Experience with retroperitoneal partial nephrectomy in bilateral Wilms tumor

Area of Science:

• Pediatric Surgery
• Urologic Oncology

Background:

• Bilateral Wilms tumors require nephron-sparing surgery after neoadjuvant chemotherapy.
• The retroperitoneal approach for partial nephrectomy in this context has not been extensively studied.
• Potential benefits include isolated urine leaks, reduced bowel injury, and quicker diet resumption.

Purpose of the Study:

• To compare the outcomes of retroperitoneal versus transabdominal partial nephrectomy in pediatric patients with bilateral Wilms tumors.

Main Methods:

• Retrospective review of 14 pediatric patients (15 procedures) with bilateral Wilms tumors undergoing partial nephrectomy (1994-2014).
• Comparison of retroperitoneal (n=5) and transabdominal (n=10) approaches.
• Analysis of tumor characteristics (size, nephrometry score) and surgical outcomes (operative time, blood loss, complications, recurrence).

Main Results:

• Tumor characteristics and R0 resection rates were comparable between groups.
• Retroperitoneal approach showed a trend towards faster return to oral diet (p=0.08).
• One bowel enterotomy occurred in the transabdominal group; four recurrences were noted in the transabdominal group.

Conclusions:

• The retroperitoneal approach is a viable alternative to the transabdominal approach for partial nephrectomy in bilateral Wilms tumors.
• It offers comparable efficacy regarding intraoperative complications and oncologic outcomes.
• Key advantages include reduced bowel injury risk and faster postoperative feeding resumption.