Oncological and renal function outcome in children with unilateral wilms' tumors treated with nephron sparing surgery or ablative nephrectomy

Abstract

Background: We prospectively evaluated the oncological and renal functional outcomes of children with unilateral Wilms' tumor (WT) undergoing nephron-sparing surgery (NSS) versus ablative nephrectomy. Materials and Methods: Children presenting with unilateral WT from January 2006 to December 2015 were prospectively randomized to undergo either ablative (simple/radical) nephrectomy or NSS. Treatment was administered according to the Societe Internationale d'Oncologie Pediatrique-2001 protocol. Results: During the 10-year study period, 13 children underwent ablative nephrectomy, and 15 underwent NSS (partial nephrectomy/wedge excision). The contralateral kidneys were found to be normal on ultrasonography and computed tomography imaging. The mean age at intervention was 44.8 ± 16.7 months. Eight children presented with Stage I disease and the remaining 20 had Stage II disease. The mean follow-up period was 53. 68 ± 23.82 months and all children were alive at the last follow-up without any clinical evidence of disease. The event-free survival rates were 100% and 92.3% in the children undergoing NSS and ablative nephrectomy, respectively. The children who underwent ablative nephrectomy presented with considerably higher mean systolic and diastolic blood pressures, as well as significantly elevated mean values of serum creatinine compared to their ablative nephrectomy counterparts. Conclusion: The oncological outcome of NSS was as good as ablative nephrectomy in children with unilateral WTs. NSS also minimized the loss of renal function.