Wilms’ tumor in low- and middle-income countries: survey of current practices, challenges, and priorities

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Wilms’ tumor in low- and middle-income countries: survey of current practices, challenges, and priorities


JournalAnnals of Pediatric Surgery
Article typeJournal research article – Clinical research
Publication date – May – 2022
Authors – Megan Thuy Vu, Jaime Shalkow, Bindi Naik-Mathuria, Sajid S. Qureshi, Doruk Ozgediz, Kokila Lakhoo & Hafeez Abdelhafeez On behalf of the Pan African Paediatric Surgery Association (PAPSA) and Global Initiative for Children’s Surgery (GICS) initiative
Keywordsglobal surgery, Nephroblastoma, oncology, pediatrics, Wilms tumor
Open access – Yes
SpecialityPaediatric surgery, Surgical oncology
World region Global

Language – English
Submitted to the One Surgery Index on May 15, 2022 at 2:32 am
Abstract:

Purpose
To identify the current practices and priorities in Wilms’ tumor management for surgeons in low- and middle-income countries (LMICs).

Methods
One hundred thirty-seven pediatric surgeons from 44 countries completed surveys on Wilms’ tumor surgical strategy in LMIC. This survey was distributed through the Global Initiative for Children’s Surgery, Pan-African Pediatric Surgical Association, and Latin American Pediatric Surgical Oncology Group.

Results
Ninety-two respondents (67.2%) participated from 19 lower middle-income countries (43.2%). Twenty-one respondents (15.3%) participated from nine lower income countries (20.5%). Nineteen respondents (13.9%) participated from 13 upper middle-income countries (29.5%). Most providers do not obtain biopsy for suspected Wilms’ tumor (79%). Delayed resection after preoperative chemotherapy is the preferred approach (70%), which providers chose due to protocol (45%), to decrease tumor rupture (22%), and to decrease complications (8%). The providers’ goal was to prevent tumor spillage and upstaging (46%) or to prevent bleeding, complication, or other organ resections (21%). Most surgeons believed that upfront resection increased the risk of tumor spillage (72%).

Conclusion
Providers in LMICs prefer delayed resection after preoperative chemotherapy to reduce the incidence of tumor spillage and upstaging of Wilms’ tumor. An evidence-based guideline tailored to the LMIC context can be developed from these findings.

OSI Number – 21600

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