Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2023; 22: 121-126
Опыт протезирования нижней полой и подвздошных вен при местнораспространенной нефробластоме, осложненной опухолевым тромбозом
https://doi.org/10.24287/1726-1708-2023-22-4-121-126Аннотация
Опухолевый тромбоз нижней полой вены при нефробластоме в детском возрасте – относительно редкое осложнение основного заболевания, которое требует мультимодального подхода в лечении с привлечением множества специалистов. Данное состояние встречается у 10% детей с опухолью Вильмса, однако случаи распространения опухолевого тромба до устья печеночных вен и краниальнее встречаются существенно реже. Неоадъювантная химиотерапия в большинстве случаев позволяет значимо сократить размер опухолевого тромба, что может исключить необходимость ревизии нижней полой вены. Учитывая редкость данного клинического состояния, не до конца определена хирургическая тактика при опухолевом тромбозе нижней полой вены у детей. В статье представлено клиническое наблюдение комплексного лечения ребенка с местнораспространенной нефробластомой правой почки IV стадии, опухолевым тромбозом нижней полой вены, который распространялся в большей степени каудально к месту слияния подвздошных вен. В неоадъювантной терапии применяли 6-недельный блок AVD (актиномицин Д, винкристин, доксорубицин), локальный контроль в объеме нефрэктомии с протезированием терминальных отделов общих подвздошных вен, нижней полой вены до подпеченочного отдела и имплантацией левой почечной вены с последующим тромбозом протеза в раннем послеоперационном периоде без гемодинамически значимых нарушений. На момент написания статьи период наблюдения за пациентом составил 12 мес, констатирована ремиссия болезни. Родители пациента дали согласие на использование информации, в том числе фотографий ребенка, в научных исследованиях и публикациях.
Список литературы
1. Cabezalí Barbancho D., Guerrero Ramos F., López Vázquez F., Aransay Bramtot A., Gómez Fraile A. Laparoscopic approach for Wilms tumor. Surg Laparosc Endosc Percutan Tech 2014; 24: 22–5. DOI: 10.1097/SLE.0b013e31829cebf1
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6. Emir S. Wilms tumor with intravascular tumor thrombus. Transl Pediatr 2014; 3 (1): 29–33. DOI: 10.3978/j.issn.2224-4336.2014.01.03
7. Anselmi G., Suárez J.A., Machado I., Moleiro F., Blanco P. Wilms' tumour propagated through the inferior vena cava into the right heart cavities. Br Heart J 1970; 32 (4): 575–8. DOI: 10.1136/hrt.32.4.575
8. Murphy D.A., Rabinovitch H., Chevalier L., Virmani S. Wilms tumor in right atrium. Am J Dis Child 1973; 126 (2): 210–1. DOI: 10.1001/archpedi.1973.02110190184015
9. McMahon S., Carachi R. Wilms' tumor with intravascular extension: A review article. J Indian Assoc Pediatr Surg 2014; 19 (4): 195–200. DOI: 10.4103/0971-9261.141998
10. Lin W.C., Chen J.H., Westphalen A., Chang H., Chiang I.-P., Chen C.H., et al. Primary Renal Rhabdomyosarcoma in an Adolescent With Tumor Thrombosis in the Inferior Vena Cava and Right Atrium: A Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95 (21): e3771. DOI: 10.1097/MD.0000000000003771
11. Xu S., Sun N., Zhang W.P., Song H.C., Huang C.R. Management of Wilms tumor with intravenous thrombus in children: a single center experience. World J Pediatr 2019; 15 (5): 476–82. DOI: 10.1007/s12519-019-00272-0
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13. Sekhon V., Suryavanshi M. Nephroureterectomy with inferior venacaval thrombectomy in post-chemotherapy Wilms' tumour in a child – From the eyes of the surgeon! J Pediatr Urol 2018; 14 (4): 351–2. DOI: 10.1016/j.jpurol.2018.06.005
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20. Qureshi S.S., Bhagat M., Smriti V., Murli D., Baheti A., Yadav S., et al. Intravascular extension of Wilms tumor: Characteristics of tumor thrombus and their impact on outcomes. J Pediatr Urol 2021; 17 (1): 69.e1–e8. DOI: 10.1016/j.jpurol.2020.10.003
21. Tekin A., Yağmur İ., Ergün O., Fatih Ayık M., Atay Y., Ulman İ., Avanoğlu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2019; 61 (3): 436–9. DOI: 10.24953/turkjped.2019.03.019
22. Grimaldi C., Bertocchini A., Crocoli A., de Ville de Goyet J., Castellano A., Serra A., et al. Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature. J Pediatr Surg 2019; 54 (3): 557–61. DOI: 10.1016/j.jpedsurg.2018.06.008
23. Bader M.I., Abdelaal K., Rogers T., Arul S.G. A surgical approach to Wilms' tumour with retrohepatic vena caval extension. Pediatr Surg Int 2013; 29 (3): 229–32. DOI: 10.1007/s00383-013-3263-2
24. Ceccanti S., Büyükünal C., Emre S., Masselli G., Schiavetti A., Cozzi D.A. Resection of Inferior Vena Cava Without Reconstruction for Intravascular Intrusion of Wilms Tumor. Urology 2021; 149: e29–33. DOI: 10.1016/j.urology.2020.11.004
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26. Ахаладзе Д.Г., Шаталов К.В., Джиджихия К.М., Рабаев Г.С., Твердов И.В., Качанов Д.Ю. и др. Нефрэктомия с резекцией и протезированием нижней полой вены у пациентки в возрасте одного года с нефробластомой левой почки и опухолевым тромбом нижней полой вены и правого предсердия. Флебология 2022; 16 (4): 296–303. DOI: 10.17116/flebo202216041296
Pediatric Hematology/Oncology and Immunopathology. 2023; 22: 121-126
Prosthetic replacement of the inferior vena cava and common iliac veins in a child with locally advanced Wilms tumor complicated by tumor thrombosis
https://doi.org/10.24287/1726-1708-2023-22-4-121-126Abstract
Tumor thrombosis of the inferior vena cava in children with nephroblastoma is a relatively rare complication that requires a multimodal approach to treatment and involves many specialists. This condition occurs in 10% of children with Wilms tumor but cases when a tumor thrombus extends to the orifices of the hepatic veins and more cranially, are much less common. In most patients, neoadjuvant chemotherapy can significantly reduce the size of a tumor thrombus, which may eliminate the need for revision surgery of the inferior vena cava. Due to the rarity of this clinical condition, the optimal surgical strategy for tumor thrombosis of the inferior vena cava in children has not been fully defined yet. Here, we present a clinical case of a child with locally advanced stage 4 Wilms tumor of the right kidney and tumor thrombosis of the inferior vena cava that extended mostly in the caudal direction, to the confluence of the iliac veins. The patient received 6 weeks of neoadjuvant therapy with AVD (actinomycin D, vincristine, doxorubicin) and underwent nephrectomy for local control, with prosthetic replacement of the terminal sections of the common iliac veins as well as of the inferior vena cava up to its subhepatic segment, and implantation of the left renal vein. In the early postoperative period, the child developed thrombosis of the prosthesis, without hemodynamically significant abnormalities. At the time of writing, the patient had been followed up for 12 months and was considered to be in remission. The patient’s parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.
References
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