Academic Journal of Surgery 2016. 3(3-4):50-53.

Hypertension after Bilateral Nephron Sparing Surgery for Bilateral Wilms
Seyed Mohammad Vahid-Hosseini, Seyedeh Narges Tabatabaee, Babak Sabet, Manuchehr Kamali, Sakieneh Falahi

Abstract


Background: Nephron sparing surgery (NSS) for unilateral Wilms tumor (WT) has been debated recently and is being used to preserve kidney tissue and function. However, NSS is feasible only for selected cases with higher local relapse rates. There is a significant reduction of nephrons with the development of renal hypertension and progressive renal failure. In this paper, we have analyzed outcomes after bilateral partial nephrectomy (PN) and unilateral partial plus contralateral total nephrectomy in our patients with bilateral WT.

Methods: We have analyzed our four patients (8 kidneys) with bilateral WT and 8 unilateral complete resection. Kidney size was measured using volumetric analysis computed tomography scan imaging. The patients were matched with children who had undergone imaging of the abdomen for other malignancies.

Results: Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (60.9 cm3) were significantly greater than the reference kidneys. Total kidney volume was significantly larger after bilateral PN (98.1 cm3) versus unilateral partial plus total contralateral nephrectomy (60.9 cm3).

Conclusions: Our findings suggest that patients with bilateral WT benefit from bilateral NSS. Hypertension is less common after bilateral PN. However, rates of local relapse or disease associated death are separately between the groups.


Keywords


Wilms’ tumor; Hypertension; Nephron-sparing surgery

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References


Davidoff AM, Interiano RB, Wynn L, Delos Santos N, Dome JS, Green DM, et al. Overall survival and renal function of patients with synchronous bilateral wilms tumor undergoing surgery at a single institution. Ann Surg 2015; 262(4): 570-6.

Romao RL, Lorenzo AJ. Renal function in patients with Wilms tumor. Urol Oncol 2016; 34(1): 33-41.

Giel DW, Williams MA, Jones DP, Davidoff AM, Dome JS. Renal function outcomes in patients treated with nephron sparing surgery for bilateral Wilms tumor. J Urol 2007; 178(4 Pt 2): 1786-9.

Ritchey ML, Green DM, Thomas PR, Smith GR, Haase G, Shochat S, et al. Renal failure in Wilms' tumor patients: a report from the National Wilms' Tumor Study Group. Med Pediatr Oncol 1996; 26(2): 75-80.

Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: Indications, techniques and outcomes. J Urol 2001; 166(1): 6-18.

Haecker FM, von Schweinitz D, Harms D, Buerger D, Graf N. Partial nephrectomy for unilateral Wilms tumor: results of study SIOP 93-01/GPOH. J Urol 2003; 170(3): 939-42.

Sukarochana K, Tolentino W, Kiesewetter WB. Wilms' tumor and hypertension. J Pediatr Surg 1972; 7(5): 573-6.

Kieran K, Williams MA, McGregor LM, Dome JS, Krasin MJ, Davidoff AM. Repeat nephron-sparing surgery for children with bilateral Wilms tumor. J Pediatr Surg 2014; 49(1): 149-53.

Scherr DS, Ng C, Munver R, Sosa RE, Vaughan ED Jr, Del Pizzo J. Practice patterns among urologic surgeons treating localized renal cell carcinoma in the laparoscopic age: technology versus oncology. Urology 2003; 62(6): 1007-11.

Luyckx VA, Shukha K, Brenner BM. Low nephron number and its clinical consequences. Rambam Maimonides Med J 2011; 2(4): e0061.

Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? J Urol 2009; 181(1): 55-61.

Millar AJ, Davidson A, Rode H, Numanoglu A, Hartley PS, Desai F. Nephron-sparing surgery for bilateral Wilms' tumours: a single-centre experience with 23 cases. Afr J Paediatr Surg 2011; 8(1): 49-56.

Mavinkurve-Groothuis AM, van de Kracht F, Westland R, van Wijk JA, Loonen JJ, Schreuder MF. Long-term follow-up of blood pressure and glomerular filtration rate in patients with a solitary functioning kidney: a comparison between Wilms tumor survivors and nephrectomy for other reasons. Pediatr Nephrol 2016; 31(3): 435-41.

Hadley GP, Mars M, Ramdial PK. Bilateral Wilms' tumour in a developing country: a descriptive study. Pediatr Surg Int 2013; 29(5): 419-23.

Aronson DC, Slaar A, Heinen RC, de Kraker J, Heij HA. Long-term outcome of bilateral Wilms tumors (BWT). Pediatr Blood Cancer 2011; 56(7): 1110-3.

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114(2 Suppl 4th Report): 555-76.

Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens 1988; 1(4 Pt 1): 335-47.

Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis 1994; 23(2): 171-5.

Cozzi F, Schiavetti A, Morini F, Zani A, Gambino M, Donfrancesco C, et al. Renal function adaptation in children with unilateral renal tumors treated with nephron sparing surgery or nephrectomy. J Urol 2005; 174(4 Pt 1): 1404-8.

Davidoff AM, Giel DW, Jones DP, Jenkins JJ, Krasin MJ, Hoffer FA, et al. The feasibility and outcome of nephron-sparing surgery for children with bilateral Wilms tumor. The St Jude Children's Research Hospital experience: 1999-2006. Cancer 2008; 112(9): 2060-70.

Hubertus J, Gunther B, Becker K, Graf N, Furtwangler R, Ferrari R, et al. Development of hypertension is less frequent after bilateral nephron sparing surgery for bilateral Wilms tumor in a long-term survey. J Urol 2015; 193(1): 262-6.


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