WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 277

Outcomes of Standardizing Lymph Nodal Sampling for Nephroblastoma

Shahnoor Islam 1, AKM Amirul Morshed 2, Bibekananda Halder 1, Daanish Arefin Biswas 1, Shahanaz Akter 1, Wahid Akater 1, Tajul Islam 1, Mohammed Mahbubul Hoque 3
1 Sir Salimullah Medical College Mitford Hospital
2 Children's Cancer Center, Dr. Azmal Hospital , Mirpur, Dhaka, Bangladesh
3 National Institute Of Laboratory Medicine and Referral Centre

Background: Every cooperative group mandates proper LN sampling during Wilms tumor (WT) surgery. The omission of lymph node sampling is the most frequent protocol deviation in WT surgeries worldwide. We intend to perform systematic station-wise nodal sampling whether affects overall outcomes for WT. This study aimed to assess the feasibility of systematic station-wise LN sampling and how it affects the staging, risk-stratification, treatment, and prognosis of WT.

Method: This prospective type of observational study was conducted at two tertiary care hospital over a period of 3.5 years between December 2021 to June 2025. A total of 39 children (0 to 14 years) with unilateral or bilateral Wilms tumor were included in this study according to International Society of Pediatric Oncology (SIOP) protocol. All these patients underwent a systematic 4-station nodal sampling during Wilms tumor surgery. Those with a history of renal surgery or biopsy of the renal mass, positive 24-hour urinary VMA, and histology-proven non-Wilms tumor after surgery were excluded.

Result: Among the 39 children with Wilms tumor, nine children with Wilms tumor harbored histologically proven positive nodal disease. Total lymph node yield (LNY) was 195, with a median LNY of 5. Four interaortocaval lymph nodes had metastesis in four children with Wilms tumor and 13 lymph nodes were histologically proven positive in five children with wilms tumor. Right-sided tumors had more frequent involvement of interaortocaval nodes and skip disease.

Conclusions: The proposed strategy of systematic station-wise lymph node sampling provides a framwork to lead surgeons in performing lymph node collection. Routinely interaortocaval nodes sampling should be performed and metastasis may skip hilar nodes. It eliminates the unreliability of visual assessments by surgeons due to performance of systematic station-wise lymph nodes sampling.

Keywords: Lymph Node Sampling; Staging, Station-wise, Prognosis, Wilms tumor.

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