ENUCLEATIVE SURGERY FOR STAGE-I NEPHROBLASTOMA WITH A NORMAL CONTRALATERAL KIDNEY

Purpose: Tumor enucleation is not recommended for children with nephro blastoma and a normal contralateral kidney. However, in adults with un ilateral low stage renal cell carcinoma tumor enucleation may offer an alternative to radical nephrectomy, since functioning renal tissue is preserved without a greater risk of residual microscopic disease, Enu cleative surgery may be more reasonable in children with nephroblastom a, because the risk of relapse can be reduced with chemotherapy. There fore, we prospectively evaluated the feasibility of enucleative surger y in children with stage I unilateral nephroblastoma. Materials and Me thods: Between 1992 and 1995, 13 children with nephroblastoma and a no rmal contralateral kidney were consecutively admitted to our surgical unit. Possible candidates ibr tumor enucleation were evaluated accordi ng to certain criteria, including stage I disease at diagnosis, well-d efined margins on post-contrast computerized tomography and at least 5 0% of the functioning kidney could be preserved, Preoperative and post operative chemotherapy was given in all cases. Results: Of 4 children with preservation of more than 50% of the functioning kidney 3 were co nsidered eligible for enucleation. The tumors, which were confined to the mid kidney in 2 children and upper renal pole in 1, were successfu lly enucleated without hypothermia or vascular occlusion, All 3 childr en are disease-free at 49, 48 and 26 months of followup, respectively. Renal function has been almost completely restored postoperatively. C onclusions: These preliminary data suggest that enucleative surgery ma y be a reasonable option in select children with stage I nephroblastom a and a normal contralateral kidney.