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Aktuelle chirurgische Behandlungskonzepte beim Wilms-Tumor

Ein Update

Surgical concepts in the treatment of Wilms tumor

An update

  • Urologische Forschung
  • Published:
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Zusammenfassung

Hintergrund

Die multimodalen Behandlungskonzepte beim Wilms-Tumor haben in den letzten 50 Jahren zu einer eindrucksvollen Verbesserung der stadienunabhängigen Überlebensraten auf > 90 % geführt. Die aktuellen Herausforderungen sind v. a. die noch unzureichenden Therapieergebnisse von Kindern mit Hochrisikotumoren aber auch Tumorrezidiven.

Material und Methode

Das Manuskript stellt die aktuellen chirurgischen Konzepte als eine essentielle Therapiesäule der Behandlung von Wilms-Tumoren dar. Grundlage für den Reviewartikel bildet eine selektive Literaturrecherche mit Fokussierung auf die letzten 5 Jahre.

Ergebnisse

In der Behandlung des unilateralen Wilms-Tumors werden mit der nierenerhaltenden Tumorresektion analoge Behandlungsergebnisse wie mit der konventionellen Tumornephrektomie erzielt. Das chirurgische Panel der in Europa basierten „International Society of Pediatric Oncology“ (SIOP) hat eine neue Nomenklatur für die nierenerhaltende Tumorresektion erstellt, um damit einen prospektiven Datenvergleich zu ermöglichen. Die laparoskopische Tumornephrektomie stellt einen alternativen Zugangsweg mit gleichem Outcome wie beim offenen Vorgehen dar. Bei bilateralen Tumoren ist die nierenerhaltende Chirurgie der Goldstandard. Die komplette chirurgische Resektion von Lungen- und Lebermetastasen hat einen signifikanten Einfluss auf das Überleben der Kinder.

Schlussfolgerungen

Mit der Neuauflage von nationalen und internationalen Therapieoptimierungsprotokollen sollten Guidelines für die nierenerhaltende Tumorresektion und die minimal-invasive Tumornephrektomie etabliert werden. Die Risikostratifizierung für Kinder gilt es individueller, mit dem Ziel einer Reduktion von Spätfolgen bei mindestens analogem Outcome zu gestalten. Die unbefriedigenden Überlebensraten bei Tumorrezidiven erfordern aufgrund der geringen Fallzahlen in den Einzelstudien eine internationale Kollaboration.

Abstract

Background

Treatment results of Wilms tumors have been impressively improved over the past 50 years resulting in a stage-independent overall survival of greater than 90 %. However, unsatisfying treatment results still remain in children with high-risk tumors and tumor relapses.

Materials and methods

This review highlights the current concepts of Wilms tumor surgery as a cornerstone of the treatment strategy for this malignancy. A selective literature review focusing on the past 5 years served as the basis for this article.

Results

Nephron-sparing surgery is associated with an analogue outcome compared to tumor nephrectomy in unilateral Wilms tumors. The surgical panel of the International Society of Pediatric Oncology (SIOP) group has recently introduced a novel nomenclature for organ-preserving resection procedures in order to facilitate a prospective comparison of data. The minimally invasive approach represents an alternative technique with adequate outcome. In bilateral disease, nephron-sparing procedures are gold standard. Complete resection of lung and liver metastases has a significant impact on patients’ survival.

Conclusions

Surgical guidelines for nephron-sparing surgery and minimally invasive tumor nephrectomy need to be established and implemented within newly formulated treatment protocols of the different national and international treatment trials. Risk stratification of patients needs to be more individualized with the aim of reducing late effects while at least maintaining the same survival rates. The unsatisfying treatment results of tumor relapses—associated with low patient numbers within the different trials—emphasize the need for international collaboration.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Fuchs gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 03, 72076, Tübingen, Deutschland

    J. Fuchs

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Fuchs, J. Aktuelle chirurgische Behandlungskonzepte beim Wilms-Tumor. Urologe 54, 1784–1791 (2015). https://doi.org/10.1007/s00120-015-4014-x

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