loading page

Evidence-Based Surgical Guidelines for Treating Children with Wilms Tumor in Low-Resource Settings
  • +23
  • Abdelhafeez Abdelhafeez,
  • Tea Reljic,
  • Ambuj Kumar,
  • Tahmina Banu,
  • Sharon Cox,
  • Andrew Davidoff,
  • Ahmed Elgendy,
  • Khalil Ghandour,
  • Justin Gerstle,
  • Jonathan Karpelowsky,
  • Sue Kaste,
  • Nahla Kechiche,
  • Natia Esiashvili,
  • Abdulrasheed Nasir,
  • Amon Ngongola,
  • Jin Marollano,
  • Amabelle Moreno,
  • Arlene Muzira ,
  • Jeannette Parkes,
  • Lily Saldaña,
  • Jaime Shalkow-Klincovstein ,
  • Gordan Vujanic,
  • Thelma Velasquez ,
  • Kokila Lakoo,
  • Sheena Mukkada,
  • Simone Abib
Abdelhafeez Abdelhafeez
St. Jude Children's Research Hospital

Corresponding Author:[email protected]

Author Profile
Tea Reljic
University of South Florida College of Medicine
Author Profile
Ambuj Kumar
University of South Florida College of Medicine
Author Profile
Tahmina Banu
Chittagong Research Institute for Children Surgery (CRICS)
Author Profile
Sharon Cox
Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
Author Profile
Andrew Davidoff
St. Jude Children's Research Hospital
Author Profile
Ahmed Elgendy
Tanta University
Author Profile
Khalil Ghandour
King Hussein Cancer Center
Author Profile
Justin Gerstle
Memorial Sloan Kettering Cancer Center
Author Profile
Jonathan Karpelowsky
12The Children’s Hospital at Westmead, Division of Child & Adolescent Health, The University of Sydney, Children’s Cancer Research Unit –Kids Research Institute
Author Profile
Sue Kaste
St. Jude Children's Research Hospital
Author Profile
Nahla Kechiche
University Hospital Monastir, LR12SP13, University of Monastir
Author Profile
Natia Esiashvili
Emory University Winship Cancer Institute
Author Profile
Abdulrasheed Nasir
University of Ilorin Teaching Hospital
Author Profile
Amon Ngongola
University of Zambia University Teaching Hospital
Author Profile
Jin Marollano
Childhood Cancer International
Author Profile
Amabelle Moreno
University of the Philippines-Philippine General Hospital Department of Surgery
Author Profile
Arlene Muzira
Uganda Cancer Institute
Author Profile
Jeannette Parkes
Groote Schuur Hospital
Author Profile
Lily Saldaña
Instituto Nacional de Salud del Niño San Borja
Author Profile
Jaime Shalkow-Klincovstein
National Institute of Paediatrics and ABC Cancer Centre
Author Profile
Gordan Vujanic
Sidra Medicine, Weill Cornell Medicine – Qatar
Author Profile
Thelma Velasquez
Unidad Nacional de Oncologia Pediatrica
Author Profile
Kokila Lakoo
Oxford University
Author Profile
Sheena Mukkada
St. Jude Children's Research Hospital
Author Profile
Simone Abib
Pediatric Oncology Institute – GRAACC – Federal University of São Paulo
Author Profile


Survival of Wilms tumor (WT) is >90% in high-resource settings but <30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes. Objective: Provide resource-sensitive recommendations for the surgical management of WT. Methods: We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Recommendations: Initiation of treatment should be expedited, and surgery should be done in a high-volume setting. Cross-sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6–12 weeks. Neither routine use of complex hilar control techniques during nephron-sparing surgery, nor nephron-sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post-chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole-lung irradiation in patients with non-anaplastic histology stage IV WT with pulmonary metastasis. Conclusion: We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.
16 Feb 2022Submitted to Pediatric Blood & Cancer
16 Feb 2022Submission Checks Completed
16 Feb 2022Assigned to Editor
18 Feb 2022Reviewer(s) Assigned
21 Mar 2022Review(s) Completed, Editorial Evaluation Pending
21 Mar 2022Editorial Decision: Revise Minor
12 Apr 20221st Revision Received
12 Apr 2022Assigned to Editor
12 Apr 2022Submission Checks Completed
13 Apr 2022Reviewer(s) Assigned
05 May 2022Review(s) Completed, Editorial Evaluation Pending
06 May 2022Editorial Decision: Revise Minor
09 Jun 2022Submission Checks Completed
09 Jun 2022Assigned to Editor
09 Jun 20222nd Revision Received
13 Jun 2022Reviewer(s) Assigned
04 Jul 2022Review(s) Completed, Editorial Evaluation Pending
04 Jul 2022Editorial Decision: Accept
Dec 2022Published in Pediatric Blood & Cancer volume 69 issue 12. 10.1002/pbc.29906