How are bilateral Wilms tumors treated?

Updated: Feb 01, 2019
  • Author: Tunc Ozan, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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With bilateral Wilms tumor (6% of cases), surgical exploration, biopsy of both sides, and accurate surgical staging (including lymph node biopsy of both sides) are performed. This is followed by 6 weeks of chemotherapy that is appropriate to the stage and histology of the tumor. Reassessment is then performed using imaging studies, followed by definitive surgery with one of the following:

  • Unilateral radical nephrectomy and partial nephrectomy on the contralateral side

  • Bilateral partial nephrectomy

  • Unilateral nephrectomy only, if the response was complete on the opposite side

This approach dramatically reduces the renal failure rate following bilateral Wilms tumor therapy.The overall 2-year survival rate is higher than 80% with this approach, and the nephrectomy rate drops by 50% in patients with bilateral Wilms tumor. Bilateral partial nephrectomy is possible after chemotherapy or, if the tumor on one side responds completely to chemotherapy, with no subsequent need for nephrectomy.

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