Management of Intravascular Thrombus in Bilateral Wilms Tumor or Horseshoe Kidney
Topic overview
This retrospective study of 5 patients demonstrates that nephron-sparing surgery is feasible for bilateral Wilms tumor with intravascular thrombus using 12-week neoadjuvant chemotherapy and staged surgical approaches. Four of five patients underwent successful nephron-sparing procedures with thrombectomy, with no patients requiring renal replacement therapy during follow-up.
Key takeaways
- 12 weeks of neoadjuvant chemotherapy enables nephron-sparing surgery in bilateral Wilms tumor with IVC thrombus in most cases
- Staged bilateral surgery (6 weeks apart) allows tumor response assessment and optimizes nephron preservation
- Complete thrombus response to chemotherapy occurred in 1/5 patients, eliminating need for thrombectomy
- Successful nephron-sparing thrombectomy requires branched renal veins or accessory vessels—preoperative mapping is critical
- All patients avoided dialysis/transplant despite CKD stage II-III in 60%, validating aggressive nephron preservation approach
Comments