• Nicholas G Cost, Krystyna Sawicz-Birkowska, Abdol-Mohammad Kajbafzadeh, Ali Tourchi, Gian Battista Parigi, Gabriela Guillén, W Robert DeFoor, and Wojciech Apoznanski.
• Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Urology, University of Colorado School of Medicine and the Children's Hospital Colorado, Aurora, CO. Electronic address: nicholas.cost@sbcglobal.net.
• Urology. 2014 Jun 1; 83 (6): 1388-93.

ObjectiveTo better understand the impact of nephron-sparing surgery (NSS) on renal function in patients with nonsyndromic unilateral Wilms tumor (uWT), a group of such patients treated with NSS were compared with a stage-matched cohort managed with radical nephrectomy (RN). The recommended management of nonsyndromic uWT is RN. However, NSS may decrease the risk of long-term renal disease and associated comorbidities.Materials And MethodsAn international, multi-institutional review was conducted of nonsyndromic uWT cases managed with NSS and compared with a stage-matched RN cohort. Data were collected on demographics, oncologic characteristics and outcomes, serum creatinine, and estimated glomerular filtration rate (eGFR) calculated via Schwartz formula.ResultsFifteen patients who underwent NSS (6 females and 9 males) met study criteria and were diagnosed at a median age of 2.5 years (range, 0.2-8.2 years) and followed for a median of 8.4 years (range, 0.5-31.8 years). The stage-matched RN cohort consisted of 15 patients (8 females and 7 males) diagnosed at a median age of 3.7 years (0.3-7.4) and followed for a median of 2.1 years (0.6-10.5 years). The median preoperative eGFR was 91.7 (39.4-237.7) and 149.9 (93.8-215.9) for NSS and RN, respectively, P=.026. The median eGFR at last follow-up was 135.3 (57.5-185.8) and 131.0 (98.6-161.2) for NSS and RN, respectively, P=.95. The median change in eGFR during the study period was a gain of 28.6 (-51.9 to 83.0) for the NSS cohort vs a loss of 19.1 (-54.7 to 25.2) for the RN cohort, P=.007.ConclusionIn a highly selected patient population with nonsyndromic uWT, NSS provides excellent renal function preservation when compared with RN. These data require validation via prospective investigation on a larger scale.Copyright © 2014 Elsevier Inc. All rights reserved.

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