Primary surgery in treatment of stages II and III Wilms' Tumour: a developing countries' experience

Background: Treatment options for Wilms' tumour [WT] are costly and it affects the country's health budget and resources if adopted and implemented at the national level especially in developing countries with low or resource-challenged settings

Aim: The objective of this study is to evaluate the role and effectiveness of primary surgery in the treatment of stage II and III pediatric WT following the schedule indicated in the National Wilms' Tumor Study [NWTS-4] in the institutes of two developing countries

Patients and Methods: The study enrolled 40 children who were primarily diagnosed as stage II and III WT. They were divided into 2 equal groups. Group I [n = 20] included those children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II [n = 20] included those children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20+/-5 months, clinical and radiological evaluation was performed for all patients

Results: In group I, 15 patients were preoperatively diagnosed as stage II and 5 patients as stage III while in group II, 16 patients were proved to be stage II and 4 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed on all patients. In patients with stage II, evidence of recurrence was noted in 4 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 2 patients in group I and only one patient in group II

Conclusion: Primary surgery with appropriate adjuvant therapy improves the treatment results compared to the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. It may be used as a safe and effective tool in treating WT patients with relatively no changes from the long administration schedules. This will have a highly positive impact in lowering treatment cost in developing countries

Different surgical modalities in management of paediatric abdominal lymphoma

The abdomen is one of the most frequent sites for lymphoma in children. The role of surgery has been limited to intra-abdominal resectable tumours or as a diagnostic procedure in case of disseminated disease. Laparotomy without total excision of the tumour does not improve survival; moreover, it may cause complications and delays initiation of chemotherapy. This study was undertaken to assess the role of surgery in the management of children and adolescents presenting with intra-abdominal lymphoma in order to create certain criteria to select the proper surgical modality for managing those patients. This case-series, retrospective study was done on 33 patients of abdominal lymphoma over a period of seven years from 2000 to 2007. Patients' files were reviewed regarding the full clinical examinations, laboratory and radiological investigations as well as surgical and diagnostic procedures. Collected data were tabulated and statistically analyzed using SPSS program package. Eleven patients [33.3%] presented with huge pelvi-abdominal mass and eleven [33.3%] had generalized lymphadenopathy beside their abdominal affection. The remaining 11 [33.3%] patients presented with symptoms of an acute abdomen. A total of 15 laparotomies were done. 11 patients underwent emergency laparotomy for acute abdomen and 4 patients had elective abdominal exploration. Lymph node biopsies were taken in 7 patients and laparoscopy procedures were performed in 3 patients as a diagnostic tool. Out of the total 33, the remaining 8 patients underwent true cut needle biopsy for diagnosis of their disease. Surgery still has a role in treatment of lymphoma whether non Hodgkin or Hodgkin's. However, in disseminated metastatic disease, aggressive debulking of the tumour should be avoided as chemotherapy is to be instituted primarily. Surgical resection does not cause significant change in morbidity or mortality