Nephron-sparing surgery in synchronous bilateral Wilms' tumors

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Nephrology

Background:

• Synchronous bilateral Wilms' tumor is a rare condition with limited institutional experience in renal salvage procedures.
• This study investigates the impact of evolving surgical techniques and awareness of nephroblastomatosis on treatment outcomes.

Purpose of the Study:

• To evaluate the effectiveness of atypical renal resections and nephroblastomatosis management in treating synchronous bilateral Wilms' tumor.
• To determine the long-term renal function outcomes in patients undergoing these procedures.

Main Methods:

• Retrospective analysis of 14 patients treated between 1977 and 1995.
• Review of surgical reports, clinical data, follow-up information, and pathology slides for histology and nephroblastomatosis.
• Pre- and post-operative and follow-up renal function assessment.

Main Results:

• 13 out of 14 patients survived with preserved renal function at 2-20 years post-surgery.
• Atypical resections and superficial dissection of nephroblastomatosis allowed for renal salvage in cases where traditional criteria would have necessitated nephrectomy.
• Nephrectomy was unavoidable in cases with hilar tumor invasion.

Conclusions:

• Atypical resections and superficial dissection of suspected nephroblastomatosis are viable surgical options for localized Wilms' tumors, avoiding nephrectomy.
• Renal salvage is achievable for synchronous bilateral Wilms' tumor, preserving kidney function.
• Hilar tumor invasion remains an indication for nephrectomy.