A Call to Action to Improve Rates of Lymph Node Sampling During Wilms Tumor Resection

Failure to perform lymphadenectomies for patients with Wilms tumor (WT) was recognized as a practice gap by the American Pediatric Surgical Association in 2018. An educational campaign was conducted to promote lymphadenectomy. We sought to evaluate the national patterns of lymph node sampling, examine provider-level differences, and assess whether sampling rates changed following this initiative. This is a retrospective analysis of the ACS NSQIP-Pediatric Participant Use Files from 2012 to 2022. Patients aged 0-17 years undergoing nephrectomy for malignant renal tumors were identified using ICD diagnosis codes. Lymph node sampling was defined by the presence of appropriate CPT codes. A total of 2260 patients met the inclusion criteria; 1629 (72.1%) underwent nephrectomy with lymph node sampling, while 631 (27.9%) underwent nephrectomy alone. There were no differences in age or sex between groups. Pediatric surgeons were more likely to perform lymph node sampling than pediatric urologists (74% vs. 64%, p < 0.01). Patients with advanced or bilateral WT were less likely to undergo lymph node sampling compared with those with localized disease (66.6% vs. 72.1%, p = 0.01). No significant change in lymph node sampling rates was observed following the 2018 APSA educational campaign (71.2% pre-2018 vs. 72.1% post-2018, p = 0.26). Despite current recommendations, we found that lymphadenectomy rates during WT resection remain unchanged. We recommend a multidisciplinary strategy in collaboration with international organizations. This could include workshops on lymph node sampling maps, adoption of synoptic operative checklists, and quality improvement campaigns to increase lymphadenectomy rates in WT nephrectomies.