Management of Wilms' tumor with intracardiac extension

We review our experience and the literature in treating 4 patients with Wil ms' tumor (WT) with intracardiac extension among 92 patients with this neop lasm. Cardiopulmonary bypass with circulatory arrest and profound hypotherm ia was used. There were 3 boys (3 years, 4 years 5 months, and 15 years) an d 1 girl (6 years). The follow-up periods were 8 months, 3 years, 2 years 6 months, and 15 years, respectively. We had no surgical complications and c onclude that the preoperative diagnosis is extremely important. These patie nts must be transferred to institutions where concomitant cardiac procedure s can be performed. In treating patients with WT, Doppler ultrasound must b e used preoperatively in all cases, not only those in which clinical and ra diologic signs of intravascular involvement are found. We propose that preo perative chemotherapy should be used, as it shrinks the thrombus and causes desirable adherence of the thrombus to the venous wall, reducing the proba bility of thromboembolism during the surgical procedure. We also find this method safer than in our 1st case, where neither cardiac arrest nor hypothe rmia was used. Our results agree with the literature that intracardiac exte nsion of WT does not worsen its prognosis when a rational surgical approach is used.