Ricerc@Sapienza

Background: Whether partial nephrectomy (NSS) is a reasonable alternative to nephrectomy in children with Wilms tumor (WT) in the setting of a normal contralateral kidney remains controversial. Main issue against such clinical scenario is that there is no convincing evidence that 50% reduction of renal mass is associated with increased risk of renal failure. However, we have already produced robust data supporting the oncologic efficacy and safety of such approach, along with positive effect on long-term renal function in our cohort of children with non-metastatic WT.
Purpose: To validate the efficacy and safety of our clinical protocol of NSS in children with unilateral primary renal tumor and normal contralateral kidney. In particular, we will focus our attention on the oncologic and nephrological outcomes of NSS in our cohort of patients.
Methods: Single Institution, longitudinal and cross-sectional pilot study. Primary end points will include:
- To determine residual renal function and relative renal volume of the kidney remnants after NSS;
- To compare oncologic and nephrological outcomes of patients with primary renal tumor receiving either radical nephrectomy or NSS.
Matched case-control analysis will be employed to control for known potential confounding variables. We will also assess local and systemic recurrence rates, overall and event-free survival rates, and morbidity (especially surgery-related).
Hypothesis: Kidney remnants after NSS significantly contribute to overall renal mass and function. Such renal function advantage of NSS does not adversely affect the oncologic outcome of these patients, in comparison to patients treated with radical nephrectomy.
Implication: In children, nephrectomy should no longer be considered as the gold standard surgical treatment for unilateral WT, even in the setting of a normally functioning contralateral kidney.