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Introduction: Wilms tumor is the most common renal malignancy in children. The occurrence of Wilms tumor with various congenital genitourinary anomalies has been reported, particularly in horseshoe kidneys, hypospadias, disorder of sexual development, and double collecting system. However, Wilms tumor with crossed renal ectopia is a rare finding. Case Description: We are reporting a case report of Wilms tumor in a 3-year-old girl who presented with a huge left flank mass with cross-fused renal ectopia. After the initial workup and triphasic computed tomography scan of the chest, abdomen, and pelvis for confirmation of diagnosis and metastasis, the patient underwent image-guided tissue biopsy, followed by neoadjuvant chemotherapy, left radical nephrectomy with separation of fused right ectopic renal moiety, and adjuvant chemoradiation. Practical Implication: This report shows an association of Wilms tumor with cross-fused renal ectopia, a rare combination. Unusual findings on imaging with unilateral flank mass should be considered as part of the differential diagnosis for this rare finding. Adjuvant chemotherapy and modern imaging helped delineate the anatomy and ease the surgery for safe resection, improving the overall outcome.
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Introduction: The recommended treatment method for bone sarcoma is wide local excision and reconstruction to preserve limb function. Established methods of reconstruction are mega prosthesis or biological reconstruction. This study aimed to determine the complications and functional outcomes associated with limb salvage surgery using liquid nitrogen-treated bone. Materials and Methods: We retrospectively observed the short-term outcome of limb salvage surgeries where liquid nitrogen bone was used for reconstruction. A total of 15 patients underwent reconstruction with liquid nitrogen auto graft from January 2018 to December 2020. We used the free freezing method of liquid nitrogen treatment after wide local excision of sarcoma. We observed short-term outcomes after liquid nitrogen-treated bone reconstruction in limb salvage surgery. Survival of the auto grafts was recorded using the Kaplan-Meier method with a 95% confidence interval. Results: The mean follow-up was 19.83 ± 4.5 months. The mean musculoskeletal tumor society score was 62.4 ± 7.9%, while the average Toronto extremity score was 59.6 ± 5.7%. Three patients died during the study duration due to visceral metastasis. Skin necrosis and wound breakdown were major complications in 9 (60%) patients. Deep infection was observed in 4 (26.7%). Similarly, 4 (26.7%) patients had non-union at either the proximal or distal osteotomy site, while the average time of bone union in the rest of the patients was 6.3 ± 1.7 months. A total of 6 (40%) patients underwent reoperation after liquid nitrogen treatment, either due to infection or non-union at the osteotomy site. Recurrence was observed in 3 (20%) of patients. Conclusion: We observed a high complication rate with liquid nitrogen-treated autograft reconstruction. Vascularized fibula with liquid nitrogen-treated autograft or endoprosthesis should be encouraged.
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Introduction Extremity soft-tissue sarcomas are uncommon malignancies of mesenchymal tissue, it accounts for <1 % of cancers and has a high recurrence rate with positive resection margins and unplanned excision. This study aims to determine the influence of unplanned excision and resection margins on local recurrence, metastasis, and overall survival in soft tissue sarcoma of the extremities. Methods A retrospective review was conducted from January 2005 to December 2015 on all the patients with soft tissue sarcoma of the extremities. Age, sex, histopathology, site, tumor grade, biopsy type, recurrence, metastasis, and end outcome were analyzed. Kaplan-Meir curves were used for Survival analysis, and log-rank or the Cox proportional-hazards regression model was used for Significance analysis. The data were entered into SPSS version 20, and Statistical significance was set at a p-value ≤0.05. Results One hundred forty-five patients with soft tissue sarcoma of extremities were managed with a mean follow-up of 76.3+/-6.7 months. Undifferentiated pleomorphic sarcoma 47 (32.4%) was the most common pathology found in this cohort, followed by Synovial sarcoma 34 (23.4%) and Liposarcoma 19 (13.1%). The most common site of occurrence was lower extremity 102 (70.3%). All the patients had residual disease after unplanned excisions; 107 underwent R0 resection, while 38 underwent R1 resection. Five-year overall survival was 70.2 & 71.1 % for R1 & R0 resections, respectively, and 71.3% for excisional and 74.2% for incisional biopsy. The tumor grade significantly influences overall survival, while other variables were not found to affect Recurrence-free survival and metastasis-free survival. Conclusion The data indicates that the high-grade tumor has a negative influence on overall survival, while resection margins width and unplanned excision have no significant effect on local recurrence, Metastasis free survival, and overall survival; however, before excision, adequate planning and awareness among general surgeons is necessary to improve the surgical morbidity and financial burden over the health care facilities.
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Introduction Wilms tumor is the most common (90%) renal tumor in children. With the recent advances survival rate approaches 90%. This study was designed to identify factors associated with early recovery and hospital discharge, a step forward in the future development of early recovery after surgery (ERAS) protocol in children. Methods A retrospective cohort study was conducted from May 2020 to February 2022 among children up to the age of 18-years with a diagnosis of primary malignant renal tumors who underwent radical nephrectomy. Baseline parameters (preoperative), intraoperative, and postoperative components were analyzed. A univariable and multivariable logistic regression model was used to identify the factors leading to early discharge. The data were entered into SPSS version 20 (IBM Inc., Armonk, USA), and a p-value ≤0.05 was statistically significant. Results A total of 44 patients with malignant renal tumors were managed with a mean age at diagnosis of 4.06±3.00 years. Twenty-six (59.1%) were male and 18 (40.9%) were female. All the patients received neoadjuvant chemotherapy. Wilms tumor was the most common pathology found in 41 (93.1%) patients; 19 (43.0 %) had stage I, 21 (47.7%) stage II, and four (9.1%) stage III disease. Thirty-four (77.3%) patients had a nasogastric tube placed postoperatively. Median blood loss (BL) was 40 ml (range: 5-250), and the median operative time was two hours (range: 1-4). The median postoperative day to mobilization was one day (range: 1-3), to clear liquids was two days (range: 1-3), and advanced to regular diet was three days (range: 2-5). The median postoperative day of discharge (from surgery to discharge) was four days (range: 2-7), with 31 (70.5%) patients discharged early. Conclusion Our findings indicate that early removal of tube, mobilization, and re-feedings were significantly associated with the early hospital discharge, while the other analyzed factors were not statistically significant. Furthermore, our findings are important in the future development and implementation of ERAS protocol in pediatric oncological resections.