Repeat nephron-sparing surgery for children with bilateral Wilms tumor.

Abstract:

BACKGROUND:Renal insufficiency is a significant complication of Wilms tumor treatment in the 5% with bilateral disease. Nephron-sparing surgery (NSS) is recommended after neoadjuvant chemotherapy initially. However, the role of NSS in recurrent disease is unknown. We reviewed our experience to assess the feasibility and oncologic and functional outcomes of repeat NSS for children with recurrent disease. METHODS:A retrospective review was performed of all children treated at our institution for bilateral, favorable histology (FH) Wilms tumor. Patients undergoing repeat NSS for locally recurrent disease were identified. The outcomes evaluated included tumor recurrence, renal function, and patient survival. RESULTS:Since 2001, 36 children with bilateral FH Wilms tumor have been treated at our institution. Eight patients (22%) underwent repeat NSS for locally recurrent disease. Two patients had a second local recurrence and underwent a third NSS. Six patients are alive without disease (75%) with an average follow-up of 4.5years. Two patients have died, each with blastemal-predominant histology at repeat NSS. The surviving patients have normal renal function, although two patients require medical management of hypertension. CONCLUSIONS:Our experience suggests that repeat NSS for local recurrence of FH bilateral Wilms tumor is feasible and affords acceptable oncologic outcome with preservation of renal function. However, more aggressive therapy may be required for patients whose recurrence has blastemal-predominant histology, given the poor outcome for these patients in our series.

journal_name

J Pediatr Surg

authors

Kieran K,Williams MA,McGregor LM,Dome JS,Krasin MJ,Davidoff AM

doi

10.1016/j.jpedsurg.2013.09.048

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

149-53

issue

1

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(13)00767-7

journal_volume

49

pub_type

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