Treatment for Bilateral Wilms Tumour Achieved – Only 16 Similar Cases Documented Worldwide-

In a ground-breaking medical achievement, Doctors at Fortis Escorts, Okhla, have successfully performed India’s first treatment of Bilateral Wilms Tumour (nephroblastoma), a rare and complex form of paediatric kidney cancer in a 6-year-old boy from Uzbekistan.

The boy’s condition was critical, with tumours affecting both kidneys, endangering his life. Despite undergoing chemotherapy in his home country, his chances of survival remained uncertain, prompting his parents to seek advanced treatment options in India. The child was brought to Fortis Escorts, Okhla, where a skilled team of doctors, led by Dr Paresh Jain, Director of Urology & Kidney Transplant, performed a highly intricate kidney auto-transplant procedure. The surgery, which lasted eight hours, was successful, and the boy recovered swiftly without any complications, following post-surgery observation.

Upon the child’s admission to the hospital, a comprehensive assessment revealed the presence of tumours in both kidneys. However, the left kidney was significantly affected by cancer, making it unsuitable for complete tumour removal without risking damage to the kidney itself. Additionally, the cancer had caused enlargement of the lymph nodes, which are critical to the body’s immune system. To address this, the medical team decided to perform a laparoscopic right partial nephrectomy (Nephron-Sparing Surgery – NSS) to remove the affected portion of the right kidney in August 2024. During this procedure, the right-sided lymph nodes, as well as the enlarged left-sided lymph node, were carefully removed. A biopsy of the left kidney was also performed within the same laparoscopic session, effectively minimizing the need for multiple surgeries.

Following the surgery, the child underwent a prescribed course of chemotherapy in Uzbekistan and returned to Fortis Escorts Okhla for re-assessment in November of the previous year. A follow-up PET-CT scan showed no signs of cancer in the right kidney and significant regression of the tumor in the left kidney. Encouraged by these positive outcomes, the medical team proceeded with further treatment for the remaining tumor in the left kidney. However, during the second stage of surgery, it was discovered that the left kidney was surrounded by thickened tissues due to previous treatments and surgeries, making it extremely difficult to safely separate the tumor from the healthy kidney tissue.

Considering the complexity of the situation, the doctors decided to remove the kidney from the body (Auto Kidney Transplant) through a small lower abdominal incision. This approach allowed for safer and more precise tumor removal while minimizing the risk of spreading cancer cells. The kidney was meticulously dissected to remove the tumor, and the doctors skillfully reconstructed the blood vessels and urine drainage pathways. Once the kidney was free of cancer, it was successfully re-implanted (auto-transplanted) back into the child’s lower abdomen. Following the procedure, the child experienced a gradual and smooth recovery.

Giving details of the case, Dr Paresh Jain, Director of Urology & Kidney Transplant, Fortis Escorts, Okhla, New Delhi said, “This medical achievement is especially noteworthy, as only 16 similar cases have been documented worldwide, with none reported previously in India. Wilms tumour, usually diagnosed in children aged 3-4 years, present significant challenges due to its rarity and complexity. Its advanced stage poses a unique challenge because it can be bilateral, affecting both the kidneys and if not treated promptly, it can become life-threatening.”

“Globally, most similar procedures are not performed laparoscopically and typically involve two separate surgical teams-one for paediatric oncosurgery and another for kidney transplantation. However, in this case, both complex procedures were successfully carried out by a single specialized team, highlighting the team’s exceptional surgical expertise and coordination. The significance of this particular surgery was to avoid Maternal Kidney Donation: The procedure spared the child’s mother from donating a kidney, preserving her health and kidney function; Eliminated Lifelong Immunosuppression: By preserving the child’s own kidney, the need for lifelong immunosuppressive medications—typically required after transplants—was completely avoided. These medications could have caused harmful side effects and increased infection risk, reduced financial burden.”

“Given the child’s young age, he would likely have required at least three kidney transplants over his lifetime. This surgery preserved his natural kidney function, eliminating the need for multiple transplants,” Dr Jain added.

Patient’s Mother said, “We came to India with a hope after our son’s condition did not improve in Uzbekistan. The Doctors at Fortis gave us the confidence that our son would recover. We are extremely thankful to Dr Paresh Jain and the entire team of doctors for their hard work and for saving our son’s life. He is now back to playing and smiling, and we are beyond grateful for this second chance at life.”

 Dr Vikram Aggarwal, Facility Director, Fortis Escorts, Okhla said, “This rare case marks India’s first reported successful surgical intervention, underscoring the hospital’s leadership in multidisciplinary care. Our dedicated team, led by Dr Paresh Jain, assessed all parameters and conducted the procedure with exceptional precision. This case was uniquely challenging, and our success is a testament to the dedication, skill, and collaboration of our team.”