Jamshed Akhtar, Tayyaba Batool, Naima Zamir, Raees Taqvi, Muhammad Ali Sheikh, Rubab Naqvi, Nasir Saleem, Tariq Hussain, Salmna Manzoor, Farhat Mirza.
Surgical management of renal tumors in children.
J Surg Pak Jan ;11(1):6-9.

Purpose: To analyze case records of children with renal tumors. Study Design: Case series. Place & Duration of Study: Surgical Unit B, National Institute of Child Health, Karachi during years 2004 - 2005. Patients & methods: Case records of all patients managed during the study period were reviewed for clinical presentation, investigations and surgical management. National Wilms` Tumor Study. Group (NWTSG) and International Society of Pediatric Oncology (SIOP) protocols were used depending upon stage in cases of Wilms` tumor. Trucut biopsy was done for tissue diagnosis as proposed by UK Children`s Cancer Study Group (UKCCSG). Touch imprints were also made. Surgical procedure was analyzed in terms of ease of dissection, tumor spillage and extent of excision. Results: Twenty-one patients of renal tumors were managed in two years period. Nearly 60% of patients were less than 2 years of age. Majority (n 14) presented with abdominal mass. Few had complaints of abdominal pain. One patient an infant, presented with profuse hematuria. Trucut biopsy was done in 18 cases to have tissue diagnosis. Three patients underwent primary exploration. There were 17 cases of Wilms` tumor and in one case it was suspected on touch imprints. Fourteen patients of Wilms` tumor were given pre operative chemotherapy (SIOP protocol). Twelve of them were in stage III and IV. Nine out of this have undergone nephrectomy. Marked tumor regression in size of tumor was noted. The tumor also became firm. Only one tumor ruptured during excision. In one tumor with horse-shoe kidney, residual tumor left at margins of dissection. Three patients underwent primary nephrectomy. Two of these were in stage I and one in stage HI (NWTSG protocol). Patient in stage III died in immediate post operative period because of hemorrhage. There was one case each of mesoblastic nephroma, cystic nephroma and rhabdoid tumor. In all these nephrectomy was done following trucut biopsy. Patient with rhabdoid tumor received pre operative chemotherapy. This tumor ruptured during surgery and gross spillage occurred. Conclusion: Wilms` tumor was the most common pediatric renal tumor. Most of the patients were younger than the reported age and presented with advanced stage of disease. SIOP protocol found more appropriate in our group of patients.

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