Önder ÖZDEN, Ender FAKIOĞLU, Murat ALKAN, Hilmi Serdar İSKİT, Recep TUNCER, Hasan OKUR, Serhan KÜPELİ, Şeyda ERDOĞAN, Süreyya SOYUPAK, Ünal ZORLUDEMİR

Wilms Tümöründe Beş Yıllık Cerrahi Deneyim

Amaç: Wilms tümörü tanısı konulan ve cerrahi tedavi uygulanan hastaların tedavi sonuçlarını değerlendirmek. Materyal ve Metod: 2008-2012 tarihleri arasında Wilms tümörü tanısıyla izlenen ve cerrahi tedavi uygulanan hastaların dosyaları retrospektif olarak incelendi. Cinsiyet, yaş, ek anomali birlikteliği, hastalığın evresi, ameliyat öncesi biyopsi alınıp alınmadığı, ameliyatın kemoterapi öncesi veya sonrası yapıldığı, histopatolojik özellikler, komplikasyonlar, ameliyat sırasında tümör rüptürü olup olmadığı ve sağkalım oranları irdelendi. Bulgular: Wilms tümörü tanısı ile ameliyat edilen toplam 31 hasta için Erkek/Kız oranı 0,7, ortalama yaş 3,1 yıldı (6 ay-11 yaş). Beş hastada konjenital ek anomali vardı. Tümör 13 hastada evre I, altışar hastada evre II ve III, üçer hastada evre IV ve V idi. Hastaların 11"ine ilk girişim olarak nefroüreterektomi, 11"ine biyopsi alınmadan neoadjuvan kemoterapi verildikten sonra nefroüreterektomi yapıldı. Sekiz hastada biyopsi ile tanı konuldu, kemoterapi verildi ve sonra nefroüreterektomi yapıldı. Bir hastada biyopsi alındıktan sonra tedavi verilmeden nefroüreterektomi uygulandı. Ameliyat sırasında iki hastada tümör rüptürü görüldü. Üç hastada cerrahi sınır pozitifti. Hastaların %68,9"unun histopatolojik tanısı trifazik Wilms tümörüydü. İki hastada postoperatif komplikasyon (menenjit ve pnömoni) gelişti. Üç hastada yineleme oldu. Ameliyat sonrası takip süresi ortalama 2,9 yıldı (1-6 yıl). Mortalite görülmedi. Sonuç: Cerrahi deneyimin artması, radyolojik görüntüleme tekniklerinin gelişmesi ve kemoterapi ile kitlelerin küçülmesi Wilms tümöründe tedaviyi kolaylaştırmakta ve sağkalım oranını arttırmaktadır.

Anahtar Kelimeler:

Wilms tümörü, çocuk, cerrahi tedavi

Five Years Experience In Surgical Treatment of Wilms Tumor

Purpose: To evaluate the treatment results of the patients operated with diagnosis of Wilms" tumor . Materials and Methods: The records of patients operated for Wilms" tumor in 2008-2012 were evaluated retrospectively. Sex, age, additional anomalies, tumor stages, preoperative biopsy and chemotherapy history, histopathological features, preoperative tumor rupture, complications and survival rates were reviewed Results: Male/Female ratio of total 31 patients operated due to Wilms" tumor was 0.7 and mean age was 3.1 years (6 months - 11 years). Five of the patients had additional congenital anomalies. Thirteen patients had stage I tumor, 6 had stage II, 6 had stage III, 3 had stage IV and 3 had stage V. Eleven of the patients underwent immediate nephrouretectomy as a first intervention, eleven patients went through delayed nephrouretectomy after neoadjuvant chemotherapy without biopsy, eight patients were diagnosed via biopsy and underwent delayed nephrectomy after neoadjuvant chemotherapy. One of the patients went through immediate nephrouretectomy with biopsy. The histopathologic examination of 68,9% of the patients reported as triphasic Wilms" tumor. Three patients had positive surgical margins. Peroperative spillage was experienced in two patients. Two patients had postoperative complications (pneumonia and meningitis) and three patients had tumor relapses. Mean follow-up period was 2.9 years (1-6 years) and no mortality was observed. Conclusion: Increased surgical experience, development of radiologic imaging techniques and chemotherapeutic reduction of tumor size make treatment of Wilms" tumor easier and increase the survival rate.

Keywords:

Wilms\' tumor, children, surgical treatment,

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Yazışma Adresi / Address for Correspondence: Dr. Önder Özen Çukurova Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalı Email: onder24@hotmail.com G eliş tarihi/Received on: 22.01.2014
Kabul tarihi/Accepted on:24.02.2014