Wilms tumour a comparison of surgical aspects in patients with or without pre-operative chemotherapy

ABSTRACT

To compare the technical aspects of Wilms' tumour [WT] surgery in patients with and without pre-operative chemotherapy. Quasi-experimental. Military Hospital [MH] and Combined Military Hospital [CMH], Rawalpindi, from January 1999 to December 2004. Patients of WT, presenting between January 1999 and December 2001, were treated, using the NWTSG protocol, with primary surgery [group I]. Between January 2001 and December 2004, WT patients were treated according to SIOP protocol, with pre-operative chemotherapy followed by surgery [group II]. Volume reduction with chemotherapy, duration of surgery, rupture of tumour, extent of excision, adherence and damage to surrounding structures, blood loss, complications, stay in hospital and event-free survival [EFS] were compared in the two groups. Out of 22 patients in group I, 19 [86.4%] underwent primary surgery. Of the 23 patients in group II, 21 [91.3%] received pre-operative chemotherapy followed by surgery. Average volume reduction in this group was 54% with chemotherapy. Difference in duration of surgery and blood loss was significantly low in group II [p=0.003 and p<0.001, respectively]. In group I, rupture [6 vs 2], adherence [14 vs 10] and damage to surrounding structures [5 vs 2] were more. Complete macroscopic excision was possible in 90.5% of WT in group II as compared to 73.7% in group I. Immediate postoperative complications and length of hospital stay were similar in both groups. There was no difference in EFS. Pre-operative chemotherapy makes it technically easier and safer to operate, without jeopardizing the final outcome: