THE PLACE OF CONSERVATIVE SURGERY IN THE TREATMENT OF NEPHROBLASTOMAS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 88  (4) , 223-229
Abstract
Experience with partial nephrectomy for nephroblastoma in children is reported. In a series of 83 cases, 10 had this operation in order to avoid chronic renal insufficiency: 6 for nephroblastomas which were bilateral from the onset; 2 for nephroblastoma in a single remaining kidney; 1 for nephroblastomatosis; and 1 operated with an erroneous diagnosis. In bilateral nephroblastomas 2-stage operations with extemporaneous histologic control are advised. The easiest side to operate on is done first, and a urographic examination is done prior to the 2nd operation. The location of the tumor, more than its size, is a determining factor for this conservative intervention. Minute dissection of the pedicle should be anticipated. 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 9 mo. to 8 yr. None have a progressive tumor.

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