Wilms’ tumor differs primarily by the administration of neoadjuvant chemotherapy followed by nephrectomy. With advancements in minimally invasive surgery, reports of laparoscopic post-chemotherapy radical nephrectomy in patients with Wilms’ tumor have emerged [1,2]. We report the successful laparoscopic removal of two unilateral Wilms’ tumors prior to the administration of chemotherapy.
Case reports Case 1 A 14-month-old African-American female (9.75 kg, 76.5 cm) presented with a palpable abdominal mass. CT imaging revealed an 8.0 6.8 6.6-cm left renal mass nearly
1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2009.01.011
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor replacing the kidney, composed of soft-tissue density with a few areas of cystic density, consistent with localized Wilms’ tumor (Fig. 1A). The contralateral kidney was free of tumor and the largest left hilar lymph node was 3 mm in diameter. No visceral metastases or involvement of adjacent organs was noted. Subsequently, the patient was taken for laparoscopic left radical nephrectomy. A transabdominal approach was utilized. Positioning was in a modified right lateral decubitus position, using a roll to elevate the left flank approximately 30 degrees. Three trocars were placed (two working and one camera). A 10-mm camera port was placed infra-umbilically; 5-mm trocars were placed in the left lower quadrant midaxillary line and midline epigastrium respectively. Following mobilization and reflection of the descending colon, the initial dissection was directed toward the left renal hilum but was challenging due to the tumor size. Therefore, attention was turned toward identification of the ureter and dissection of the lower pole of the kidney. Following dissection of the lower pole of the kidney, the renal hilum was visualized and the renal vessels were ligated with surgical clips. No tumor spillage occurred and the ipsilateral adrenal gland was left intact. Following completion of the nephrectomy and lymph node biopsy, the specimen was removed via a Pfannenstiel incision. Operative time was 252 min. Intraoperative blood loss was 25 cc. Postoperatively, the patient had an uneventful course and was discharged on postoperative day 2. Pathology revealed complete resection of a 12.4-cm-long, 284-g kidney containing a multifocal Wilms’ tumor of favorable histology. Review of the case by the Children’s Oncology Group Renal Tumor Pathology center identified extensive involvement of hilar fat by nephroblastomatosis thus upstaging the tumor to Stage II. The lymph node biopsy returned no nodes. Tumor cytogenetics were 46, XX, der(16)t(1;16)(q21;q12.1). Following recovery from surgery, the patient was started on adjuvant dactinomycin and vincristine per National Wilms’ Tumor Study Group (NWTSG) V protocol for Stage II disease [3]. Five months postoperatively, the patient continues to do well and has had no evidence of tumor recurrence.
Case 2 A 16-year-old female was found to have an incidental 8 6.8 6.4-cm central right renal mass with hydronephrosis on an
417 abdominal CT scan following a motor vehicle collision (Fig. 1B). There was no contralateral kidney tumor, metastasis or lymphadenopathy noted. A transperitoneal laparoscopic nephrectomy was performed. The patient was positioned over the kidney rest in a right modified lateral decubitus position elevating the right flank on a roll. Trocar positioning was performed in an identical fashion to the first case. The ascending colon and hepatic flexure were mobilized medially. With the increased intra-abdominal space in this older child, the right renal hilar dissection was achieved with some minimal blood loss. The right renal artery and vein were ligated with surgical clips and polyglactin ties. No intraoperative tumor spill was noted. The adrenal was left in situ and the kidney specimen was withdrawn via a Pfannenstiel incision. Operative time was 304 min. Blood loss was 300 cc. No intraoperative or postoperative blood transfusion was needed. The patient was discharged home on postoperative day 3. Final pathology revealed anaplastic histology with extracapsular tumor extension and invasion of the hilar lymphatics, but negative surgical margins. Thus, this tumor was NWTSG Stage II. The patient subsequently underwent local external beam radiation therapy and two-agent systemic chemotherapy with vincristine and dactinomycin. Sixteen months postoperatively, the patient remains recurrence free.
Discussion With the development of multimodal treatment for Wilms’ tumor, survival rates are now in excess of 90% for those patients with low-stage (Stage I and II), favorable histology tumors [4e6]. As survival rates have increased, attention has begun to focus on minimizing patient morbidity without negatively impacting event-free survival. In the last 15 years, laparoscopy has been introduced into the treatment armamentarium for pediatric benign renal disease. Unlike adult urology, which rapidly transitioned to laparoscopic radical nephrectomy as standard of care for malignancies of the kidney, pediatric laparoscopic nephrectomy for malignancy has rarely been reported. Concerns raised over the laparoscopic treatment of Wilms’ tumor have included: (1) an increased risk of tumor rupture due to decreased tactile feedback and the fragile nature of the tumor capsule, and (2) inadequate abdominal exploration for complete staging. While these are certainly
Figure 1 A. Preoperative CT image from case 1 showing a large left renal mass involving the entire kidney. B. Preoperative CT image from case 2 showing right renal mass.
