{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:12:49Z","timestamp":1778868769372,"version":"3.51.4"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.<\/jats:p>","DOI":"10.3389\/fped.2021.753232","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T08:10:59Z","timestamp":1641283859000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Management of Pediatric Tumors With Vascular Extension"],"prefix":"10.3389","volume":"9","author":[{"given":"Mayara Caroline Amorim","family":"Fanelli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 C\u00edcero Stocco","family":"Guilhen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre Alberto Barros","family":"Duarte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Kelly Marques de","family":"Souza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica dos Santos","family":"Cypriano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliana Maria Monteiro","family":"Caran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrique Manoel","family":"Lederman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Teresa de","family":"Seixas Alves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone de Campos Vieira","family":"Abib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1016\/j.jpedsurg.2011.06.041","article-title":"Strategy for management of retroperitoneal tumors with caval tumor thrombus","volume":"46","author":"Khozeimeh","year":"2011","journal-title":"J Pediatr Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/S0022-5347(06)00561-1","article-title":"Cavectomy for the treatment of Wilms tumor with vascular extension","volume":"176","author":"Ribeiro","year":"2006","journal-title":"J Urol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s003839900334","article-title":"Management of Wilms tumor with intracardiac extension","volume":"16","author":"Schettini","year":"2000","journal-title":"Pediatr Surg Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.jpedsurg.2014.11.044","article-title":"Long-term phsysiologic and oncologic outcomes of inferior vena cava thrombosis in pediatric malignant abdominal tumors","volume":"50","author":"Loh","year":"2015","journal-title":"J Pediatr Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"zrab020","DOI":"10.1093\/bjsopen\/zrab020","article-title":"Impact of neoadjuvant chemotherapy on thrombus viability in patients with Wilms tumour and caval extension: systematic review with meta-analysis","volume":"5","author":"Boam","year":"2021","journal-title":"BJS Open."},{"key":"B6","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s00383-017-4197-x","article-title":"Surgical Management and Outcomes of 12 cases of Wilms Tumor with intracardiac extension from a single centre","volume":"34","author":"Cox","year":"2018","journal-title":"Pediatr Surg Int."},{"key":"B7","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1590\/S1677-55382007000500010","article-title":"Intracaval and intracardiac extension of Wilms' tumor. 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