Pediatric Surgery
Wilms Tumor: Audio Chapter
An interactive discussion about Wilms tumor between Todd Ponsky, MD, Avraham Schlager, and Peter Ehrlich, MD.
Dr. Peter Ehrlich is a professor of pediatrics surgery at the University of Michigan C.S. Mott Children’s Hospital who is also a vice chair of surgery and renal tumor section of the children oncology group.
Sections
- Introduction (00:00)
- Clinical case (01:32)
- CT scan findings (03:29)
- Workup before the surgery (04:50)
- Therapeutic approach when there is no metastasis (06:06)
- Management of Wilms tumor that extends beyond the Infra-hepatic cava (09:12)
- Intestinal invasion management (10:15)
- Consequences of upstaging (10:50)
- Therapeutic approach algorithm (12:29)
- Crossing midline tumor (14:55)
- Lung lesion impact on the therapeutic plan (15:37)
- Biopsy technique (17:17)
- Negative biopsy management (18:34)
- Central line type (19:13)
- Wilms tumor staging (19:34)
- Chemotherapy regimen (23:02)
- Management of stage I and II with lung lesion (25:02)
- Need for lung lesion biopsy (27:39)
- Management of lung lesion after nephrectomy (29:02)
- Treatment without biopsy (29:19)
- Differences between COG and SIOP (30:10)
- Abdominal radiation criteria (31:19)
- Impact of spillage (32:25)
- How to approach in case of unclear imaging (33:14)
- Preoperative preparation (34:13)
- Patient position and incision (37:15)
- Does it make a difference to get the artery or vein first? (40:15)
- Do you place metal clip? (40:46)
- Significance of the surgical margins (41:18)
- Frozen section (42:17)
- Can any case treated by surgery alone? (43:29)
- Caval extension management (45:56)
- Effect of chemotherapy on the tumor consistency (48:41)
- Technical steps to remove thrombus (49:25)
- Pathological results (52:29)
- Other types of renal tumors (56:41)
- Bilateral wilms (57:40)
- Role of the biopsy (01:00:28)
- Radiation after the biopsy (01:02:35)
- Closure (01:03:11)