Surgical practices and oncological outcomes of Wilms tumor in a resource limited setting: a risk-adapted approach.

Purpose: Wilms tumor (WT) is the most common renal neoplasm in children and the third most common pediatric cancer globally. Though survival rates exceed 90% in high-income countries, it is suboptimal in low- and middle-income countries (LMICs) due to late presentation, advanced disease stages, and limited healthcare access. We retrospectively analyzed WT patients undergoing definitive surgery between 2011 and 2023 from a single LMIC institution.

Methods: Patients were classified into Group I (upfront surgery as per COG guidelines) and Group II (neoadjuvant chemotherapy followed by surgery as per SIOP guidelines). Surgical outcomes, post-operative morbidity, and oncological outcomes, including overall survival (OS) and event-free survival (EFS), were analyzed. Thirty-six patients were included: ten in Group I and twenty-six in Group II.

Results: Significant post-operative complications occurred in 15.3% of Group II, while none were noted in Group I. Lymph node involvement rates were 10 and 3.8% in Groups I and II, respectively. The 5-year OS and EFS for the cohort were 90.9% (Group I 83%, Group II 92%) and 91.4% (Group I 80%, Group II 96%).

Conclusion: Risk-adapted strategy, multi-disciplinary decision-making, adherence to international protocols can emulate survival outcomes comparable to high-income countries, even in LMICs.