Is There A Surgery For Wilms Tumor?

Yes, surgery is the main treatment option for the majority of children with Wilms’ tumor (WT). The main objective of the surgery is to remove the whole tumor in one piece to prevent the spread of cancer cells to the abdomen. The operation should be done by an experienced surgeon specialized for this type of surgery in children. If the surgeon thinks that it would be impossible to remove the entire tumor then neoadjuvant treatment to shrink the tumor should be carried out prior to the surgery.

Surgery Process:

Indications And Contraindication For Surgery

Indications

Tumors confined completely to the kidney
Tumors that extend beyond the kidney but that does not cross the midline with or without vascular extension
Surgical resection after chemotherapy
Bilateral tumors
Tumors that cross the midline with vascular extension

Contraindications

Some of the bilateral tumors
Tumors with metastatic disease
Large tumors that cross the midline with the vascular extension (relative contraindication)

Surgical Treatment For Wilms’ Tumor

There are two types of main surgical options, depending on the patient’s condition, the involvement of the tumor and the spread of the tumor a suitable option would be chosen.

Radical Nephrectomy For Wilms’ Tumor

In a radical nephrectomy, the entire kidney is removed along with the other close by structures such as the adrenal gland, fatty tissue, and the ureter. Radical nephrectomy is done in children with Wilms’ tumor in one kidney. The goal of the surgery is to remove the entire tumor along with the kidney and other structures nearby to completely remove all cancerous cells. If the other kidney is healthy, most children will survive well with just one kidney. This is the best surgical option as the recurrence rates are less.

Partial Nephrectomy For Wilms’ Tumor

This is also called nephron-sparing surgery. As the name indicates the only part of the kidney is removed. This is mainly done in children who have Wilms’ tumor in both kidneys, solitary kidney and renal insufficiency and partial nephrectomy is done to save some amount of normal kidney tissue to preserve the kidney function. However, this is feasible only in about 10-15% of children as most of the time the tumor is too large. One option for this surgery is to remove the kidney that is larger and contain more tumor cells completely and do a partial nephrectomy on the other kidney by just removing the tissue with tumor cells along with a margin of the normal tissue. Another option for this surgery is to do partial nephrectomies for both kidneys and save enough normal tissue. The main problem is the local recurrence which is about 8% following partial nephrectomy.

If both kidneys cannot be saved, then both kidneys need to be removed. Then the child will have to undergo dialysis regularly to remove the waste products. When the child is healthy and when a donor’s kidney is available, kidney transplantation can be done. ^{(1) (2) (4)}

Surgical Exploration

With radical and partial nephrectomy, surgical exploration is done to check if the other kidney, nearby lymph nodes and other structures such as the liver are involved and this is important to determine the extent and stage of Wilms’ tumor. Sometimes biopsies are taken during the time of surgery. ^{(1) (2) (3)}

Surgical Approaches For Wilms’ Tumor

Open Surgery: Usually, a midline incision is made on the abdomen. This allows surgical exploration however; the recovery is slow.

Laparoscopic Nephrectomy: Laparoscopic nephrectomy can be done in children with a small tumor, not spread locally or metastasized. The faster recovery is the benefit of it.

Conclusion

Surgery is the main treatment option for Wilms’ tumor. There are two surgical methods which are radical and partial nephrectomy. In a radical nephrectomy, the affected kidney and another close by structures are removed completely in children with Wilms’ tumor in one kidney. Partial nephrectomy is done in children who have Wilms’ tumor in both kidneys, solitary kidney and renal insufficiency and it’s done to save some amount of normal kidney tissue to preserve the kidney function. However, the recurrence rate is high in partial nephrectomy. Surgical exploration is done with partial or radical nephrectomy to check if the other kidney, nearby lymph nodes and other structures such as the liver are involved and this is important to determine the extent and stage of Wilms’ tumor.

References:

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Is There A Surgery For Wilms Tumor?