Nephron Sparing Surgery for Synchronous Bilateral Wilms—Operative Steps

Abstract

Approximately 5% of children with Wilms tumor present with bilateral disease. The treatment challenge is to achieve a high cure rate while maintaining adequate long-term renal function. We report the feasibility and outcome of nephron sparing surgery in a child with bilateral Wilms tumor who was treated at our institution.

Bilateral Wilms’ Tumor With Different Responses to Preoperative Chemotherapy

“…As per the recommendations of the Children’s Oncology Group (COG), patients with BWT should start treatment with NACT, followed by repeat imaging at an interval of six weeks [ 6 ]. If chemotherapy reduces the tumor by 50% or more, a bilateral open biopsy should be performed, followed by additional chemotherapy for a maximum period of another 12 weeks [ 6 , 7 ]. Thereafter, NSS should be planned.…”

“…Thereafter, NSS should be planned. The aim of NSS is to remove the renal tumor completely with the preservation of functional renal tissue as much as possible [ 6 , 7 ]. Table 1 enlists similar cases of BWT reported in the literature, along with their case findings, adopted treatment, and final outcomes.…”

“…In many of the cases of Wilms’ tumor, preoperative chemotherapy leads to a significant decrease in tumor size, thus allowing subsequent renal salvage surgery (NSS) [ 7 , 9 ]. In our patient, unfortunately, the right-sided tumor reduction following chemotherapy was less than 50%, making NSS for the right kidney impossible.…”