Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature

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 diag...

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Main Authors: Simone Sforza, Valeria Emma Palmieri, Maria Rosaria Raspollini, Giandomenico Roviello, Alberto Mantovani, Umberto Basso, Maria Carmen Affinita, Alberto D'Angelo, Lorenzo Antonuzzo, Marco Carini, Andrea Minervini, Lorenzo Masieri
Format: Article
Language:English
Published: Elsevier 2023-04-01
Series:Asian Journal of Urology
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Online Access:http://www.sciencedirect.com/science/article/pii/S2214388222000340
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author Simone Sforza
Valeria Emma Palmieri
Maria Rosaria Raspollini
Giandomenico Roviello
Alberto Mantovani
Umberto Basso
Maria Carmen Affinita
Alberto D'Angelo
Lorenzo Antonuzzo
Marco Carini
Andrea Minervini
Lorenzo Masieri
author_facet Simone Sforza
Valeria Emma Palmieri
Maria Rosaria Raspollini
Giandomenico Roviello
Alberto Mantovani
Umberto Basso
Maria Carmen Affinita
Alberto D'Angelo
Lorenzo Antonuzzo
Marco Carini
Andrea Minervini
Lorenzo Masieri
author_sort Simone Sforza
collection DOAJ
description 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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spelling doaj-art-ae3c61dafd894ae29733aebe7a2ff9ee2025-08-20T03:38:59ZengElsevierAsian Journal of Urology2214-38822023-04-0110212813610.1016/j.ajur.2021.10.004Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literatureSimone Sforza0Valeria Emma Palmieri1Maria Rosaria Raspollini2Giandomenico Roviello3Alberto Mantovani4Umberto Basso5Maria Carmen Affinita6Alberto D'Angelo7Lorenzo Antonuzzo8Marco Carini9Andrea Minervini10Lorenzo Masieri11Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy; Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy; Corresponding author. Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.Clinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, ItalyHistopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, ItalyClinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, ItalyDepartment of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, ItalyMedical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, ItalyHematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, ItalyDepartment of Biology and Biochemistry, University of Bath, Bath, UKClinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, ItalyDepartment of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, ItalyDepartment of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, ItalyDepartment of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy; Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, ItalyObjective: 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.http://www.sciencedirect.com/science/article/pii/S2214388222000340NephroblastomaNephrectomyRenal neoplasmMinimally invasive surgeryRare tumorWilms' tumor
spellingShingle Simone Sforza
Valeria Emma Palmieri
Maria Rosaria Raspollini
Giandomenico Roviello
Alberto Mantovani
Umberto Basso
Maria Carmen Affinita
Alberto D'Angelo
Lorenzo Antonuzzo
Marco Carini
Andrea Minervini
Lorenzo Masieri
Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
Asian Journal of Urology
Nephroblastoma
Nephrectomy
Renal neoplasm
Minimally invasive surgery
Rare tumor
Wilms' tumor
title Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
title_full Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
title_fullStr Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
title_full_unstemmed Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
title_short Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature
title_sort robotic approach with neoadjuvant chemotherapy in adult wilms tumor a feasibility study report and a systematic review of the literature
topic Nephroblastoma
Nephrectomy
Renal neoplasm
Minimally invasive surgery
Rare tumor
Wilms' tumor
url http://www.sciencedirect.com/science/article/pii/S2214388222000340
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