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SURGICAL TREATMENT OF BILATERAL WILMS TUMOR IN CHILDREN: TWO CASE REPORTS AND A LITERATURE REVIEW
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Abstract
Overview: Wilms tumor (nephroblastoma) is one of the most common solid tumors in children. The survival rate after treatment for unilateral kidney tumors is over 80%, following the principle of combining chemotherapy with complete removal of the affected kidney. We report two pediatric cases of bilateral Wilms tumor treated surgically with follow-up periods of over 36months. Case Reports: Case 1: Patient Trần Tâm A, female, 8 months old, had bilateral kidney tumors— a large tumor on the left kidney and a small one on the right. The patient underwent left nephrectomy after one week of chemotherapy due to lack of tumor shrinkage and breathing difficulty. Postoperative treatment included chemotherapy and radiotherapy according to the SIOP protocol. A second surgery was performed to remove part of the right kidney containing the tumor. Chemotherapy was continued. After 48 months of treatment, there was no recurrence, and kidney function remained stable. Case 2: Patient Lê An Ph, male, 12 months old, had bilateral kidney tumors and received preoperative chemotherapy per the SIOP protocol. The first surgery involved removal of the right kidney and the lower pole of the left kidney (tumor-containing part). Chemotherapy and radiotherapy were continued. A second surgery was performed 4 months later to remove residual tumor at the previous resection site of the left kidney. After 36 months of treatment, there was no tumor recurrence, and kidney function remained stable. Discussion: Wilms tumor is most commonly seen in children aged 2–5 years. Bilateral involvement is rare, accounting for only 4–8% of cases. Diagnosis mainly relies on imaging modalities such as multi-slice CT or MRI. The SIOP treatment protocol involves a combination of preoperative chemotherapy, surgery, postoperative chemotherapy, and radiotherapy in stage 3 cases. The survival rate after treatment is over 80%. Conclusion: Surgery for bilateral kidney tumors requires careful planning to remove the tumor while preserving as much kidney function as possible.
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Keywords
Bilateral Wilms tumor, surgical treatment, nephron sparing.
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