Expanding the Use of Nephron-Sparing Surgery for Wilms Tumor

Authors: Christopher J. Long MD1,2, Sameer Mittal MD, MSc1,2, and Thomas F. Kolon MD, MS1,2
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  • 1 Division of Urology, Children’s Hospital of Philadelphia, and
  • | 2 Department of Urology (Surgery), Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.

Radical nephrectomy combined with contemporary chemotherapeutic and radiation therapy protocols has drastically improved outcomes for children with Wilms tumor. Patients with bilateral disease and a syndrome predisposing to tumor development have necessitated the use of nephron-sparing surgery in select cases. Success in managing these patients has increased the indication for partial nephrectomy, although current guidelines for unilateral Wilms tumor are limited. Given that children are being cured with increasing success, recent focus has shifted to long-term health outcomes in addition to tumor treatment. Specifically, renal function has an impact on long-term cardiovascular health and events. Adult outcomes with partial nephrectomy provide a guideline for a paradigm shift in the management of children with Wilms tumor, particularly with advances in imaging and adjuvant therapy. The data are limited for children undergoing partial nephrectomy for unilateral Wilms tumor and outcomes for larger tumors will need to be studied closely in future trials. Increased utilization of neoadjuvant chemotherapy could further expand the number of patients eligible for partial nephrectomy.

Submitted February 28, 2021; final revision received September 8, 2021; accepted for publication September 28, 2021. Published online February 17, 2022.

Disclosures: The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Correspondence: Thomas F. Kolon, MD, MS, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 3rd Floor, Wood Building, Philadelphia, PA 19140. Email: Kolon@chop.edu
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