Nephron-sparing surgery for unilateral primary renal tumor in children

D. A. Cozzi, A. Schiavetti, F. Morini, M. A. Castello, F. Cozzi

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: Definition of the role of nephron-sparing surgery (NSS) in the treatment of children with primary unilateral renal tumor (URT). Methods; Between January 1992 and June 2000, 28 children with URT were admitted to our surgical unit. Criteria for selection of patients eligible for NSS were at least 50% of affected kidney preservable and stage I at surgery (frozen section biopsies from regional lymph nodes, perirenal fat, and surrounding renal parenchyma). Preoperative 2-drug chemotherapy was given to all patients more than 6 months of age. Between 1992 and 1995, 3-drug chemotherapy was used after NSS. Thereafter, following NSS, 2-drug chemotherapy was given if no microscopic residual disease was found on final histologic examination. Results: NSS was feasible in 10 of 28 children (35%). Enucleation of 6 tumors (1 metachronous) was performed in 5 patients. NSS was elective in 5 patients, mandatory in 3 patients (1 with aniridia and genitourinary anomalies, 1 with chronic glomerulonephritis, 1 with bilateral hyperplastic nephroblastomatosis), and advisable in 2 patients (1 with familial vesicoureteric reflux and 1 with cystic nephroma). Seven children had standard histology nephroblastoma, 1 highly differentiated epithelial type nephroblastoma, 1 oncocytoma, and 1 cystic nephroma. The only post-NSS complication was macroscopic hematuria in 1 patient. None of the patients had a relapse. All children are alive and disease free with good functioning of the affected kidney after NSS, at a mean follow-up of 40.7 months (range, 2 to 100 months). Conclusion: NSS should be considered in selected children with URT, especially in patients with increased risk for metachronous tumor or renal disease, and in patients with benign or low-grade malignant URT.

Original languageEnglish
Pages (from-to)362-365
Number of pages4
JournalJournal of Pediatric Surgery
Volume36
Issue number2
DOIs
Publication statusPublished - 2001

Fingerprint

Nephrons
Kidney
Neoplasms
Wilms Tumor
Drug Therapy
Patient Selection
Aniridia
Pharmaceutical Preparations
Oxyphilic Adenoma
Frozen Sections
Hematuria
Glomerulonephritis
Histology
Lymph Nodes
Fats
Biopsy
Recurrence

Keywords

  • Cystic nephroma
  • Partial nephrectomy
  • Renal tumor
  • Wilms' tumor

ASJC Scopus subject areas

  • Surgery

Cite this

Nephron-sparing surgery for unilateral primary renal tumor in children. / Cozzi, D. A.; Schiavetti, A.; Morini, F.; Castello, M. A.; Cozzi, F.

In: Journal of Pediatric Surgery, Vol. 36, No. 2, 2001, p. 362-365.

Research output: Contribution to journalArticle

Cozzi, D. A. ; Schiavetti, A. ; Morini, F. ; Castello, M. A. ; Cozzi, F. / Nephron-sparing surgery for unilateral primary renal tumor in children. In: Journal of Pediatric Surgery. 2001 ; Vol. 36, No. 2. pp. 362-365.
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abstract = "Purpose: Definition of the role of nephron-sparing surgery (NSS) in the treatment of children with primary unilateral renal tumor (URT). Methods; Between January 1992 and June 2000, 28 children with URT were admitted to our surgical unit. Criteria for selection of patients eligible for NSS were at least 50{\%} of affected kidney preservable and stage I at surgery (frozen section biopsies from regional lymph nodes, perirenal fat, and surrounding renal parenchyma). Preoperative 2-drug chemotherapy was given to all patients more than 6 months of age. Between 1992 and 1995, 3-drug chemotherapy was used after NSS. Thereafter, following NSS, 2-drug chemotherapy was given if no microscopic residual disease was found on final histologic examination. Results: NSS was feasible in 10 of 28 children (35{\%}). Enucleation of 6 tumors (1 metachronous) was performed in 5 patients. NSS was elective in 5 patients, mandatory in 3 patients (1 with aniridia and genitourinary anomalies, 1 with chronic glomerulonephritis, 1 with bilateral hyperplastic nephroblastomatosis), and advisable in 2 patients (1 with familial vesicoureteric reflux and 1 with cystic nephroma). Seven children had standard histology nephroblastoma, 1 highly differentiated epithelial type nephroblastoma, 1 oncocytoma, and 1 cystic nephroma. The only post-NSS complication was macroscopic hematuria in 1 patient. None of the patients had a relapse. All children are alive and disease free with good functioning of the affected kidney after NSS, at a mean follow-up of 40.7 months (range, 2 to 100 months). Conclusion: NSS should be considered in selected children with URT, especially in patients with increased risk for metachronous tumor or renal disease, and in patients with benign or low-grade malignant URT.",
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