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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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%).</p> Conclusion <p>Risk-adapted strategy, multi-disciplinary decision-making, adherence to international protocols can emulate survival outcomes comparable to high-income countries, even in LMICs.</p>

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

  • 期刊论文

  • 发表日期：

    2025年4月8日

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  • Gaurav Ravi Kumar,
  • Anand Chetan Shah,
  • Anand Murali,
  • Shalini Shree Krishnamurthy,
  • Venkatraman Radhakrishnan,
  • Anand Raja

摘要

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.