Background/Objectives: In bilateral nephroblastoma and high-risk neuroblastoma in children with extensive tumor involvement of the renal vessels or pedicle, complete tumor resection with preservation of healthy renal tissue is not feasible with in situ nephron-sparing surgery or vascular replacement. The aim of this study was to present our experience with ante situ tumor resection and renal autotransplantation (RATX) in these children. Methods: A retrospective study of children with bilateral nephroblastoma and high-risk neuroblastoma who underwent tumor resection and RATX at an international referral center for pediatric surgical oncology between 2006 and 2024 was performed. RATX was performed by transection of renal vessels, ante situ mobilization, and perfusion of the kidney with Bretschneider’s solution. Tumor resection was performed on a bloodless kidney under hypothermia. Results: Ante situ tumor resection and RATX were performed at a median age of 36 months (range 13–62) in 4 children with bilateral nephroblastoma and 4 children with high-risk neuroblastoma. Complete tumor resection was achieved in all patients. One patient with neuroblastoma died of sepsis after 14 days. The 7 surviving patients showed no evidence of disease and normal to slightly decreased glomerulofiltration rates at a median follow-up of 20 months (range 3–155). Limitations include the retrospective design, small sample size, and heterogeneity of the study population due to very rare indication. Conclusions: Ante situ tumor resection and RATX is a feasible surgical approach for children with multifocal bilateral nephroblastoma or high-risk neuroblastoma who are ineligible for in situ nephron-sparing surgery or vascular reconstruction.
背景/目的：对于双侧肾母细胞瘤及高危神经母细胞瘤患儿，若肿瘤广泛累及肾血管或肾蒂，原位保留肾单位手术或血管置换术无法在保留健康肾组织的前提下实现肿瘤完全切除。本研究旨在总结我们在此类患儿中采用离体前位肿瘤切除联合肾自体移植术的经验。方法：回顾性分析2006年至2024年间在一家国际儿科肿瘤外科转诊中心接受肿瘤切除联合肾自体移植术的双侧肾母细胞瘤及高危神经母细胞瘤患儿资料。肾自体移植术通过离断肾血管、前位游离肾脏并以Bretschneider液灌注肾脏实施。肿瘤切除在低温无血状态下进行。结果：共8例患儿接受离体前位肿瘤切除联合肾自体移植术，其中双侧肾母细胞瘤与高危神经母细胞瘤各4例，中位手术年龄36个月（范围13-62个月）。所有患者均实现肿瘤完全切除。1例神经母细胞瘤患儿术后14天因脓毒症死亡。存活的7例患儿中位随访20个月（范围3-155个月）期间未见疾病证据，肾小球滤过率正常或轻度下降。研究局限性包括回顾性设计、样本量小以及因适应症罕见导致的研究人群异质性。结论：对于不适合行原位保留肾单位手术或血管重建的多灶性双侧肾母细胞瘤或高危神经母细胞瘤患儿，离体前位肿瘤切除联合肾自体移植术是一种可行的手术方案。
肿瘤(癌症)患者之家