Conservative surgery of the kidney in children

Increasing recognition of bilateral renal involvement in Wilms' tumor (nephroblastoma) has led to a less radical approach to surgical treatment. Experience with bilateral nephrectomy and subsequent dialysis or transplant has been unsatisfactory, and unilateral nephrectomy with contralateral radiotherapy carries the morbidity of radiation in addition to the risk of recurrent disease. Advances in chemotherapy have facilitated preoperative shrinkage of tumors and subsequent local excision of remaining tumor nodules with preservation of functioning renal tissue. We have treated 10 children with bilateral (stage V) Wilms' tumor in this manner. Two-year disease-free survival in this group is 60%, and renal function is satisfactory in all survivors. This experience suggests that nephron-sparing surgery may be possible in the majority of children with Wilms' tumor. Conservative surgery is essential in certain special situations such as solitary kidney or the horse-shoe abnormality.