Nephron-sparing surgery for Wilms tumor: A systematic review
Rand N Wilcox Vanden Berg1, Emily N Bierman2, Megan Van Noord3
1Duke University School of Medicine, Durham, NC.
Urologic Oncology
|August 10, 2015
Summary
Nephron-sparing surgery (NSS) shows similar outcomes to radical nephrectomy (RN) for treating pediatric Wilms tumors (WT). However, current evidence is limited by study biases, necessitating further research into NSS effectiveness and optimal application in WT treatment.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Nephrology
Background:
- Radical nephrectomy (RN) is the standard surgical treatment for pediatric Wilms tumors (WT).
- Nephron-sparing surgery (NSS) is emerging as a viable alternative for WT treatment.
- A systematic review is needed to compare the effectiveness of NSS versus RN in children with WT.
Purpose of the Study:
- To systematically review and compare the effectiveness of NSS and RN for treating pediatric Wilms tumors.
- To evaluate oncologic and survival outcomes between NSS and RN in pediatric WT patients.
Main Methods:
- Comprehensive literature search of multiple databases including Cochrane, MEDLINE, EMBASE, and clinicaltrials.gov.
- Inclusion of studies reporting on NSS versus RN for pediatric Wilms tumors.
- Qualitative systematic review due to high heterogeneity; no meta-analysis performed.
Main Results:
- Analysis of 66 studies including 4,002 patients; 26% underwent NSS and 74% underwent RN.
- Similar reported rupture rates (13% vs. 7%), recurrence rates (12% vs. 11%), and survival rates (85% vs. 88%) between NSS and RN.
- Comparisons are limited by inherent biases and methodological limitations in the included studies.
Conclusions:
- Contemporary studies suggest comparable long-term outcomes for NSS and RN in pediatric WT.
- Existing evidence is constrained by small sample sizes, inconsistent reporting, and methodological biases.
- Future research should focus on surgical quality, technique, chemotherapy, and center variations in NSS for WT.
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