[Is nephron-sparing surgery relevant for unilateral Wilms tumors?]

Area of Science:

• Pediatric Oncology
• Surgical Oncology

Background:

• Wilms tumors (WTs) are the most common pediatric renal malignancy.
• Radical nephrectomy (RN) is the standard treatment, but nephron preservation is increasingly considered.
• This review evaluates nephron-sparing surgery (NSS) for nonsyndromic unilateral Wilms tumor (UWT).

Purpose of the Study:

• To systematically review the efficacy and safety of NSS versus RN for UWT in children.
• To compare oncologic and renal outcomes between NSS and RN.

Main Methods:

• A systematic review of English-language articles from the Medline database.
• Keywords included "unilateral Wilms tumor," "partial nephrectomy," and "renal function."
• Data extraction and qualitative analysis of included studies.

Main Results:

• 14 articles involving 4288 children were analyzed; 6.8% underwent NSS.
• Overall survival and event-free survival were similar between RN and NSS groups.
• NSS was associated with a higher rate of positive margins (8.5% vs 0.5%) but similar tumor rupture and recurrence rates.
• Mild to moderate renal impairment was more frequent after RN (42%) compared to NSS (10%).

Conclusions:

• NSS is a viable alternative for UWT, particularly for smaller, exophytic tumors.
• Preoperative chemotherapy may facilitate NSS by reducing tumor volume and positive margin rates.
• Advancements in imaging and virtual simulation will aid in selecting ideal candidates for NSS.