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Fluorescence-guided lymph node sampling is feasible during up-front or delayed nephrectomy for Wilms tumor

  • Abdelhafeez H. Abdelhafeez
    Correspondence
    Corresponding author at: Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA.
    Affiliations
    Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA

    Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA
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  • Andrew M. Davidoff
    Affiliations
    Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA

    Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA
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  • Andrew J. Murphy
    Affiliations
    Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA

    Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA
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  • G Suren Arul
    Affiliations
    Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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  • Max J. Pachl
    Affiliations
    Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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      Abstract

      Background

      Lymph node sampling is critical to surgical staging in Wilms tumor; failure to sample lymph nodes is associated with under-staging and an increased incidence of local relapse. However, no standard lymphatic mapping method is currently being utilized for Wilms tumor to aid identification of regional draining lymph nodes. Herein, we describe the use of fluorescence-guided lymphatic mapping for Wilms tumor.

      Materials and methods

      Two tertiary level referral centers independently began indocyanine green (ICG) fluorescence-guided nodal mapping. In one center, this was achieved with ipsilateral intra-parenchymal (IP) injection of ICG during minimally invasive tumor nephrectomy (MIN) following neoadjuvant chemotherapy and in the other, with Peri‑Hilar (PH) injection during upfront, open tumor nephrectomy (ON). Successful lymph node mapping was defined as the presence of fluorescence signal in draining lymph nodes.

      Results

      Eight patients (median age of 2.5 years) underwent fluorescence-guided lymphatic mapping (four IP and four PH injection). Lymphatic mapping was successful in seven patients (88%) including each of the four patients with IP injection.

      Conclusions

      Fluorescence-guided lymphatic mapping of Wilms tumor drainage is feasible by both IP injection and PH injection techniques. However, whether lymphatic mapping improves the precision of lymph node sampling is unknown and should be studied in prospective trials.

      Keywords

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