Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus
Objective: The objective of the study was to highlight the rarity of Wilms tumor with metastatic thrombus in inferior vena cava and right atrium, emphasize the multi-disciplinary approach, meticulous surgical techniques, associated technical challenges, and the outcome. Methods: This study was condu...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-07-01
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| Series: | Journal of Pediatric Surgery Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S294971162500022X |
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| author | Nabila Talat Muhammad Usama Aziz Imran Hashim Farrukh Mahmood Sattar Muhammad Bilal Mirza Wajeeh Ur Rehman Sajid Iqbal Nayyar Muhammad Saleem Warda Tahir |
| author_facet | Nabila Talat Muhammad Usama Aziz Imran Hashim Farrukh Mahmood Sattar Muhammad Bilal Mirza Wajeeh Ur Rehman Sajid Iqbal Nayyar Muhammad Saleem Warda Tahir |
| author_sort | Nabila Talat |
| collection | DOAJ |
| description | Objective: The objective of the study was to highlight the rarity of Wilms tumor with metastatic thrombus in inferior vena cava and right atrium, emphasize the multi-disciplinary approach, meticulous surgical techniques, associated technical challenges, and the outcome. Methods: This study was conducted in the Department of Pediatric Surgery, The University of Child Health Sciences, and The Children’s Hospital Lahore, Pakistan. Out of total 183 patients with Wilms tumor presented, 17 patients showed Wilms tumor with vascular extension. A review of their data regarding demographic details, clinical presentation, radiological findings, operative management, and post-operative course was done. Results: All 17 patients of Wilms tumor with IVC thrombus were discussed in the Institutional Tumor Board meeting and after receiving neoadjuvant chemotherapy. 16 patients underwent surgical resection. One patient with distant metastasis expired before surgery. Non-anatomical hepatic resection of segment VIII has to be done in one patient. Right atrial exploration was done in 2 patients in a joint venture with a cardiac surgery team. Tragically, 2 patients passed away postoperatively. One patient had recurrent tumor thrombus for which he had extensive chemotherapy followed by thrombectomy. The remaining 13 patients are doing fine on follow-up with the longest follow-up of 5 years. Conclusion: Our small number of patients describe the rarity of Wilms tumor with IVC thrombus. Neoadjuvant chemotherapy has gained success in the regression of thrombus which is followed by surgical excision. IVC Thrombectomy after taking proximal and distal vascular control is quite challenging for surgeons not frequently dealing with these cases. Cardiac surgery aid is also required in cases of intra-atrial extension of thrombus. Multidisciplinary management is essential for improved outcomes. |
| format | Article |
| id | doaj-art-33eb5c4a85194cc49b236000f78bcf7c |
| institution | Kabale University |
| issn | 2949-7116 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj-art-33eb5c4a85194cc49b236000f78bcf7c2025-08-20T03:31:34ZengElsevierJournal of Pediatric Surgery Open2949-71162025-07-011110021310.1016/j.yjpso.2025.100213Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombusNabila Talat0Muhammad Usama Aziz1Imran Hashim2Farrukh Mahmood Sattar3Muhammad Bilal Mirza4Wajeeh Ur Rehman5Sajid Iqbal Nayyar6Muhammad Saleem7Warda Tahir8Department of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanDepartment of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, Pakistan; Corresponding author at: Senior Registrar of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, Pakistan.Department of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanDepartment of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanDepartment of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanDepartment of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanDepartment of Pediatric Surgery, The University of Child Health Sciences and The Children’s Hospital, Lahore, PakistanThe College of Physicians and Surgeons PakistanDepartment of Pediatric Surgery, Gujranwala Medical College, Gujranwala, PakistanObjective: The objective of the study was to highlight the rarity of Wilms tumor with metastatic thrombus in inferior vena cava and right atrium, emphasize the multi-disciplinary approach, meticulous surgical techniques, associated technical challenges, and the outcome. Methods: This study was conducted in the Department of Pediatric Surgery, The University of Child Health Sciences, and The Children’s Hospital Lahore, Pakistan. Out of total 183 patients with Wilms tumor presented, 17 patients showed Wilms tumor with vascular extension. A review of their data regarding demographic details, clinical presentation, radiological findings, operative management, and post-operative course was done. Results: All 17 patients of Wilms tumor with IVC thrombus were discussed in the Institutional Tumor Board meeting and after receiving neoadjuvant chemotherapy. 16 patients underwent surgical resection. One patient with distant metastasis expired before surgery. Non-anatomical hepatic resection of segment VIII has to be done in one patient. Right atrial exploration was done in 2 patients in a joint venture with a cardiac surgery team. Tragically, 2 patients passed away postoperatively. One patient had recurrent tumor thrombus for which he had extensive chemotherapy followed by thrombectomy. The remaining 13 patients are doing fine on follow-up with the longest follow-up of 5 years. Conclusion: Our small number of patients describe the rarity of Wilms tumor with IVC thrombus. Neoadjuvant chemotherapy has gained success in the regression of thrombus which is followed by surgical excision. IVC Thrombectomy after taking proximal and distal vascular control is quite challenging for surgeons not frequently dealing with these cases. Cardiac surgery aid is also required in cases of intra-atrial extension of thrombus. Multidisciplinary management is essential for improved outcomes.http://www.sciencedirect.com/science/article/pii/S294971162500022XWilms tumorsTumor thrombusInferior vena cavaAtriumNephrectomyThrombectomy |
| spellingShingle | Nabila Talat Muhammad Usama Aziz Imran Hashim Farrukh Mahmood Sattar Muhammad Bilal Mirza Wajeeh Ur Rehman Sajid Iqbal Nayyar Muhammad Saleem Warda Tahir Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus Journal of Pediatric Surgery Open Wilms tumors Tumor thrombus Inferior vena cava Atrium Nephrectomy Thrombectomy |
| title | Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus |
| title_full | Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus |
| title_fullStr | Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus |
| title_full_unstemmed | Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus |
| title_short | Navigating complexities: Confronting intriguing challenges in Wilms tumor with inferior vena cava (IVC) and atrial thrombus |
| title_sort | navigating complexities confronting intriguing challenges in wilms tumor with inferior vena cava ivc and atrial thrombus |
| topic | Wilms tumors Tumor thrombus Inferior vena cava Atrium Nephrectomy Thrombectomy |
| url | http://www.sciencedirect.com/science/article/pii/S294971162500022X |
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