Renal Function Outcomes in Patients Treated With Nephron Sparing Surgery for Bilateral Wilms Tumor

Abstract

When combined with adjuvant radiation and/or chemotherapy, nephron sparing surgery provides an opportunity to preserve renal function, while maintaining excellent long-term oncological outcomes for patients with bilateral Wilms tumor.

Current surgical standards of care in Wilms tumor

“…The understanding of the effect of NSS on renal functional outcomes is hampered by the lack of agreement between institutions on the definition of renal insufficiency as well as by the knowledge that some outcomes (e.g., hypertension) may improve following tumor resection, independent of the choice of surgical technique. Although serum creatinine appears to be consistently preserved in children undergoing NSS for BWTs, (and the need for dialysis appears to be nearly exclusive to patients in whom renal function is insufficient owing to large-volume parenchymal resection or underlying WT-associated syndromes) [63], a recent multicenter international study of children with UWTs treated with either NSS or radical nephrectomy identified specific tumor and patient characteristics associated with postsurgical changes in GFR. Children with large tumors had lower preoperative GFR than children with smaller tumors did, and patients with initial renal function placing them in chronic kidney disease stage 2 or greater were more likely to experience an increase in GFR following NSS [64].…”

“…A German group found that in patients with BWTs, bilateral NSS was associated with a lower prevalence of postoperative hypertension than nephrectomy and contralateral NSS were [65]. The effect of the primary tumor [63] as well as of neoadjuvant and adjuvant therapies (chemotherapy and radiation) [55] on postsurgical blood pressure measurements cannot be predicted with certainty yet.…”

“…Proteinuria after NSS for BWTs appears to be relatively uncommon, affecting approximately 1 in 6 patients, and rarely severe in the absence of predisposing syndromes [63]. The prevalence of microalbuminuria, which has been proposed by nephrologists to be a more accurate predictor of subclinical renal damage [66], has not been reported in patients undergoing NSS for BWTs.…”

Renal function in patients with Wilms tumor

“…The prognosis of favorable histology, bilateral WT is very good, with overall survival rates in excess of 80% being well documented [27,28]. Unfortunately, development of renal dysfunction in survivors of bilateral WT is a well-recognized complication.…”

Management of Bilateral Wilms’ Tumor: Our Experience

“…Apart from this, it is also indicated in tumors involving a solitary kidney, bilateral renal involvement, and contralateral renal impairment [3]. Nephronsparing surgery should also be attempted in select patients with a solid renal mass in whom the contralateral kidney is threatened by local, systemic, or genetic conditions that may affect future function or the likelihood of subsequent contralateral tumors [14].…”