. 2022 Dec;69(12):e29906.

doi: 10.1002/pbc.29906. Epub 2022 Aug 5.

Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings

Abdelhafeez H Abdelhafeez^{1

2}, Tea Reljic³, Ambuj Kumar⁴, Tahmina Banu⁵, Sharon Cox⁶, Andrew M Davidoff^{1

2}, Ahmed Elgendy⁷, Khalil Ghandour⁸, J Ted Gerstle⁹, Jonathan Karpelowsky¹⁰, Sue C Kaste^{2

11}, Nahla Kechiche¹², Natia Esiashvili¹³, Abdulrasheed Nasir¹⁴, Amon Ngongola¹⁵, Jin Marollano¹⁶, Amabelle A Moreno¹⁷, Arlene Muzira¹⁸, Jeannette Parkes¹⁹, Lily J Saldaña²⁰, Jaime Shalkow²¹, Gordan M Vujanić²², Thelma Velasquez²³, Kokila Lakhoo²⁴, Sheena Mukkada^{2

25}, Simone Abib²⁶

Affiliations

¹ Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
² University of Tennessee Health Science Center, Memphis, Tennessee.
³ Office of Research Conduct and Morsani College of Medicine, University of South Florida, Tampa, Florida.
⁴ Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida.
⁵ Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh.
⁶ Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁷ Surgical Oncology Unit, Tanta University & Department of Pediatric Surgery, Children's Cancer Hospital - Egypt, Tanta, Gharbia, Egypt.
⁸ Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
⁹ Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
¹⁰ The Children's Hospital at Westmead, Division of Child & Adolescent Health, The University of Sydney, Children's Cancer Research Unit -Kids Research Institute, Sydney, Australia.
¹¹ Department of Radiaology and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
¹² Department of Pediatric Surgery, University Hospital Monastir, LR12SP13, University of Monastir, Monastir, Tunisia.
¹³ Department of Radiation Oncology, Emory Winship Cancer Institute, Atlanta, Georgia.
¹⁴ Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, Ilorin, Kwara State, Nigeria.
¹⁵ Department of Pediatric Surgery, University Teaching Hospital, Lusaka, Zambia.
¹⁶ Childhood Cancer International, Manila, Philippines.
¹⁷ Division of Pediatric Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines.
¹⁸ Department of Paediatric Surgery, Uganda Cancer Institute, Kampala, Uganda.
¹⁹ Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa.
²⁰ Pediatric Surgery Service, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru.
²¹ Pediatric Surgery, National Institute of Paediatrics and ABC Cancer Centre, Mexico City, Mexico.
²² Department of Pediatric Pathology, Sidra Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.
²³ Department of Oncology, Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala.
²⁴ Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK.
²⁵ Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
²⁶ Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil.

PMID: 35929184
DOI: 10.1002/pbc.29906

Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings

Abdelhafeez H Abdelhafeez et al. Pediatr Blood Cancer. 2022 Dec.

. 2022 Dec;69(12):e29906.

doi: 10.1002/pbc.29906. Epub 2022 Aug 5.

Authors

Affiliations

¹ Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
² University of Tennessee Health Science Center, Memphis, Tennessee.
³ Office of Research Conduct and Morsani College of Medicine, University of South Florida, Tampa, Florida.
⁴ Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida.
⁵ Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh.
⁶ Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁷ Surgical Oncology Unit, Tanta University & Department of Pediatric Surgery, Children's Cancer Hospital - Egypt, Tanta, Gharbia, Egypt.
⁸ Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
⁹ Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
¹⁰ The Children's Hospital at Westmead, Division of Child & Adolescent Health, The University of Sydney, Children's Cancer Research Unit -Kids Research Institute, Sydney, Australia.
¹¹ Department of Radiaology and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
¹² Department of Pediatric Surgery, University Hospital Monastir, LR12SP13, University of Monastir, Monastir, Tunisia.
¹³ Department of Radiation Oncology, Emory Winship Cancer Institute, Atlanta, Georgia.
¹⁴ Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, Ilorin, Kwara State, Nigeria.
¹⁵ Department of Pediatric Surgery, University Teaching Hospital, Lusaka, Zambia.
¹⁶ Childhood Cancer International, Manila, Philippines.
¹⁷ Division of Pediatric Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines.
¹⁸ Department of Paediatric Surgery, Uganda Cancer Institute, Kampala, Uganda.
¹⁹ Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa.
²⁰ Pediatric Surgery Service, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru.
²¹ Pediatric Surgery, National Institute of Paediatrics and ABC Cancer Centre, Mexico City, Mexico.
²² Department of Pediatric Pathology, Sidra Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.
²³ Department of Oncology, Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala.
²⁴ Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK.
²⁵ Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
²⁶ Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil.

PMID: 35929184
DOI: 10.1002/pbc.29906

Abstract

Background: 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 nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis.

Conclusion: We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.

Keywords: Wilms tumor; guidelines; nephroblastoma; surgery.

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Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings

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Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings

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