Exploration Of Adrenal Retention In The Treatment Of Pediatric Nephroblastoma

Objective: Nephroblastoma(Wilms' tumor)is a common retroperitoneal tumor in children,with an incidence of about 0.8 per 100 000,with the majority occurring between the ages of 1 and 3.Over the past 30 years,with the multi-disciplinary comprehensive treatment is unceasingly thorough,the patient's overall 5 years survival rate by 25% to nearly 90%.With the improvement of overall survival rate,modern medicine began to focus on precise resection and the survival status of children after treatment.Therefore,by analyzing the clinical data of the children with renal blastoma treated in this clinical center,this paper summarizes whether there is any difference in the outcome of the disease caused by the preservation and removal of adrenal gland in the surgical treatment of renal blastoma.Therefore,it is necessary to remove the same adrenal gland during radical tumor resection..Methods: Statistics and analysis of renal blastoma in our center from 2003 to 2018.The statistical data included the basic situation of the children,tumor characteristics(shape and location),intraoperative situation,histopathological classification,clinical stage,and follow-up results,which include postoperative development,renal function,rate of no event progression within five years,levels of corticosteroids and glucocorticoids,and complete radiological renal chart examination in some children.Results: A total of 147 children with nephroblastoma were collected,including 75 males and 72 females.The average age of diagnosis is 42±27 months;The mean follow-up time was 93±8.6months.A total of 89 children had their ipsilateral adrenal glands removed at the same time during the first-stage operation,including 35(74.47%)of stage III children and 17(70.83%)of stage IV children.Postoperative pathological examination showed tumor infiltration of adrenal glands in 2 children(1.36%).All the children with positive pathological examination were in clinical stage III,and there was no tumor rupture in the 2 children during the operation.A total of 33 children died during the follow-up,including 2 in phase I,8 in phase II,14 in phase III,and 9 in phase IV.No statistically significant association was found between excision and retention of adrenal glands during radical nephrectomy(p=0.997).Conclusions: Retention of adrenal glands have no effect on overall survival rate at any clinical stage.The adrenal gland should be preserved when the boundary between tumor and ipsilateral adrenal gland is clear.If the tumor is closely related to the ipsilateral adrenal gland,or if intraoperative rupture occurs,it may be excised together.