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Long-Term Complications of Children with Wilm's Tumor

Saturday, October 20, 2012: 2:30 PM
Versailles Ballroom (Hilton Riverside)
Beth Rymeski, DO1, Linda Levin, PhD2, Rajaram Nagarajan, MD3, Karen Burns, MD3, Debra Kent, CNP3, Judy Correll, CNP3 and Roshni Dasgupta, MD, MPH4, (1)Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, (3)Department of Hematology and Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (4)Pediatric General and Thoracic Surgery, Cincinnati Childrens Hospital, Cincinnati, OH

Purpose To describe long-term complications experienced by children who had surgery for Wilm’s tumor

Methods Retrospective review of medical records of patients followed in our long-term survivor clinic (>5 years post-treatment). All patients who had surgery and survived 5 years were analyzed. Fisher’s exact tests were performed to test associations between repeat laparotomy, radiation treatments, and primary surgical procedure.

Results 72 patients were identified in our database as >5 year survivors of Wilm's tumor. The mean age at diagnosis was 3.1 yrs (SD +/- 2.4 yrs) with a mean follow-up of 18.9 years off treatment (SD +/- 9.3 yrs, range 5.5-43.8 yrs). 67 of the patients underwent complete nephrectomy (93%) as primary surgical therapy, 2 had partial nephrectomy, and 2 had complete nephrectomy and contralateral partial nephrectomy. Stage of disease at presentation was 1 in 20 patients (29%), 2 in 18 patients (26%), 3 in 13 patients (19%), 4 in 10 patients (14%) and  8 patients had bilateral disease (12%).  All patients received at least one chemotherapeutic drug and 33 patients (46%) had at least one course of radiation treatment. 12 patients (16.7%) had at least one repeat laparotomy from 1 month to 20 years after the initial surgery (median 7.5 months). Repeat laparotomy was performed for bowel obstruction in 8 patients and recurrent or bilateral disease in 4 patients. Risk of undergoing repeat laparotomy was not associated with radiation exposure except at the highest quartile of total radiation dose (>3000cGy). One patient who received chest radiation developed a secondary malignancy, a chest wall osteosarcoma 18 years after initial surgery. 6/72 (8.3%) patients had renal complications: 5 developed chronic kidney disease and 1 patient required renal transplantation. Scoliosis was identified in 7 patients who received radiation (mean dose 2260 cGy) versus 2 patients who did not have radiation (RR 4.1). Other complications observed in the patient cohort included hypertension in 7 patients and chronic pain in 7 patients.

Conclusion This study provides long-term survivor data on complications of patients that have undergone resection for Wilm’s tumor. The rate of repeat laparotomy for bowel obstruction is significantly higher than literature norms (11% vs 4.5%) and appears to occur in the early post-operative period. Renal complications including chronic kidney disease and hypertension are common. These patients mandate long-term multi-disciplinary clinic follow up to mitigate these risks.