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Bilateral Wilms' tumor
1Department of Pediatric Surgery, University Hospital, S-221 85 Lund, Sweden.
Insights
This study on Wilms' tumor (WT) in children found that renal salvage procedures are feasible and preserve kidney function. These techniques are recommended for treating bilateral WT cases, improving patient outcomes.
Area of Science:
- Pediatric Oncology
- Nephrology
- Surgical Oncology
Background:
- Wilms' tumor (WT) is a common pediatric kidney cancer.
- Bilateral WT, affecting both kidneys, presents unique treatment challenges.
- Preserving renal function is crucial for long-term pediatric health.
Purpose of the Study:
- To evaluate the feasibility and outcomes of renal salvage procedures in children with bilateral Wilms' tumor (WT).
- To assess the efficacy of preoperative chemotherapy and surgical techniques in managing synchronous and metachronous bilateral WT.
- To advocate for organ-sparing approaches in pediatric kidney cancer treatment.
Main Methods:
- Retrospective analysis of 49 children treated for Wilms' tumor (WT) over 16 years.
- Focus on 7 cases of bilateral WT (5 synchronous, 2 metachronous).
- Details of preoperative chemotherapy, tumor reduction, and surgical interventions (nephrectomy, enucleation) are reviewed.
Main Results:
- Renal salvage procedures were technically feasible in bilateral WT cases.
- Tumor enucleation and heminephrectomy were performed in synchronous cases.
- Three patients died of WT, one is alive with disease, and three are disease-free.
Conclusions:
- Renal salvage procedures are safe and effective for treating bilateral Wilms' tumor (WT).
- Organ-sparing surgery preserves renal function and is advocated in pediatric WT management.
- Multidisciplinary treatment, including chemotherapy and tailored surgery, improves outcomes for bilateral WT.
Abstract:
During a 16-year period, 49 children were treated for Wilms' tumor (WT); 7 were bilateral, 5 synchronous and 2 metachronous. The age at primary diagnosis was 6 months to 5 years (mean 2.4 years). All but 1 child received preoperative chemotherapy with tumor reduction. Unilateral nephrectomy was performed in 2 metachronous cases. In 3 synchronous WTs, the tumor was enucleated in 5 kidneys and a heminephrectomy was performed in 1 kidney with a double pelvis. Two children were not operated upon. At relapse in the contralateral kidney the tumor was enucleated. Three patients died of WT, 1 is alive with disease, and 3 are without evidence of disease. Renal salvage procedures were technically feasible without complications and are advocated to preserve renal function.