Management of Intravascular Thrombus in Bilateral Wilms Tumor or Horseshoe Kidney
Topic overview
Retrospective study of 5 pediatric patients with bilateral Wilms tumor or horseshoe kidney Wilms tumor complicated by intravascular thrombus. Neoadjuvant chemotherapy followed by nephron-sparing surgery with thrombectomy achieved tumor control while preserving renal function in all patients, with no cases requiring dialysis or transplant.
Key takeaways
- 12 weeks of neoadjuvant chemotherapy enables nephron-sparing surgery in bilateral Wilms tumor with intravascular thrombus in most cases
- Staged surgical approach (6 weeks apart) allows tumor response assessment and optimizes nephron preservation in bilateral disease
- Complete thrombus response to chemotherapy occurred in 1/5 patients, eliminating need for thrombectomy at definitive surgery
- Nephron-sparing surgery with thrombectomy requires branched renal venous anatomy or accessory renal veins for technical success
- All patients avoided dialysis/transplant despite complex disease; 3/5 developed manageable stage II-III chronic kidney disease
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