Nephron-sparing surgery in synchronous bilateral Wilms' tumors.
BACKGROUND
Synchronous bilateral Wilms' tumor is rare and experience with renal salvage procedures and their limitations accumulates slowly at single institutions. The authors analyzed whether their growing experience with atypical renal resections and awareness of nephroblastomatosis had influenced the outcome of surgical procedures.


METHODS
Retrospective analysis of patients treated from 1977 to 1995 was performed. Surgical reports, clinical sheets, and follow-up data were evaluated. All pathology slides were reviewed for histological classification and presence of nephroblastomatosis. Renal function was evaluated pre- and postoperatively and at final follow-up.


RESULTS
Fourteen patients were treated. Two to 20 years after surgery, 13 patients are alive, and none has had renal failure. Five patients had unilateral nephrectomies, and a renal salvage procedure was performed on 22 kidneys. One patient with an anaplastic bilateral Wilms' tumor died of tumor progress 1 year after surgery. Several kidneys, which would have been sacrificed by application of traditional criteria, could be salvaged by atypical and unconventional tumor resections and by superficial dissection and enucleation of supposed nephroblastomatosis. Nephrectomy appeared unavoidable with hilar invasion by tumor.


CONCLUSIONS
Atypical resections of localized lesions and superficial dissections of suspected nephroblastomatosis appeared as valid surgical treatment options for patients who would otherwise have been candidates for nephrectomy. In the case of hilar tumor invasion, however, nephrectomy seems unavoidable.
Fuchs
J
J
Department of Pediatric Surgery, Medizinische Hochschule Hannover, Germany.
Wünsch
L
L
Flemming
P
P
Weinel
P
P
Mildenberger
H
H
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods; D009396:Wilms Tumor / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*