Efficacy of Neoadjuvant Chemotherapy on Nephron-Sparing Surgery for Wilms Tumor in Horseshoe Kidney

The recent call for the development of standardized criteria to guide the feasibility of nephron-sparing surgery (NSS) for Wilms tumor (WT) in horseshoe kidney [1] stimulated us to share our thoughts on the subject. Amongst the proposed criteria, the authors appropriately included >50% preservation of the remaining renal parenchyma. This is actually the minimum requirement to be met in NSS for horseshoe kidney, given that the removal of one-half along with half a portion of the connecting isthmus equals unilateral nephrectomy in the normal (two-kidney) population.