title: Therapeutic results in stage I Wilms' tumors in children - 15 years of surgical experience.
abstract: BACKGROUND
  Progress in the therapeutic management of Wilms' tumors (WT) in children has resulted in the fact that presently, almost all children with stage I and favorable histology diseases have a chance for a cure.
  
  
  OBJECTIVE
  The objective of the report is an analysis of therapeutic results in children with unilateral stage I Wilms' tumors depending on the extent of tumor resection.
  
  
  METHODS
  The analysis included children treated between 1993 and 2008 under the Polish Wilms' Tumor Study, initially following the protocol SIOP 93-01 (patients treated up to 2002) and subsequently SIOP 2001. Following neoadjuvant chemotherapy, depending on tumor size and tumor response to treatment, the children were qualified for a radical nephrectomy, simple nephrectomy, or nephron-sparing surgery. Following surgical treatment, all the children were subjected to adjuvant chemotherapy in keeping with the therapeutic protocol obligatory at the time.
  
  
  RESULTS
  Within the 15 years, 111 children with Wilms' tumor were treated; the group included 43 children with stage I disease, which constituted 38.9% of the total number. Radical nephrectomies were performed in three (6.98%) children, simple nephrectomies in 32 (74.42%), and nephron-sparing surgery in eight (18.6%). Regardless of the employed surgical treatment modality, all the children are alive and none have demonstrated recurrent disease. The mean post-treatment completion follow-up period is 73 months (median value, 68 months).
  
  
  CONCLUSIONS
  A simple nephrectomy and, whenever possible, nephron-sparing surgery represents sufficient treatment in 93% of children with stage I Wilms' tumor. To improve qualification for surgical treatment we propose the employment of NSS for stage Ia Wilms' tumors and SN for stage Ib Wilms' tumors.
authors.affiliation: Department of Pediatric Surgery Collegium Medicum Jagiellonian University in Cracow; Institute of Clinical Farmacy Jagiellonian University Collegium Medicum in Cracow, Poland.
authors.forename: Sabina
authors.initials: S
authors.lastname: Szymik-Kantorowicz
authors.affiliation: Department of Pediatric Urology Collegium Medicum Jagiellonian University in Cracow, Poland.
authors.forename: Wiesław
authors.initials: W
authors.lastname: Urbanowicz
authors.affiliation: Laboratory of Molecular Biology and Clinical Genetics Collegium Medicum Jagiellonian University in Cracow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Surmiak
authors.affiliation: Department of Pediatric Urology Collegium Medicum Jagiellonian University in Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Sulisławski
keywords: nephron-sparing surgery; simple nephrectomy; stage I Wilms' tumor