Abstract
Introduction Retroperitoneal partial nephrectomy has not been studied as a surgical approach for
children with bilateral Wilms tumor. There are advantages to this technique, including
isolation of urine leaks to the retroperitoneum, decreased risk of bowel injury, and
decreased time to resuming a diet. Presently, all bilateral Wilms tumors are treated
with neoadjuvant chemotherapy and attempted nephron-sparing surgery. In this study,
we compare the outcomes of the retroperitoneal and transabdominal approaches in doing
partial nephrectomy for bilateral Wilms tumor.
Methods With the institutional review board approval, we reviewed records of 14 pediatric
patients with metachronous or synchronous bilateral Wilms tumors who underwent surgery
after chemotherapy between 1994 and 2014. Only operative procedures with the intent
to cure were included (n = 15) and of these, 5 procedures were retroperitoneal and 10 were transabdominal
in approach. Individual kidneys operated upon (n = 26) were analyzed using the preoperative radius exophytic/endophytic nearness anterior/posterior
location nephrometry score to ensure that resected tumors were comparable between
the two surgical groups. Charts were retrospectively analyzed for intraoperative parameters
and postoperative course. Differences between parameters were evaluated using Mann-Whitney
and chi-square tests.
Results Resected tumors in both surgical treatment groups had comparable sizes, nephrometry
scores, and rates of anaplasia. Operative time, blood loss, and transfusion requirement
were similar between the two groups. The extent of lymph node sampling and rates of
R0 resection were equivalent. One adverse intraoperative event, a bowel enterotomy,
was seen in the transabdominal group. Patients after retroperitoneal partial nephrectomy
required half the time to return to an oral diet as compared with those after a transabdominal
surgery, approaching statistical significance (p = 0.08). Rates of the postoperative urine leak were similar, though two in the transabdominal
group required reoperation for drainage. There were four recurrences, all in the transabdominal
group.
Conclusion Our experience demonstrates that the retroperitoneal approach is equivalent to the
transabdominal technique with regards to intraoperative complications, lymph node
dissection, and R0 resection. Advantages include less time to resumption of oral feeding,
decreased risk of bowel injury, and isolation of urine leaks to the retroperitoneum.
It should be considered a viable surgical option in the treatment of bilateral Wilms
tumors.
Keywords
Wilms tumor - surgical technique - kidney resection
