title: Image based feasibility of renal sparing surgery for very low risk unilateral Wilms tumors: a report from the Children's Oncology Group.
abstract: OBJECTIVE
  Nephrectomy with lymph node sampling is the recommended treatment for children with unilateral Wilms tumor under the Children's Oncology Group protocols. Using radiological assessment, we determined the feasibility of performing partial nephrectomy in a select group of patients with very low risk unilateral Wilms tumor.
  
  
  METHODS
  We reviewed imaging studies of 60 patients with a mean age of less than 2 years with very low risk unilateral Wilms tumor (mean weight less than 550 gm) to assess the feasibility of partial nephrectomy. We evaluated percentage of salvageable parenchyma, tumor location and anatomical features preventing a nephron sparing approach.
  
  
  RESULTS
  A linear relationship exists between tumor weight and computerized tomography estimated tumor volume. Mean tumor weight in the study population was 315 gm. Partial nephrectomy was deemed feasible in only 5 of 60 patients (8%).
  
  
  CONCLUSIONS
  When considering a select population with very low risk unilateral Wilms tumor (lower volume tumor), only a small percentage of nonpretreated patients are candidates for nephron sparing surgery.
authors.affiliation: Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, Connecticut. Electronic address: fferrer@ccmckids.org.
authors.forename: F A
authors.initials: FA
authors.lastname: Ferrer
authors.forename: N
authors.initials: N
authors.lastname: Rosen
authors.forename: K
authors.initials: K
authors.lastname: Herbst
authors.forename: C V
authors.initials: CV
authors.lastname: Fernandez
authors.forename: G
authors.initials: G
authors.lastname: Khanna
authors.forename: J S
authors.initials: JS
authors.lastname: Dome
authors.forename: E
authors.initials: E
authors.lastname: Mullen
authors.forename: K W
authors.initials: KW
authors.lastname: Gow
authors.forename: D C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: R C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: M
authors.initials: M
authors.lastname: Ritchey
authors.forename: P
authors.initials: P
authors.lastname: Ehrlich
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments; D011859:Radiography; D018570:Risk Assessment; D009396:Wilms Tumor / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: CKD; COG; CT; Children’s Oncology Group; GFR; International Society of Pediatric Oncology; NSS; PN; RCC; SIOP; Wilms tumor; chronic kidney disease; computerized tomogram; diagnostic imaging; glomerular filtration rate; kidney neoplasms; nephrectomy; nephron sparing surgery; partial nephrectomy; renal cell carcinoma