Camille Linick Stewart1, Jennifer Lynn Bruny2. 1. Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States. 2. Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
Abstract
INTRODUCTION: Sampling lymph nodes (LNs) is independently associated with decreased recurrence and improved survival for Wilms tumor (WT). Despite sampling, we noted cases where a few or no LNs were identified after resection of WT. We hypothesized fewer LNs were identified when submitted en bloc with the tumor, compared with when submitted separately. PATIENTS/ MATERIALS AND METHODS: We conducted a retrospective chart review from 2003 to 2012 of WT resection cases, examining the type of LN dissection, the specimens submitted to pathology, number of LNs evaluated, and complications associated with the procedure. RESULTS: We identified 74 children with WT; 59 of 74 (79.7%) had unilateral disease and 15 of 74 (20.3%) had bilateral disease. With unilateral disease, more LNs were identified by separate versus en bloc sampling (5.2 ± 0.6 vs. 4.4 ± 1.2 nodes, p=0.61). Both the methods identified fewer LNs compared with en bloc+separate sampling (12.5 ± 2.7 nodes, p<0.001 and p=0.04, respectively). The majority of children with bilateral disease (10/15, 66.6%) did not have LN sampling intraoperatively. When submitted separately, 83.3 ± 3.8% of all LNs were identified in the separate specimen, and two en bloc specimens that were noted to have adenopathy intraoperatively had no LNs pathologically identified. Few cases had complications, which did not appear associated with LN sampling. CONCLUSIONS: En bloc+separate sampling yields the most LNs during resection of WT. We recommend using this technique to facilitate the maximum number of LNs evaluated in WT. Low rates of LN sampling in bilateral disease may indicate decreased regard for sampling when tumor stage is already known. Georg Thieme Verlag KG Stuttgart · New York.
INTRODUCTION: Sampling lymph nodes (LNs) is independently associated with decreased recurrence and improved survival for Wilms tumor (WT). Despite sampling, we noted cases where a few or no LNs were identified after resection of WT. We hypothesized fewer LNs were identified when submitted en bloc with the tumor, compared with when submitted separately. PATIENTS/ MATERIALS AND METHODS: We conducted a retrospective chart review from 2003 to 2012 of WT resection cases, examining the type of LN dissection, the specimens submitted to pathology, number of LNs evaluated, and complications associated with the procedure. RESULTS: We identified 74 children with WT; 59 of 74 (79.7%) had unilateral disease and 15 of 74 (20.3%) had bilateral disease. With unilateral disease, more LNs were identified by separate versus en bloc sampling (5.2 ± 0.6 vs. 4.4 ± 1.2 nodes, p=0.61). Both the methods identified fewer LNs compared with en bloc+separate sampling (12.5 ± 2.7 nodes, p<0.001 and p=0.04, respectively). The majority of children with bilateral disease (10/15, 66.6%) did not have LN sampling intraoperatively. When submitted separately, 83.3 ± 3.8% of all LNs were identified in the separate specimen, and two en bloc specimens that were noted to have adenopathy intraoperatively had no LNs pathologically identified. Few cases had complications, which did not appear associated with LN sampling. CONCLUSIONS: En bloc+separate sampling yields the most LNs during resection of WT. We recommend using this technique to facilitate the maximum number of LNs evaluated in WT. Low rates of LN sampling in bilateral disease may indicate decreased regard for sampling when tumor stage is already known. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Amanda F Saltzman; Derek E Smith; Dexiang Gao; Debashis Ghosh; Arya Amini; Jennifer H Aldrink; Roshni Dasgupta; Kenneth W Gow; Richard D Glick; Peter F Ehrlich; Nicholas G Cost Journal: J Pediatr Surg Date: 2019-06-20 Impact factor: 2.545
Authors: Jonathan P Walker; Jared S Johnson; Megan M Eguchi; Amanda F Saltzman; Myles Cockburn; Nicholas G Cost Journal: J Pediatr Urol Date: 2019-11-06 Impact factor: 1.830