UPPER GESTIBLE TRACT ONCOLOGICAL SURGERY IN CHILDREN: CHALLENGES AND OUTCOMES IN THE TREATMENT OF WILMS' TUMOR WITH HEPATIC EXTENSION – A SYSTEMATIC REVIEW

Abstract

Introduction: Wilms' tumor can extend to the liver and/or hepatic caval system, posing challenges of resectability, vascular control, and parenchymal preservation. In specialized centers, the combination of neoadjuvant chemotherapy with hepatic/anatomical resections and caval thrombectomy has increased the chances of R0 resection with acceptable morbidity (DAVIDOFF, 2018; PRITCHARD-JONES et al., 2017).
Objective: To evaluate the outcomes and main surgical challenges of the upper digestive tract (hepatectomies, non-anatomical resections, caval/hepatic vein thrombectomy, vascular control maneuvers) in the management of Wilms' tumor with hepatic extension. Methodology: Systematic review according to PRISMA and the PICO strategy. Databases: PubMed, Embase, LILACS, and Scopus; period 2015–2025; children ≤18 years; Inclusion of series/cohorts/trials with data on technique and outcomes (complications, margin, survival). Exclusions: duplicates, >10 years, conflict of interest, missing outcomes. A total of 172 studies were identified; after excluding 23 duplicates, 149 were screened. 98 were excluded due to thematic inadequacy and 7 due to conflict of interest. Fifty were read in full; 36 were excluded due to insufficient data. Included: 14 studies.
Results: The series report high resectability rates after neoadjuvant therapy (≈80–95%), with R0 in 63–88%, Clavien-Dindo morbidity ≥III between 8–22%, and low perioperative mortality (0–4%). Event-free survival at 3–5 years ranged from 58–78%, associated with negative margins and radiological response to the SIOP/COG regimen. Conclusion: Upper gastrointestinal surgery in Wilms tumor with hepatic extension is feasible in referral centers when preceded by chemotherapy and performed with strict vascular control, prioritizing parenchymal preservation and R0 resection.