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Bilateral Wilms' tumor--surgical aspects.

K Paya1, E Horcher, K Lawrenz

  • 1Department of Pediatric Surgery, University of Vienna, Austria. kurosh.paya@akh-wien.ac.at

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|May 24, 2001
PubMed
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.

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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.

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  • 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.