It is technically feasible to perform bilateral nephron-sparing surgery in children with bilateral Wilms tumors, and the outcome is favorable in most cases, a team at St. Jude Children’s Research Hospital and the University of Tennessee in Memphis reports in the May 1 issue of Cancer.
In a retrospective study, Dr. Andrew M. Davidoff and colleagues identified twelve children with synchronous, bilateral Wilms tumors who were treated at St. Jude between 1999 and 2006.
Ten patients underwent successful bilateral nephron-sparing procedures. One patient presented with renal failure and anaplastic histology and underwent bilateral nephrectomies. One patient had intra-atrial tumor extension and underwent an ipsilateral nephrectomy/thrombectomy and subsequent contralateral partial nephrectomy.
Mean follow-up was 3.9 years. There were two deaths, for an overall survival rate of 83%. Both deaths occurred in patients with bilateral, diffuse, anaplastic histology. Long-term renal function was “excellent.”
There were some notable post-operative complications, including persistent urine leak in three patients, macroscopic residual tumor in two patients and pyelonephritis in one patient.
Long-term complications included local tumor recurrence in two patients, intestinal obstruction in two patients, ureteropelvic junction obstruction in one patient and renal failure in another.
Nephron-sparing surgery, in combination with adjuvant therapy, Dr. Davidoff and colleagues conclude, “provides an opportunity to preserve renal function while maintaining a high probability of cure and should be considered strongly for all patients with who have synchronous, bilateral Wilms tumors, despite the radiographic appearance of the kidneys and associated tumors.”
Cancer 2008;112:2060-2070.
Reviewed by Ramaz Mitaishvili, MD
