WOFAPS 2025 8th World Congress of Pediatric Surgery

Hela Oueslati, Yasmine Houas, Fatma Thamri, Senda Houidi, Yosra Kerkeni, Sondes Sahli, Riadh Jouini, Said Jlidi

Department of Pediatric Surgery, Children’s Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

Introduction:

Wilms tumor, or nephroblastoma, is the most common malignant renal tumor in children. Thanks to therapeutic advances, survival rates now exceed 90%. However, vascular thrombosis—seen in approximately 25–35% of cases—poses significant challenges in diagnosis and treatment. This study reviews our experience with nephroblastoma cases complicated by vascular thrombus, highlighting clinical characteristics, therapeutic approaches based on thrombus extent, and outcomes.

Methods:

We conducted a retrospective review over eight years (2015–2022) at the Pediatric Surgery Department of the Children's Hospital. The study included 12 children (aged 0–14 years) diagnosed with nephroblastoma and intravascular thrombosis. Data collected covered demographic, clinical, radiological, pathological, treatment, and follow-up details.

Results:

These 12 patients represented 24% of all nephroblastoma cases treated during the study period (n=50), with a median age of 5 years and 2 months. All had tumor extension into at least the renal vein, while 33% showed thrombus progression into the inferior vena cava. Neoadjuvant chemotherapy led to tumor shrinkage in 90% and thrombus regression in 67% of cases. Surgical management involved thrombectomy in 75% of patients, followed by adjuvant chemotherapy in all and radiotherapy in 42%. After a mean follow-up of 6 years and 3 months, the overall survival rate was 100%, despite one recurrence with local and metastatic disease.

Conclusion:

Nephroblastoma with vascular thrombosis demands an individualized, multidisciplinary strategy. Tailoring treatment to the thrombus extent—with coordinated chemotherapy, surgical intervention, and radiotherapy—can lead to excellent oncologic outcomes. Our findings emphasize the importance of integrated care in managing these complex cases.