[The place of conservative surgery in the treatment of nephroblastomas (author's transl)]

Abstract

The authors report their experience with partial nephrectomy for nephroblastoma in children. In a series of 83 cases, 10 had this operation in order to avoid chronic renal insufficiency: six for nephroblastomas which were bilateral from the onset; two for nephroblastoma in a single remaining kidney; one for nephroblastomatosis, and one operated with an erroneous diagnosis. In bilateral nephroblastomas they advise two stage operations with extemporaneous histologic control. The easiest side to operate is operated the first, and a urographic examination is done prior to the second operation. The location of the tumor, more than its size, is a determining factor for this conservative intervention. One must be prepared to do minute dissection of the pedicle. However, if there remains too little renal parenchyma, it is not worthwhile to preserve the pedicle. Contraindications for conservative surgery are: thrombosis of the renal vein, central location of the tumor, fragility of the tumor risking rupture during surgical manipulation, and spread of the tumor beyond the capsule. In 13 partial nephrectomies there was a single failure due to thrombosis of a renal vein. Ten children are alive with a follow up of nine months to eight years. None have a progressive tumor. It is certain that with chemiotherapy tumorectomies are reasonable in certain cases of nephroblastoma.