Increasing recognition of bilateral renal involvement in Wilms' tumor (nephroblastoma) has led to a less radical approach to surgical treatment. Experience with bilateral nephrectomy and subsequent dialysis or transplant has been unsatisfactory, and unilateral nephrectomy with contralateral radiotherapy carries the morbidity of radiation in addition to the risk of recurrent disease. Advances in chemotherapy have facilitated preoperative shrinkage of tumors and subsequent local excision of remaining tumor nodules with preservation of functioning renal tissue. We have treated 10 children with bilateral (stage V) Wilms' tumor in this manner. Two-year disease-free survival in this group is 60Β°70, and renal function is satisfactory in all survivors. This experience suggests that nephron-sparing surgery may be possible in the majority of children with Wilms' tumor. Conservative surgery is essential in certain special situations such as solitary kidney or the horse-shoe abnormality.
Bilateral renal involvement occurs in approximately 6 % -7 % of children with Wilms' tumor (nephroblastoma) [3]. The traditional approach of primary surgical extirpation of tumor would necessitate bilateral nephrectomy in such patients. Current chemotherapy regimes have demonstrated the ability to reduce tumor bulk greatly [i41, and pre-operative chemotherapy can facilitate the removal of large, even seemingly "inoperable" lesions [6]. Maximum utilisation of this potential may allow conservative resection of tumors and preservation of functioning nephrons. At the Hospitals for Sick Children we have adopted this approach in the management of children with bilateral (stage V) Wilms' tumor in an effort to ac-