Is Nephron−Sparing Surgery in the Treatment of Unilateral Wilms' Tumor Justified? Czy operacje oszczędzające miąższ nerki mają uzasadnienie w leczeniu nerczaka jednostronnego?

Objectives. Estimation of the efficiency and radicalism of nephron−sparing surgery in 10 children with unilateral Wilms’ tumor stage I disease after preoperative chemotherapy or with metachronous bilateral Wilms’ tumor (BWT) who previously underwent nephrectomy because of tumor. Material and Methods. In 6 children with unilateral WT, in 1 with the tumor of a solitary kidney, and in 3 with metachronous BWT, resection of the tumor (in 9) and enucleation (in 1) with renal preservation were performed. The resected tumors were mostly localized peripherally on the lower or upper pole of the kidney. Criteria for resec− tion were at least 50% of the affected kidney parenchyma preservable and stage I tumor at the time of surgery (neg− ative frozen−section biopsies from the resected margin of the surrounding parenchyma, lymph nodes, and perirenal fat). In one child in whom the tumor localization was central, enucleation of the tumor with the use of an ultra− sound knife was performed. In all operated children the histological evaluation showed the histological type of intermediate−risk Wilms’ tumor according to the working classification of renal tumors in children proposed by SIOP. Thereafter, following nephron−sparing surgery two−drug chemotherapy (VCR, AMD) according to the pro− tocol of the First Polish Wilms’ Tumor Study was administrated. Radical resection of the tumor with renal preser− vation was achieved in all patients. Results. The results of treatment, localization of the tumors, and the response of the tumors to preoperative treat− ment are presented. All 10 children were cured. In one boy, local recurrence of tumor was seen in the resected pole of the kidney eight months after the operation. Radical nephrectomy was performed in this patient followed by chemotherapy and radiotherapy with an uneventful follow−up of five years. Conclusions. Partial nephrectomy in unilateral Wilms’ tumor is recommended only in very selected patients with well−responding stage I tumor when the resected margin of the tumor in the kidney is clear. In the case of devel− oped tumor in a solitary kidney, nephron−sparing surgery is the method of choice (Adv Clin Exp Med 2008, 17, 1, 77–82).