Bilateral Wilms Tumor: Looking for the Best Surgical Strategy

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Nephrology

Background:

• Bilateral Wilms tumor (BWT) management is challenging, balancing tumor control with renal function preservation.
• Nephron-sparing surgery (NSS) is crucial for reducing renal failure risk but lacks a standardized approach.
• The SIOP2001 trial provides a framework for analyzing BWT surgical strategies.

Purpose of the Study:

• To analyze surgical management and outcomes for patients with synchronous BWT within the SIOP2001 trial.
• To identify factors influencing surgical strategy and oncologic/renal outcomes in BWT.
• To evaluate the effectiveness of NSS versus total nephrectomy (TN) in BWT.

Main Methods:

• Retrospective review of French patients with synchronous BWT in the SIOP2001 protocol.
• Collection of data on imaging, surgical approach, complications, histology, oncologic results, and renal function.
• Analysis of factors associated with surgical decisions and outcomes.

Main Results:

• Out of 96 patients, 56% of kidneys underwent NSS.
• Vascular contact was the primary factor leading to total nephrectomy (TN).
• Staged surgery showed a trend towards fewer TNs, less tumor rupture, and reduced mortality compared to single-stage surgery.

Conclusions:

• Prioritize NSS for BWT whenever feasible to preserve renal parenchyma.
• Vascular proximity is a significant limitation for NSS in BWT.
• Staged surgical approaches appear to minimize surgical morbidity in BWT management.