Safety and Efficacy of Nephron-Sparing Surgery in Bilateral Wilms Tumors: A Systematic Review and Meta-Analysis

Bilateral Wilms tumor (BWT) presents a significant challenge in pediatric oncology, necessitating a delicate balance between achieving oncological control and preserving renal function. While nephron-sparing surgery (NSS) has emerged as a promising alternative to radical nephrectomy, its overall safety and efficacy profile for BWT remains to be consolidated. This systematic review and meta-analysis aimed to synthesize the available evidence to evaluate the pooled safety and efficacy outcomes of NSS in children with BWT.

Following PRISMA guidelines, a systematic search was conducted across five databases (PubMed, Medline, Web of Science, SCOPUS, Cochrane Library). We included studies reporting on pediatric patients with BWT treated with NSS. A single-arm meta-analysis was performed using a random-effects model to pool estimates for survival, recurrence, and renal function outcomes.

Thirteen studies comprising 749 patients were included. The pooled overall survival rate was 55.9% (95% CI: 38.2%-73.7%), relapse-free survival was 51.4% (95% CI: 32.6%-70.3%), and event-free survival was 38.0% (95% CI: 23.3%-52.7%). The recurrence rate was 14.9% (95% CI: 9.4%-20.5%). Critically, renal function was well-preserved, with a mean glomerular filtration rate (GFR) of 92.0 mL/min/1.73 m². The need for dialysis (1.7%) and renal transplantation (4.3%) was low.

NSS provides a viable surgical strategy for BWT, effectively preserving renal function without unduly compromising survival outcomes. The acceptable recurrence and low renal replacement therapy rates underscore its role in mitigating long-term morbidity. Significant heterogeneity across studies highlights the need for standardized treatment protocols and prospective research to optimize patient selection and outcomes.