A comparison of renal function outcomes after nephron-sparing surgery and radical nephrectomy for nonsyndromic unilateral Wilms tumor.
OBJECTIVE
To better understand the impact of nephron-sparing surgery (NSS) on renal function in patients with nonsyndromic unilateral Wilms tumor (uWT), a group of such patients treated with NSS were compared with a stage-matched cohort managed with radical nephrectomy (RN). The recommended management of nonsyndromic uWT is RN. However, NSS may decrease the risk of long-term renal disease and associated comorbidities.


METHODS
An international, multi-institutional review was conducted of nonsyndromic uWT cases managed with NSS and compared with a stage-matched RN cohort. Data were collected on demographics, oncologic characteristics and outcomes, serum creatinine, and estimated glomerular filtration rate (eGFR) calculated via Schwartz formula.


RESULTS
Fifteen patients who underwent NSS (6 females and 9 males) met study criteria and were diagnosed at a median age of 2.5 years (range, 0.2-8.2 years) and followed for a median of 8.4 years (range, 0.5-31.8 years). The stage-matched RN cohort consisted of 15 patients (8 females and 7 males) diagnosed at a median age of 3.7 years (0.3-7.4) and followed for a median of 2.1 years (0.6-10.5 years). The median preoperative eGFR was 91.7 (39.4-237.7) and 149.9 (93.8-215.9) for NSS and RN, respectively, P=.026. The median eGFR at last follow-up was 135.3 (57.5-185.8) and 131.0 (98.6-161.2) for NSS and RN, respectively, P=.95. The median change in eGFR during the study period was a gain of 28.6 (-51.9 to 83.0) for the NSS cohort vs a loss of 19.1 (-54.7 to 25.2) for the RN cohort, P=.007.


CONCLUSIONS
In a highly selected patient population with nonsyndromic uWT, NSS provides excellent renal function preservation when compared with RN. These data require validation via prospective investigation on a larger scale.
Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Urology, University of Colorado School of Medicine and the Children's Hospital Colorado, Aurora, CO. Electronic address: nicholas.cost@sbcglobal.net.
Nicholas G
NG
Cost
Department of Pediatric Surgery and Urology, Silesian Piasts University of Medicine, Wroclaw, Poland.
Krystyna
K
Sawicz-Birkowska
Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
Abdol-Mohammad
AM
Kajbafzadeh
Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
Ali
A
Tourchi
Department of Pediatric Surgery, University of Pavia, Pavia, Italy.
Gian Battista
GB
Parigi
Department of Pediatric Surgery, Section of Pediatric Surgical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Gabriela
G
Guillén
Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
W Robert
WR
DeFoor
Department of Pediatric Surgery and Urology, Silesian Piasts University of Medicine, Wroclaw, Poland.
Wojciech
W
Apoznanski
D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009399:Nephrons / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
D003404:Creatinine