# Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children

## TL;DR

A new surgical technique moves the kidney outside the body to safely remove large tumors while preserving healthy kidney tissue in children with certain cancers.

## Contribution

The study introduces renal autotransplantation as a novel surgical approach for resecting tumors in children with bilateral nephroblastoma or high-risk neuroblastoma.

## Key findings

- Complete tumor resection was achieved in all patients using renal autotransplantation.
- Surviving patients showed no evidence of disease and normal to slightly decreased kidney function after follow-up.
- The technique is feasible for children ineligible for standard in situ tumor removal methods.

## Abstract

For children with large tumors in or around the kidneys, such as bilateral nephroblastoma or high-risk neuroblastoma, surgery to remove the tumors and spare healthy kidney tissue is often not possible. This article describes an alternative surgical technique: The kidney is moved outside the body, cooled on ice, and fed with a solution. The tumor can then be removed from the kidney outside of the body, and the kidney can then be reimplanted into the body. We have found that with this method, tumors can be completely removed while saving healthy kidney tissue.

Background/Objectives: In bilateral nephroblastoma and high-risk neuroblastoma in children with extensive tumor involvement of the renal vessels or pedicle, complete tumor resection with preservation of healthy renal tissue is not feasible with in situ nephron-sparing surgery or vascular replacement. The aim of this study was to present our experience with ante situ tumor resection and renal autotransplantation (RATX) in these children. Methods: A retrospective study of children with bilateral nephroblastoma and high-risk neuroblastoma who underwent tumor resection and RATX at an international referral center for pediatric surgical oncology between 2006 and 2024 was performed. RATX was performed by transection of renal vessels, ante situ mobilization, and perfusion of the kidney with Bretschneider’s solution. Tumor resection was performed on a bloodless kidney under hypothermia. Results: Ante situ tumor resection and RATX were performed at a median age of 36 months (range 13–62) in 4 children with bilateral nephroblastoma and 4 children with high-risk neuroblastoma. Complete tumor resection was achieved in all patients. One patient with neuroblastoma died of sepsis after 14 days. The 7 surviving patients showed no evidence of disease and normal to slightly decreased glomerulofiltration rates at a median follow-up of 20 months (range 3–155). Limitations include the retrospective design, small sample size, and heterogeneity of the study population due to very rare indication. Conclusions: Ante situ tumor resection and RATX is a feasible surgical approach for children with multifocal bilateral nephroblastoma or high-risk neuroblastoma who are ineligible for in situ nephron-sparing surgery or vascular reconstruction.