Surgical complications after nephrectomy for Wilms' tumor

M. L. Ritchey, P. P. Kelalis, N. Breslow, Ruth Etzioni, I. Evans, G. M. Haase, G. J. D'Angio

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and ninety-five surgical complications occurred in 379 children (19.8 percent). Patients with inoperable tumors, bilateral renal tumors, preoperative therapy and those who refused treatment were excluded from this review. The most common complication was intestinal obstruction, which occurred in 132 patients (6.9 percent). This was followed by extensive intraoperative hemorrhage (112 patients), defined as blood loss exceeding 50 milliliters per kilogram of body weight. Intraoperative injuries to other visceral organs (including intestine, liver and spleen) occurred in 21 children and extensive vascular injuries were reported in 27 patients. There were nine deaths attributed to surgical complications (0.5 percent), only one of which was intraoperative. Survival of patients with complications was similar to patients without complications when stratified by histologic study and stage. Factors associated with the development of surgical complications included advanced local tumor stage at diagnosis, intravascular tumor extension and resection of other visceral organs at the time of nephrectomy. Complete removal of the tumor is important, but not at the expense of radical removal of adjacent structures, because of gross appearances at operation. They are often not invaded by the tumor, but rather are compressed, distorted or adherent without tumor infiltration. Identification of these groups will aid the surgeon in choosing the appropriate management for these patients at high risk. When initial exploration and precise surgical staging indicate that only a formidable operation will achieve total excision, shrinkage of the tumor with selective use of chemotherapy or radiotherapy, or both, may facilitate removal and decrease surgical morbidity. Preoperative therapy may also be the preferred approach for children with extensive intravascular tumor.

Original languageEnglish (US)
Pages (from-to)507-514
Number of pages8
JournalSurgery Gynecology and Obstetrics
Volume175
Issue number6
StatePublished - Jan 1 1992
Externally publishedYes

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Wilms Tumor
Nephrectomy
Neoplasms
Social Identification
Intestinal Obstruction
Vascular System Injuries
Intestines
Radiotherapy
Therapeutics
Spleen
Body Weight
Hemorrhage
Morbidity
Kidney
Drug Therapy
Survival
Liver
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

Cite this

Ritchey, M. L., Kelalis, P. P., Breslow, N., Etzioni, R., Evans, I., Haase, G. M., & D'Angio, G. J. (1992). Surgical complications after nephrectomy for Wilms' tumor. Surgery Gynecology and Obstetrics, 175(6), 507-514.

Surgical complications after nephrectomy for Wilms' tumor. / Ritchey, M. L.; Kelalis, P. P.; Breslow, N.; Etzioni, Ruth; Evans, I.; Haase, G. M.; D'Angio, G. J.

In: Surgery Gynecology and Obstetrics, Vol. 175, No. 6, 01.01.1992, p. 507-514.

Research output: Contribution to journalArticle

Ritchey, ML, Kelalis, PP, Breslow, N, Etzioni, R, Evans, I, Haase, GM & D'Angio, GJ 1992, 'Surgical complications after nephrectomy for Wilms' tumor', Surgery Gynecology and Obstetrics, vol. 175, no. 6, pp. 507-514.
Ritchey ML, Kelalis PP, Breslow N, Etzioni R, Evans I, Haase GM et al. Surgical complications after nephrectomy for Wilms' tumor. Surgery Gynecology and Obstetrics. 1992 Jan 1;175(6):507-514.
Ritchey, M. L. ; Kelalis, P. P. ; Breslow, N. ; Etzioni, Ruth ; Evans, I. ; Haase, G. M. ; D'Angio, G. J. / Surgical complications after nephrectomy for Wilms' tumor. In: Surgery Gynecology and Obstetrics. 1992 ; Vol. 175, No. 6. pp. 507-514.
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