Current concepts in surgery for Wilms tumor--the risk and function-adapted strategy

Area of Science:

• Pediatric Surgery
• Surgical Oncology
• Wilms Tumor Research

Background:

• Wilms tumor treatment requires balancing survival rates with long-term quality of life for pediatric patients.
• Surgical approaches are continuously evolving to optimize outcomes.

Purpose of the Study:

• To review the current status and best practices for surgical approaches in Wilms tumor management.
• To evaluate the role and limitations of nephron-sparing and minimally invasive techniques.

Main Methods:

• Review of current surgical strategies for Wilms tumor, including open nephrectomy, nephron-sparing surgery, and minimally invasive approaches.
• Discussion of patient selection criteria, surgical challenges, and prognostic factors.
• Consideration of novel descriptive methods for nephron-sparing procedures.

Main Results:

• Combined multimodal treatment with classical open nephrectomy is the most recommended approach, yielding excellent survival rates.
• Nephron-sparing surgery is important for long-term quality of life, but requires strict patient selection to avoid reduced survival.
• Minimally invasive nephrectomy is generally not recommended due to challenges with lymph node sampling and staging, though it may be feasible in rare, selected cases by experienced surgeons.
• Preoperative factors like tumor side, age, and volume can influence surgical failure risk.

Conclusions:

• Classical open nephrectomy remains the gold standard for Wilms tumor surgery.
• Nephron-sparing surgery offers significant benefits for patient quality of life but demands meticulous patient selection.
• Further research is needed for complex surgical cases, with prognosis potentially influenced by surgeon expertise and patient-specific factors.