Repeat nephron-sparing surgery for children with bilateral Wilms tumor

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Nephrology

Background:

• Wilms tumor recurrence impacts renal function, especially in bilateral cases.
• Nephron-sparing surgery (NSS) is standard for initial treatment but its role in recurrence is unclear.
• Assessing repeat NSS for recurrent Wilms tumor is crucial for preserving renal function.

Purpose of the Study:

• To evaluate the feasibility of repeat NSS for recurrent Wilms tumor.
• To assess oncologic and renal function outcomes after repeat NSS.
• To determine survival rates and identify prognostic factors in recurrent Wilms tumor.

Main Methods:

• Retrospective review of children with bilateral, favorable histology Wilms tumor.
• Identification of patients undergoing repeat NSS for local recurrence.
• Evaluation of tumor recurrence, renal function, and patient survival.

Main Results:

• Eight of 36 patients (22%) with bilateral Wilms tumor underwent repeat NSS for recurrence.
• Six patients (75%) survived without disease after repeat NSS, with preserved renal function.
• Two deaths occurred in patients with blastemal-predominant histology at repeat NSS.

Conclusions:

• Repeat NSS is a feasible option for local recurrence of favorable histology bilateral Wilms tumor.
• This approach can achieve acceptable oncologic outcomes and preserve renal function.
• Aggressive therapy may be needed for recurrences with blastemal-predominant histology.