Abstract
Introduction Sampling lymph nodes (LNs) is independently associated with decreased recurrence
and improved survival for Wilms tumor (WT). Despite sampling, we noted cases where
a few or no LNs were identified after resection of WT. We hypothesized fewer LNs were
identified when submitted en bloc with the tumor, compared with when submitted separately.
Patients/Materials and Methods We conducted a retrospective chart review from 2003 to 2012 of WT resection cases,
examining the type of LN dissection, the specimens submitted to pathology, number
of LNs evaluated, and complications associated with the procedure.
Results We identified 74 children with WT; 59 of 74 (79.7%) had unilateral disease and 15
of 74 (20.3%) had bilateral disease. With unilateral disease, more LNs were identified
by separate versus en bloc sampling (5.2 ± 0.6 vs. 4.4 ± 1.2 nodes, p = 0.61). Both the methods identified fewer LNs compared with en bloc + separate sampling
(12.5 ± 2.7 nodes, p < 0.001 and p = 0.04, respectively). The majority of children with bilateral disease (10/15, 66.6%)
did not have LN sampling intraoperatively. When submitted separately, 83.3 ± 3.8%
of all LNs were identified in the separate specimen, and two en bloc specimens that
were noted to have adenopathy intraoperatively had no LNs pathologically identified.
Few cases had complications, which did not appear associated with LN sampling.
Conclusions En bloc + separate sampling yields the most LNs during resection of WT. We recommend
using this technique to facilitate the maximum number of LNs evaluated in WT. Low
rates of LN sampling in bilateral disease may indicate decreased regard for sampling
when tumor stage is already known.
Keywords
Wilms tumor - lymph nodes - pediatric oncology
