What is the role of partial nephrectomy in the treatment of Wilms tumor?

Updated: Feb 01, 2019
  • Author: Tunc Ozan, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

The role of partial nephrectomy remains controversial. Although end-stage renal disease after unilateral radical nephrectomy is uncommon (0.25% in the NWTSG trial), preserving healthy renal tissue may prevent this complication, especially in patients with an underlying intrinsic renal disease (eg, WAGR [Wilms tumor, aniridia, genitourinary anomalies, and mental retardation] syndrome, Denys-Drash syndrome). [4] Partial nephrectomy may be feasible in only 10%-15% of patients, as most tumors are too large at initial diagnosis.

The main concern regarding a nephron-sparing procedure is that of local recurrence. The NWTS-4 study showed an 8% local recurrence rate following partial nephrectomy for patients with bilateral disease. [5] In the presence of bilateral Wilms tumors, solitary kidney, or renal insufficiency, partial nephrectomy is a reasonable consideration.


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