Recent advances in the surgical treatment of bilateral Wilms' tumor

Definite progress has been made in the treatment of bilateral Wilms' tumor with marked improvement in the prognosis. Past aggressive surgical therapy has been recently replaced by a more conservative approach. Double or triple drug chemotherapy combined with conservative nephron sparing surgery is indicated for tumors with "favorable" histology. More aggressive ablative surgical therapy combined with chemotherapy and low dose radiation therapy are reserved for tumors with "unfavorable" histology. Fine needle aspiration biopsy, by both smears and cell block, combining light and electron microscopy approach, is an accurate method in establishing the diagnosis. It has some limitation in the precise histologic differentiation between "favorable and unfavorable" tumors. Treatment should be individualized according to clinical, histologic and morphologic factors. A multispecialty team effort undoubtedly, constitutes the most important element in the successful treatment of these tumors.