Introducing new dimensions in pediatric oncologic surgery

Abstract

In the Netherlands, approximately 30 children per year are diagnosed with kidney cancer. For most patients, the entire kidney along with the tumor is surgically removed (Total Nephrectomy, TN). For the other patients, the tumor is removed from the kidney (Nephron-Sparing Surgery, NSS). NSS is performed on children with bilateral tumors or children with specific overgrowth syndromes. NSS is only performed under very strict conditions in children who have a unilateral tumor and no overgrowth syndromes. This is because NSS is very challenging, and the tumor is not completely removed in 13.3% to 36.4% of the surgeries. Despite this, NSS is expected to have benefits compared to TN. For instance, the likelihood of chronic kidney disease later in life could be reduced. In this dissertation, we conducted research to make NSS more feasible for this specific patient group. First, we examined which patients in this group could be eligible for NSS surgically. There are oncological guidelines for this decision, but no surgical guidelines exist yet. Therefore, we conducted an international Delphi consensus study among experts in the field of NSS. The other part of our study focused on technical improvements in NSS. For this, we developed and implemented 3D technology in our surgical care. Using 3D models, a surgeon can prepare for an operation and gain a better understanding of the anatomical relationships of a patient's tumor. Additionally, we worked on surgical navigation using a holographic 3D model. The 3D model is projected holographically into a patient. This should make it easier to locate the tumor and improve the surgeon's depth perception. Following these two research directions, I looked at the impact of 3D models on surgical outcomes for patients who underwent NSS at the Princess Máxima Center. We observed a trend in decreased unexpected incomplete tumor removal in surgeries where the surgeon used a 3D model during preparation. In summary, we have taken steps to improve surgical decision-making and techniques for children with kidney tumors where nephron-sparing surgery could be possible.