Nephron-Sparing Surgery for Patients With Wilms Tumor, a Surgical Delphi Study Consensus Statement

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Nephrology

Background:

• Current pediatric renal tumor treatment guidelines restrict nephron-sparing surgery (NSS) for unilateral Wilms tumor (WT) under strict conditions.
• Surgical feasibility is not adequately addressed in oncological guidelines, potentially limiting NSS use.
• Defining surgical feasibility is crucial for optimizing NSS in WT management.

Purpose of the Study:

• To establish surgical consensus statements for assessing Wilms tumor (WT) patients eligible for nephron-sparing surgery (NSS).
• To develop criteria for surgical feasibility to potentially increase the utilization of NSS in pediatric WT cases.

Main Methods:

• A Delphi study involving 34 potential surgical experts was conducted.
• Experts responded to questionnaires on surgery, oncology, contraindications, technique, and organization for NSS in WT.
• Follow-up questionnaires presented closed-ended statements derived from initial responses.

Main Results:

• Eleven surgeons participated, completing three questionnaires with 72 statements.
• Nephron-sparing surgery (NSS) for nonsyndromic unilateral WT is considered feasible after 4 weeks of neoadjuvant chemotherapy, with tumors <200 mL, and when partial nephrectomy with >5 mm margins is possible.
• Despite feasibility, some COG surgeons did not advocate NSS for nonsyndromic unilateral WT.

Conclusions:

• Surgical experts utilized the Delphi method to define consensus statements for NSS in Wilms tumor (WT).
• These consensus statements aim to define surgical feasibility for WT, potentially expanding the use of oncologically appropriate NSS.
• The findings support the integration of surgical feasibility into future WT treatment protocols to enhance NSS utilization.