title: Development of hypertension is less frequent after bilateral nephron sparing surgery for bilateral Wilms tumor in a long-term survey.
abstract: OBJECTIVE
  The option of nephron sparing surgery for unilateral Wilms tumor has been debated in the recent literature. This procedure is being used increasingly to preserve kidney tissue and function. However, nephron sparing surgery is feasible only for selected cases, and a higher local relapse rate has been observed. Moreover, a significant reduction of nephrons is associated with development of renal hypertension and progressive renal failure. We analyzed outcomes after bilateral partial nephrectomy and unilateral partial plus contralateral total nephrectomy in patients with bilateral Wilms tumor.
  
  
  METHODS
  We analyzed data from the Society of Pediatric Oncology and Hematology database on 22 patients with bilateral Wilms tumor. Kidney size was measured using volumetric analysis of magnetic resonance imaging. Patients were matched with children who had undergone magnetic resonance imaging of the abdomen for other malignancies.
  
  
  RESULTS
  Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (66.9 cm(3)) were significantly greater than the reference kidneys (p = 0.028), whereas controls were equal to the bilateral partial nephrectomy group (49.7 cm(3), p = 0.959). Total kidney volume was significantly larger after bilateral partial nephrectomy (102.1 cm(3)) vs unilateral partial plus total contralateral nephrectomy (66.9 cm(3), p = 0.0338). Eight patients (66.7%) had renal hypertension after unilateral partial plus total contralateral nephrectomy but only 2 (20%) after bilateral partial nephrectomy (p = 0.043). Overall survival and relapse rates were equal between the groups and did not correlate with unfavorable histology.
  
  
  CONCLUSIONS
  Our findings suggest that patients with bilateral Wilms tumor benefit from bilateral nephron sparing surgery. Hypertension is less common after bilateral partial nephrectomy, and rates of local relapse or disease associated death are distributed equally between the groups.
authors.affiliation: Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic address: jochen.hubertus@med.lmu.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Hubertus
authors.affiliation: Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Günther
authors.affiliation: Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Pediatric Oncology and Hematology, University of Saarland, Homburg/Saar, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.affiliation: Department of Pediatric Oncology and Hematology, University of Saarland, Homburg/Saar, Germany.
authors.forename: Rhoikos
authors.initials: R
authors.lastname: Furtwängler
authors.affiliation: Department of Pediatric Oncology and Hematology, Gemeinschaftsklinikum Koblenz-Mayen, Koblenz, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Ferrari
authors.affiliation: Department of Pediatrics, Jena University Hospital, Jena, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Gruhn
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Stahl
authors.affiliation: Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: von Schweinitz
authors.affiliation: Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Stehr
mesh_terms: D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D009396:Wilms Tumor / Q000601:surgery*
keywords: Wilms tumor; kidney neoplasms; nephrons; organ sparing treatments