{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T07:55:52Z","timestamp":1772092552665,"version":"3.50.1"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Wilms tumor is the Most common renal malignancy in children, but bilateral Wilms tumor (BWT) is rare and poses competing priorities for cure and renal preservation. Neoadjuvant chemotherapy followed by nephron-sparing surgery is standard, yet optimal timing when resistance emerges remains challenging. This case describes advanced BWT with secondary chemotherapy resistance and hepatic capsular involvement, successfully managed with timely, aggressive bilateral nephron-sparing surgery and liver capsule resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 5-year-old girl presented with progressive, painless abdominal distension and large, firm bilateral flank masses. Abdominal MRI showed large intrarenal tumors in both kidneys without metastases. After six months of neoadjuvant chemotherapy, initial partial response was followed by interval regrowth. She underwent single-stage bilateral nephron-sparing surgery with right partial nephrectomy plus\n                      <jats:italic>en bloc<\/jats:italic>\n                      liver capsule resection and left partial nephrectomy with reconstruction and nephrostomy. The patient is currently disease-free on follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Bilateral Wilms tumor represents a minority of cases and carries a substantial lifetime risk of end-stage renal disease. Protocols favor neoadjuvant chemotherapy to facilitate nephron-sparing surgery within 6\u201312 weeks. In this patient, secondary chemotherapy resistance with predominant stromal maturation supported proceeding to surgery rather than intensifying therapy. Successful single-stage bilateral nephron-sparing surgery with negative margins avoided dialysis and transplant despite extensive bilateral disease and hepatic capsular extension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that even in bilateral Wilms tumor complicated by secondary chemotherapy resistance and hepatic capsular involvement, aggressive nephron-sparing surgery can achieve disease control while preserving renal function. Prolonged oncologic and renal surveillance is warranted given the recognized risk of late renal events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1772408","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:55:56Z","timestamp":1772088956000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful bilateral nephron-sparing surgery for recurrent stage V Wilms tumor with hepatic capsule involvement: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Umer","family":"Siddiqui","sequence":"first","affiliation":[{"name":"Royal Berkshire NHS Foundation Trust","place":["Reading, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meenam","family":"Qazi","sequence":"additional","affiliation":[{"name":"John Radcliffe Hospital","place":["Oxford, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheikh Nabeel","family":"Sheikh Mohamed Nazer","sequence":"additional","affiliation":[{"name":"Uniwersytet Medyczny w Lublinie","place":["Lublin, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayed Ayman","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Burjeel Medical City","place":["Abu Dhabi, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youssef","family":"Ahmad","sequence":"additional","affiliation":[{"name":"University of Tartous","place":["Tartus, Syria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Barakat","sequence":"additional","affiliation":[{"name":"University of Tartous","place":["Tartus, Syria"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3142","DOI":"10.3390\/cancers13133142","article-title":"Prognostic factors for wilms tumor recurrence: a review of the literature","volume":"13","author":"Groenendijk","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s00383-015-3668-1","article-title":"Nephron-sparing surgery for bilateral Wilms tumor","volume":"31","author":"Kieran","year":"2015","journal-title":"Pediatr Surg Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3390\/pediatric15030051","article-title":"Prechemotherapy transperitoneal robotic-assisted partial nephrectomy (RAPN) for a Wilms tumor: surgical and oncological outcomes in a four-year-old patient","volume":"15","author":"Della 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bilateral Wilms\u2019 tumour: a case report","volume":"77","author":"Wahyudi","year":"2020","journal-title":"Int J Surg Case Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1002\/ijc.35080","article-title":"Long-term outcomes and patterns of relapse in patients with bilateral Wilms tumor or bilaterally predisposed unilateral Wilms tumor, a report from the COG AREN0534 study","volume":"155","author":"Murphy","year":"2024","journal-title":"Int J Cancer"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1093\/jnci\/djae072","article-title":"Response of bilateral Wilms tumor to chemotherapy suggests histologic subtype and guides treatment","volume":"116","author":"Duncan","year":"2024","journal-title":"J Natl Cancer Inst"},{"key":"B10","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jpedsurg.2013.09.048","article-title":"Repeat nephron-sparing surgery for children with bilateral Wilms 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