Nephron-sparing partial nephrectomy for bilateral Wilms' tumor.
OBJECTIVE
Partial nephrectomy is increasingly used in children with bilateral Wilms' tumor (BWT) or contralateral recurrence. Nephron-sparing surgery seeks to achieve complete tumor removal while preserving functional renal parenchyma. Previous series have documented high rates of complications, recurrence, and mortality.


METHODS
Twelve patients (4 boys and 8 girls aged 9-42 months) with BWT or contralateral recurrence were treated at our institution with unilateral or bilateral partial nephrectomy. Preoperative imaging, operative notes, and pathology reports were reviewed. Outcomes analyzed included complications, recurrence, readmission rate, postoperative glomerular filtration rate (GFR), and survival.


RESULTS
All patients underwent successful nephron-sparing resection using standard techniques, with only 2 patients requiring unilateral nephrectomy. Median length of stay was 3 days. There were no major complications or urine leaks. Two patients were lost to follow-up. The remaining 10 were followed up for a median of 36 months (range, 3-79 months). There have been no recurrences or unplanned readmissions. Mean GFR is 107.7 (± 32.8) mL/min per 1.73 m(2), with no patient having a GFR below the lower limit of normal for age.


CONCLUSIONS
Nephron-sparing resection is a safe and effective approach for children with BWT or contralateral recurrence and should be part of the multimodality therapeutic approach to this disease.
Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Jason
J
Sulkowski
Thomas
T
Kolon
Peter
P
Mattei
D000015:Abnormalities, Multiple / Q000453:epidemiology; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007668:Kidney / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D015143:Philadelphia / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D009396:Wilms Tumor / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery*