RESUMEN
OBJECTIVE: To compare the technical aspects of Wilms' tumour (WT) surgery in patients with and without pre-operative chemotherapy. DESIGN: Quasi-experimental. PLACE AND DURATION OF STUDY: Military Hospital (MH) and Combined Military Hospital (CMH), Rawalpindi, from January 1999 to December 2004. PATIENTS AND METHODS: Patients of WT, presenting between January 1999 and December 2001, were treated, using the NWTSG protocol, with primary surgery (group I). Between January 2001 and December 2004, WT patients were treated according to SIOP protocol, with pre-operative chemotherapy followed by surgery (group II). Volume reduction with chemotherapy, duration of surgery, rupture of tumour, extent of excision, adherence and damage to surrounding structures, blood loss, complications, stay in hospital and event-free survival (EFS) were compared in the two groups. RESULTS: Out of 22 patients in group I, 19 (86.4%) underwent primary surgery. Of the 23 patients in group II, 21 (91.3%) received pre-operative chemotherapy followed by surgery. Average volume reduction in this group was 54% with chemotherapy. Difference in duration of surgery and blood loss was significantly low in group II (p=0.003 and p < 0.001, respectively). In group I, rupture (6 vs 2), adherence (14 vs 10) and damage to surrounding structures (5 vs 2) were more. Complete macroscopic excision was possible in 90.5% of WT in group II as compared to 73.7% in group I. Immediate postoperative complications and length of hospital stay were similar in both groups. There was no difference in EFS. CONCLUSION: Pre-operative chemotherapy makes it technically easier and safer to operate, without jeopardizing the final outcome.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/cirugía , Terapia Neoadyuvante , Tumor de Wilms/tratamiento farmacológico , Tumor de Wilms/cirugía , Quimioterapia Adyuvante , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Neoplasias Renales/patología , Tiempo de Internación , Masculino , Estadificación de Neoplasias , Pakistán , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Resultado del Tratamiento , Carga Tumoral/efectos de los fármacos , Tumor de Wilms/patologíaRESUMEN
Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) or nesidioblastosis is a rare condition presenting with severe hypoglycemia. Prompt diagnosis and early pancreatectomy can save many of them, in spite of the magnitude of surgery. We present two cases in which near total pancreatectomy was performed with favourable outcome. Both patients are normoglycemic, with one requiring pancreatic enzyme supplements.