SMALL-BOWEL OBSTRUCTION AFTER NEPHRECTOMY FOR WILMS-TUMOR - A REPORT OF THE NATIONAL WILMS-TUMOR STUDY-3

Objective This study was undertaken to define the incidence and etiolo gy of small bowel obstruction (SBO) after nephrectomy for Wilms' tumor . Summary Background Data Intestinal obstruction is one of the most co mmon postoperative complications after nephrectomy for nephroblastoma. However, few reports have evaluated risk factors for SBO. Radiation t herapy has been associated with increased intestinal complications in some adult cancer patients, but this has not been reported in children undergoing cancer surgery. Methods Postoperative SBO occurred in 131 of 1,910 children (6.9%) enrolled in the Third National Wilms' Tumor S tudy (NWTS). The etiology of the SBO was bowel adhesions in 104 cases, intussusception in 17, internal hernia in 2, and uncertain in the rem aining 8 children. Results The factors found to be of potential import ance in explaining the incidence of SBO were higher local tumor stage, extrarenal intravascular involvement, and en bloc resection of other organs at the time of nephrectomy. The incidence of postoperative SBO was not increased in children who received postoperative radiation the rapy. Conclusions Although the overall incidence of SBO after nephrect omy for Wilms' tumor is comparable to that after other major abdominal operations in children, it can be responsible for significant morbidi ty. There were 4 children among the 1,91 0 patients with infectious co mplications of SBO, which contributed to their death.