Is partial nephrectomy appropriate treatment for unilateral Wilms' tumor?

Area of Science:

• Pediatric Oncology
• Nephrology
• Radiology

Background:

• Unilateral Wilms' tumor (WT) nephrectomy poses risks to the remaining kidney, including metachronous WT development and decreased renal function post-chemotherapy.
• Partial nephrectomy (PN) is considered for select cases to preserve renal function while maintaining high cure rates for WT.

Purpose of the Study:

• To determine the proportion of WT patients suitable for partial nephrectomy (PN) without compromising oncological outcomes.
• To assess the functional status of the remaining kidney after PN.
• To evaluate the accuracy of preoperative radiological criteria in selecting candidates for PN.

Main Methods:

• Retrospective analysis of 90 WT cases (1982-1992) with independent review by surgery, radiology, and pathology.
• Preoperative PN selection criteria included: functioning kidney, tumor limited to pole(s) with at least two-thirds of the kidney uninvolved, and no hilar/vascular involvement.
• Renal function post-PN assessed by calculated creatinine clearance (CC) and relative renal scintigraphy.

Main Results:

• Radiological analysis suggested PN was feasible in 13 of 85 evaluable cases; agreement with pathological criteria was high.
• Complete PN resection was achieved in 5 cases, possible in 2, and deemed impossible in 6 based on retrospective review.
• Radiological prediction accuracy for PN was 87% (80% sensitivity, 97% specificity). Kidney remnant function was preserved (median CC 110 mL/min), allowing for contralateral nephrectomy in one case.

Conclusions:

• Partial nephrectomy (PN) is a safe and viable option for approximately 10% of Wilms' tumor patients.
• The remaining kidney demonstrates good function post-PN, even supporting contralateral nephrectomy if necessary.
• Preoperative imaging accurately predicts the feasibility of PN, with an 87% accuracy rate.