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| Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature |
Simone Sforzaa,b,*( ),Valeria Emma Palmieric,Maria Rosaria Raspollinid,Giandomenico Rovielloc,Alberto Mantovanib,Umberto Bassoe,Maria Carmen Affinitaf,Alberto D’Angelog,Lorenzo Antonuzzoc,Marco Carinia,Andrea Minervinia,Lorenzo Masieria,b
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aDepartment of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
bDepartment of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
cClinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, Italy
dHistopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
eMedical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
fHematology Oncology Division, Department of Women’s and Children’s Health, Padova University Hospital, Padua, Italy
gDepartment of Biology and Biochemistry, University of Bath, Bath, UK |
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Abstract Objective: The incidence of Wilms’ tumor (WT) among adult individuals accounts for less than 1% of kidney cancer cases, with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70% for the adult patients versus 90% for the pediatric cases. The diagnosis and treatment of WT are complex in the preoperative setting; neoadjuvant chemotherapy (NAC) or robotic surgery has rarely been described. This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.
Methods: We reported a case of WT managed in a multidisciplinary setting. Furthermore, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations, a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.
Results: A 33-year-old female had a diagnosis of WT. She was scheduled to NAC, and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection, she was managed with no intraoperative rupture, a favorable surgical outcome, and a follow-up of 25 months, which did not show any recurrence. The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT. Of these, approximately 15 patients were carried out using robotic surgery in adolescents while none in adults. Moreover, NAC has not been administered before minimally invasive surgery in adults up until now.
Conclusion: WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far. The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario. Notwithstanding, additional cases of adult WT need to be identified and investigated to improve the oncological outcome.
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Received: 20 August 2020
Available online: 20 April 2023
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Corresponding Authors:
Simone Sforza
E-mail: simone.sforza1988@gmail.com
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The updated Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram for the systematic review.
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Preoperative computed tomography scan showing a 13 cm × 11 cm × 14 cm low-density mass (arrow) with a subvert structure in the left kidney, without hydronephrosis. (A) Coronal scan; (B) Axial scan.
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Computed tomography scan after neoadjuvant chemotherapy showing the radiological partial response to the therapy with a reduction of the renal mass (dimension of 8.5 cm × 60.0 cm × 8.0 cm, arrow) without the infiltration of other organs. (A) Coronal scan; (B) Axial scan.
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Intraoperative robotic lymphadenectomy. In the surgery, the lymph nodes presented aspects of fibrosis and adhesion to the major vessels.
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Histopathological examination (20×). The picture showed nephroblastoma (Wilms' tumor) which consisted of a mixture of three different tissue, including blastema (left), epithelium (right), and stroma (central).
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| Authors, year of publication; type of study design | Patient, n | Sex | Age, year | NAC | Type of surgery; operative time, min | Estimated blood loss, mL; complication | Length of hospital stay, day | Positive surgical margin; lymph node (retrieval number) | Follow-up, month | Local recurrence; overall survival | | Cost et al., 2015, [18]; case report | 1 | Female | 14.0 | No | -RN; 210 | NR; none | 2 | No; NR | NR | NR | | Meignan et al., 2018, [19]; retrospective study | 1 | Female | 3.6 | Yes | -RN; 263 | <5; none | 4 | No; NR | 84 | No; 100.0% | | Yadav et al., 2018, [20]; case report | 1 | Female | 1.5 | Yes | -PN; NR | NR; persistent output from drain (28 days) | 28 | No; none | NR | NR | | Blanc et al., 2019, [11]; prospective study | 8 | NR | Mean: 5.0 (range 3.2-10.1) | Yes | -6 RN; mean: 245 (range 120-360)
-2 PN; 120 and 110 | NR; two conversion to open surgery | Median: 4 (range 2-7) | No; median: 6 (range 2-10) | Median: 14.8 (range 4.0-25.0) | No; 87.5% | | Sala et al., 2020, [21]; case report | 1 | Male | 3.0 | Yes | -RN and PN (bilateral procedure); 90 | 50; none | 2 | NR; none | NR | NR |
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Overall features of studies of Wilms’ tumor treated with robotic approach included in this systematic review.
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