418 valid concerns, in two recent reports, eight successful laparoscopic nephrectomies for pediatric Wilms’ tumor were performed following neoadjuvant chemotherapy according to the Society of Pediatric Oncology protocol utilized at the institution [1,2]. At surgery, the mean age was 44.3 months, mean weight 14.6 kg, mean height 94.6 cm, mean specimen size 9.7 5.4 cm, and mean specimen weight 129.2 g. In each case, there was noted to be a significant reduction in tumor size following a 4-week course of chemotherapy utilizing vincristine þ actinomycin D. As it is well reported that intraoperative tumor spillage is associated with an increased risk of local relapse [7], this invites the question of whether the favorable post-chemotherapy laparoscopic nephrectomy outcomes are in part due to a decreased likelihood of the shrunken tumor to rupture. While a lower likelihood of intraoperative tumor rupture may have been due to the administration of neoadjuvant chemotherapy, in the case of our patients (who were theoretically at a higher risk of tumor rupture) the operations were completed with no disruption of the tumor capsule in either patient. In the case of our first patient, this was despite being 14 months old, weighing 9.75 kg, measuring 76.5 cm in height, and having an 8.0-cm tumor in a 12.4-cm, 284-g specimen. However, her tumor was primarily solid. Regarding the possibility of laparoscopy limiting the surgeon’s ability to perform an adequate assessment of the abdominal cavity for the presence of metastatic disease, in both our case and the previously reported cases, laparoscopy, which can magnify up to 40, did allow for excellent visual assessment of the abdominal cavity. Lymph node sampling can be easily performed laparoscopically as in the case of our second patient. While the biopsy in our first patient surprisingly found no nodes, she was upstaged due to the hilar fat nephroblastomatosis. Furthermore, palpation of the contralateral kidney in the setting of a preoperative CT or MRI showing a normal contralateral kidney is no longer recommended by NWTSG/Children’s Oncology Group [8]. While our follow up is short, no evidence of tumor recurrence was noted at up to 23 months postoperatively in the post-chemotherapy laparoscopic nephrectomy series for Wilms’ tumor [2]. Finally, while event-free survival is certainly the most important outcome measure in these patients, perhaps the greatest potential benefit of laparoscopic surgery is decreased patient morbidity. Classically, radical nephrectomy for Wilms’ tumor is performed via either a chevron, transverse abdominal or flank incision. The large incision size and extensive mobilization of the contents of the peritoneal cavity with these approaches are associated with increased length of hospitalization, increased analgesic use, and perhaps even an increased cost when compared to a laparoscopic approach [9,10]. In addition, by performing the nephrectomy portion of the operation via three 10-mm or less abdominal incisions, the mobilized specimen is able to be removed via a smaller Pfannenstiel incision made along a skin crease in the lower abdomen which is more cosmetically pleasing, concealable, and may be associated with a more rapid return of bowel function and decreased postoperative pain when compared to other abdominal incisions [11e13].
T.D. Barber et al.
Conclusion As the role of laparoscopy in the treatment of pediatric malignancies is increasing, prechemotherapy laparoscopic radical nephrectomy for Wilms’ tumor may be considered a potential treatment option for the experienced endoscopic surgeon in the properly selected patient. While our two cases suggest the feasibility of laparoscopic nephrectomy, this approach should not yet be considered the ‘gold standard’ in the surgical management of Wilms’ tumor. Challenges will lie in preoperatively identifying the proper candidates for this approach and in performing multiinstitutional, prospective trials in a larger cohort of select patients to establish the safety and efficacy of laparoscopic nephrectomy in Wilms’ tumor.
Conflict of interest statement None of the authors have financial or personal relationships with persons or organizations that could inappropriately bias the work described. No funding was received for this work.
References [1] Duarte RJ, Denes FT, Cristofani LM, Giron AM, Filho VO, Arap S. Laparoscopic nephrectomy for Wilms tumor after chemotherapy: initial experience. J Urol 2004;172: 1438e40. [2] Duarte RJ, Denes FT, Cristofani LM, Odone-Filho V, Srougi M. Further experience with laparoscopic nephrectomy for Wilms’ tumour after chemotherapy. BJU Int 2006; 98:155e9. [3] Dome JS, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey ML, et al. Treatment of anaplastic histology Wilms’ tumor: results from the fifth National Wilms’ Tumor Study. J Clin Oncol 2006;24:2352e8. [4] Pritchard J, Imeson J, Barnes J, Cotterill S, Gough D, Marsden HB, et al. Results of the United Kingdom Children’s Cancer Study Group first Wilms’ Tumor Study. J Clin Oncol 1995;13:124e33. [5] Suita S, Kinoshita Y, Tajiri T, Hara T, Tsuneyoshi M, Mizote H, et al. Clinical characteristics and outcome of Wilms tumors with a favorable histology in Japan: a report from the Study Group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan. J Pediatr Surg 2006;41:1501e5. [6] Green DM, Breslow NE, Beckwith JB, Finklestein JZ, Grundy PE, Thomas PR, et al. Comparison between single-dose and divided-dose administration of dactinomycin and doxorubicin for patients with Wilms’ tumor: a report from the National Wilms’ Tumor Study Group. J Clin Oncol 1998;16: 237e45. [7] Shamberger RC, Guthrie KA, Ritchey ML, Haase GM, Takashima J, Beckwith JB, et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg 1999;229:292e7. [8] Ritchey ML, Shamberger RC, Hamilton T, Haase G, Argani P, Peterson S. Fate of bilateral renal lesions missed on preoperative imaging: a report from the National Wilms Tumor Study Group. J Urol 2005;174:1519e21. [9] Wolf Jr JS, Merion RM, Leichtman AB, Campbell Jr DA, Magee JC, Punch JD, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation 2001;72:284e90.
Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor [10] Cervellione RM, Gordon M, Hennayake S. Financial analysis of laparoscopic versus open nephrectomy in the pediatric age group. J Laparoendosc Adv Surg Tech A 2007;17:690e2. [11] Orr Jr JW, Orr PJ, Bolen DD, Holimon JL. Radical hysterectomy: does the type of incision matter? Am J Obstet Gynecol 1995;173:399e405.
419 [12] Redman JF, Barthold JS. Experience with ileal augmentation cystoplasty using a short Pfannenstiel incision. J Urol 1996; 155:1726e7. [13] Tisdale BE, Kapoor A, Hussain A, Piercey K, Whelan JP. Intact specimen extraction in laparoscopic nephrectomy procedures: Pfannenstiel versus expanded port site incisions. Urology 2007;69:241e4.