A comparison of renal function outcomes after nephron-sparing surgery and radical nephrectomy for nonsyndromic unilateral wilms tumor

Nicholas G. Cost, Krystyna Sawicz-Birkowska, Abdol Mohammad Kajbafzadeh, Ali Tourchi, Gian Battista Parigi, Gabriela Guillén, W. Robert Defoor, Wojciech Apoznanski

Research output: Contribution to journalArticle

Abstract

Objective To better understand the impact of nephron-sparing surgery (NSS) on renal function in patients with nonsyndromic unilateral Wilms tumor (uWT), a group of such patients treated with NSS were compared with a stage-matched cohort managed with radical nephrectomy (RN). The recommended management of nonsyndromic uWT is RN. However, NSS may decrease the risk of long-term renal disease and associated comorbidities. Materials and Methods An international, multi-institutional review was conducted of nonsyndromic uWT cases managed with NSS and compared with a stage-matched RN cohort. Data were collected on demographics, oncologic characteristics and outcomes, serum creatinine, and estimated glomerular filtration rate (eGFR) calculated via Schwartz formula. Results Fifteen patients who underwent NSS (6 females and 9 males) met study criteria and were diagnosed at a median age of 2.5 years (range, 0.2-8.2 years) and followed for a median of 8.4 years (range, 0.5-31.8 years). The stage-matched RN cohort consisted of 15 patients (8 females and 7 males) diagnosed at a median age of 3.7 years (0.3-7.4) and followed for a median of 2.1 years (0.6-10.5 years). The median preoperative eGFR was 91.7 (39.4-237.7) and 149.9 (93.8-215.9) for NSS and RN, respectively, P =.026. The median eGFR at last follow-up was 135.3 (57.5-185.8) and 131.0 (98.6-161.2) for NSS and RN, respectively, P =.95. The median change in eGFR during the study period was a gain of 28.6 (-51.9 to 83.0) for the NSS cohort vs a loss of 19.1 (-54.7 to 25.2) for the RN cohort, P =.007. Conclusion In a highly selected patient population with nonsyndromic uWT, NSS provides excellent renal function preservation when compared with RN. These data require validation via prospective investigation on a larger scale.

Original languageEnglish
Pages (from-to)1388-1393
Number of pages6
JournalUrology
Volume83
Issue number6
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Urology

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    Cost, N. G., Sawicz-Birkowska, K., Kajbafzadeh, A. M., Tourchi, A., Parigi, G. B., Guillén, G., Defoor, W. R., & Apoznanski, W. (2014). A comparison of renal function outcomes after nephron-sparing surgery and radical nephrectomy for nonsyndromic unilateral wilms tumor. Urology, 83(6), 1388-1393. https://doi.org/10.1016/j.urology.2014.01.051