Jochen Hubertus1, Brigitte Günther2, Kristina Becker2, Norbert Graf3, Rhoikos Furtwängler3, Rudolf Ferrari4, Bernd Gruhn5, Robert Stahl6, Dietrich von Schweinitz2, Maximilian Stehr2. 1. Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic address: jochen.hubertus@med.lmu.de. 2. Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany. 3. Department of Pediatric Oncology and Hematology, University of Saarland, Homburg/Saar, Germany. 4. Department of Pediatric Oncology and Hematology, Gemeinschaftsklinikum Koblenz-Mayen, Koblenz, Germany. 5. Department of Pediatrics, Jena University Hospital, Jena, Germany. 6. Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Abstract
PURPOSE: 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. MATERIALS AND 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.
PURPOSE: 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. MATERIALS AND 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: Rodrigo B Interiano; M Beth McCarville; Noel Delos Santos; Shenghua Mao; Jianrong Wu; Jeffrey S Dome; Kathleen Kieran; Mark A Williams; Rachel C Brennan; Matthew J Krasin; Daniel M Green; Andrew M Davidoff Journal: J Pediatr Surg Date: 2016-10-27 Impact factor: 2.545
Authors: Marie A Neu; Alexandra Russo; Arthur Wingerter; Francesca Alt; Johanna Theruvath; Khalifa El Malki; Bettina Kron; Matthias Dittrich; Johannes Lotz; Raimund Stein; Rolf Beetz; Joerg Faber Journal: Pediatr Nephrol Date: 2017-04-28 Impact factor: 3.714
Authors: Andrew M Davidoff; Rodrigo B Interiano; Lynn Wynn; Noel Delos Santos; Jeffrey S Dome; Daniel M Green; Rachel C Brennan; M Beth McCarville; Matthew J Krasin; Kathleen Kieran; Mark A Williams Journal: Ann Surg Date: 2015-10 Impact factor: 12.969
Authors: Esmee Cm Kooijmans; Arend Bökenkamp; Nic S Tjahjadi; Jesse M Tettero; Eline van Dulmen-den Broeder; Helena Jh van der Pal; Margreet A Veening Journal: Cochrane Database Syst Rev Date: 2019-03-11
Authors: Annelies M C Mavinkurve-Groothuis; Frank van de Kracht; Rik Westland; Joanna A E van Wijk; Jacqueline J Loonen; Michiel F Schreuder Journal: Pediatr Nephrol Date: 2015-10-19 Impact factor: 3.714
Authors: Sophie E van Peer; Janna A Hol; Alida F W van der Steeg; Martine van Grotel; Godelieve A M Tytgat; Annelies M C Mavinkurve-Groothuis; Geert O R Janssens; Annemieke S Littooij; Ronald R de Krijger; Marjolijn C J Jongmans; Marc R Lilien; Jarno Drost; Roland P Kuiper; Harm van Tinteren; Marc H W A Wijnen; Marry M van den Heuvel-Eibrink Journal: J Clin Med Date: 2021-11-26 Impact factor: 4.241