Principals of Wilms tumor surgery

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"Consecutive SIOP protocols and trials have consistently considered open radical nephroureterectomy as the gold standard approach for treating WT. According to surgical guidelines, the procedure should be performed through a long transverse abdominal or thoraco-abdominal incision, to allow careful inspection of the abdominal cavity and liver, retroperitoneal lymph node sampling, and radical nephroureterectomy outside of the Gerota’s fascia, including perirenal fat and sometimes the adrenal gland in monobloc resection."

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"the same rules of systematic inspection and sampling of retroperitoneal nodes should be followed with laparoscopy than open surgery. It is advisable that exclusively transperitoneal approach be considered when discussing MIS for Wilms’ tumour resection; retroperitoneoscopic access, although theoretically feasible for radical nephrectomy of small tumours, hinders adequate LN sampling, total ureterectomy down to the ureterovesical junction, and most importantly impedes extraction of an intact specimen without morcellation for adequate staging analysis."

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -

"Complete surgical resection, without spillage, associated with a sufficient lymph node sampling (at least six) is the main goal of surgical treatment and strongly predicts final outcome. Intraoperative tumour spillage influences the multimodality treatment intensity as it upgrades the local staging to stage III and requires thus post-operative irradiation of the whole abdominal cavity, worsening the overall prognosis. Insufficient lymph node sampling may also lead to under staging and risk of recurrence and/or metastasis."