WILMS' TUMOR: Surgical Considerations and Controversies

Wilms' tumor is the most common malignant neoplasm of the genitourinary tract in children, occurring with an annual incidence of 7 cases per 1 million children under the age of 15 years. 2 More than 90% of children with Wilms' tumor can expect cure, 52 and the multimodality treatment protocols for this lesion continue to undergo refinement. Although all affected children are treated with surgery and adjuvant chemotherapy, radiotherapy is reserved for patients with advanced stage disease or with tumors that exhibit unfavorable histologic characteristics. With the objective of maximizing outcome and minimizing treatment-related short- and long-term morbidity, several protocols have been studied by the National Wilms' Tumor Study Group (NWTSG) and the International Society of Pediatric Oncology (SIOP). Despite these laudable cooperative efforts, many controversies remain in the surgical management of Wilms' tumors.