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Bilateral Wilms' tumor--surgical aspects
1Department of Pediatric Surgery, University of Vienna, Austria. kurosh.paya@akh-wien.ac.at
Summary
Bilateral Wilms tumors are rare and challenging to resect while preserving kidney function. Preoperative chemotherapy significantly improves surgical outcomes for these complex pediatric cases.
Area of Science:
- Pediatric Oncology
- Nephrology
- Surgical Oncology
Background:
- Bilateral Wilms tumors constitute 4-8% of all Wilms tumors.
- Surgical resection of bilateral Wilms tumors while preserving renal function is challenging.
- Effective neoadjuvant chemotherapy is crucial for managing bilateral Wilms tumors.
Observation:
- A review of seven patients diagnosed with bilateral synchronous Wilms tumors between 1990 and 1994.
- Mean age at diagnosis was 24.4 months (range 7-45 months).
- Preoperative imaging underestimated lesion extent in 4 cases; one bilateral involvement was discovered intraoperatively.
Findings:
- Five patients received neoadjuvant chemotherapy (≥4 weeks) followed by bilateral tumor resection.
- One patient required emergency surgery without neoadjuvant chemotherapy.
- One patient's chemotherapy was interrupted due to veno-occlusive disease.
- At a mean follow-up of 66 months, five patients were recurrence-free; two patients died.
Implications:
- Neoadjuvant chemotherapy is a valuable strategy for improving resectability and outcomes in bilateral Wilms tumors.
- Careful preoperative assessment and surgical planning are essential.
- Management strategies should consider established protocols like SIOP and NWTS.