The rationale for nephron-sparing surgery in unilateral non-syndromic Wilms tumour.
Pediatr Nephrol
; 39(4): 1023-1032, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-37603086
ABSTRACT
The central question of nephron-sparing surgery in unilateral non-syndromic Wilms tumour sits at a crossroads between surgery, oncology, and nephrology. There has been a significant paradigm shift in paediatric oncology towards reducing toxicity and addressing long-term treatment-related sequalae amongst childhood cancer survivors. After paediatric nephrectomy and 30-50 years of follow-up, 40% of patients will have chronic kidney disease, including 22% with hypertension and 23% with albuminuria. It is difficult to predict which patients will progress to develop hypertension, reduced glomerular filtration rate, albuminuria, and a higher cardiovascular risk. For these reasons, nephron-sparing surgery when it is technically feasible must be considered. To decrease the incidence of positive surgical margins (viable tumour present at a resection margin), incomplete lymph node sampling, and complications, these procedures should be performed at specialist and experienced reference centres. Based on the impacts of individual treatment pathways, survivors of childhood WT need to be followed through adulthood for early detection of chronic kidney disease, hypertension, and prevention of cardiovascular events.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Wilms Tumor
/
Renal Insufficiency, Chronic
/
Hypertension
/
Kidney Neoplasms
Type of study:
Prognostic_studies
/
Screening_studies
Limits:
Child
/
Humans
Language:
En
Journal:
Pediatr Nephrol
Journal subject:
NEFROLOGIA
/
PEDIATRIA
Year:
2024
Document type:
Article
Affiliation country: