Evolution of surgical treatment of bilateral Wilms' tumor.

Bilateral Wilms' tumor (stage V) accounts for 10 to 15% of patients with nephroblastoma. Heretofore, surgical resection in many of these children presented insoluble technical problems. Ex vivo renal perfusion with "bench" surgical excision and revascularization has been applied in the management of a child with bilateral Wilms' tumor unresectable by conventional techniques. Complete extirpation of tumor was accomplished. Furthermore, the autotransplanted kidney was removed from the field of radiation therapy given after operation. By selective application of this technique, the child with bilateral Wilms's tumor can be approached with a greater expectation of cure.