Comparative Study on the Effect of Preoperative Chemotherapy as Recommended in the SIOP Protocols Versus the Standard Upfront Surgical Resection in Cases of Stage I, II and Resectable Stage III as Recommended by the NWSG on the Surgical Outcome, Rate of Intra and Postoperative Complication and Percentage of Down Staging in Pediatric Wilms Tumor

Management of Wilm’s tumor (WT) has progressed during the last 25 years. This progress was mainly attributed to the efforts of two large cooperative groups; the National Wilms’ Tumor Study Group and the International Society of Pediatric Oncology. The approach of each to management differs philosophically regarding the benefits of preoperative chemotherapy. Although outcomes of patients treated with either up-front nephrectomy or preoperative chemotherapy have been equally good. Clinical trials directed towards reduction of therapy for children with low-risk tumors, thereby avoiding acute and long-term toxicities. The aim of the current study is to proactively compare both approach on surgical outcome, rate of intra and postoperative complication and percentage of down staging in pediatric WT as well as local recurrence rate in Egyptian population. Patients were randomized into 2 groups, group I received preoperative chemotherapy then exploration, group II underwent exploration then chemotherapy. Rates of intra and postoperative complications, rates of spillage, pathological necrosis, rates of down staging and rates of surgical outcome and morbidity in both groups were assessed. Operative and postoperative complications rates were also collected. The number of resectable tumors in group I after neoadjuvant chemotherapy was 19 patients and was s chemocantly higher when compared to number group II (13 patients) who underwent abdominal exploration at presentation without receiving preoperative chemotherapy (p=0.03). There was a significant difference seen after preoperative chemotherapy administration which resulted in tumor down staging which is apparent in the difference between radiological preoperative staging and surgical staging in group I. The local recurrence within 2 years was higher for group II (65%) versus 25% in group I (p=0.03). When evaluating most common postoperative complications, comparison between the 2 groups revealed statically significance only regarding postoperative infection. In conclusion, preoperative chemotherapy has a positive impact on surgical outcome of WT as well as on the rates of local recurrence.