Wilms Tumor Protocol Violations: 2018 Pediatric Surgery Practice Gap #3
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Key Takeaways
- Lymph node sampling is mandatory during Wilms tumor nephrectomy; failure to sample automatically upstages the patient.
- Pulmonary metastases do not contraindicate primary nephrectomy and may influence radiation therapy decisions.
- Wilms tumor has dual staging systems: local tumor stage and overall patient stage, both critical for treatment planning.
- Protocol violations in lymph node sampling remain a common practice gap requiring targeted education and quality improvement.
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Join us as we continue our review of the top 10 practice gaps of 2018, first presented at last year's update course by APs practice Development Committee. Number three was Wilms Tumor Protocol violations. So one, we need to be sure that we're taking out lymph nodes when we're take doing the nephrectomy, because that automatically upstages our patients if we're not taking out the nodes. Um, there is a local and systemic staging system that we need to remember, and pulmonary mets do not preclude a primary nephrectomy. Just because you have metastatic disease in the lung, doesn't mean you shouldn't treat the primary with an aphrectomy. Because that changes the whether or not you're going to get radiation therapy as well. So as, as Dr. Erlick would point out, there's kind of a local stage for Wilms Tumor and then there's a patient staging for Wilms Tumor. All right, Ray, that's huge because I know that that's a major violation that is something that hopefully through education, we can start increasing the numbers of people that are doing those node biopsies.