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Abstract
Over the past decades, 2 different approaches for the treatment of Wilms tumor have emerged: upfront nephrectomy (UN) and preoperative chemotherapy (PC), with adjuvant treatment adjusted to stage, histology, and chemotherapy response. Data from the international society of pediatric oncology (SIOP) suggested decreased intraoperative spillage and more feasible surgery after PC. The children oncology group (COG) has adopted the concept of UN assuming the feasibility of the resectional surgery and the proper staging information that may be lost with the administration of PC. Patients with unilateral renal masses diagnosed as WT who presented to the children cancer hospital of Egypt (CCHE) from January 2009 to January 2012, were subjected to UN with the exclusion of those who are not amenable to this approach based on the proposed COG protocol, to be treated first by chemotherapy. One hundred seven patients were identified (35 PC and 72 UN). Preoperative chemotherapy had more incidences of surgical complications. Intestinal obstruction was the most common post operative complication. Event free survival and overall survival were 76.8% and 79.9% for PC at 30 months vs 87.5% and 95.8% for UN at 36 months