INTRODUCTION
Wilms tumor (WT), one of the most common solid tumors, is highly curable
with affordable interventions.1 The majority (90%) of
patients with WT in high-income countries survive with chemotherapy,
adequate surgical local control, and radiation therapy when indicated.
However, survival in low-resource settings remains poor (50% to
<30%), reflecting limitations in resources (physical and
human) and a lack of process standardization.2,3 The
World Health Organization’s Global Initiative for Childhood Cancer
targets WT as one of six index cancers included in attempts to reduce
disparities in childhood cancer outcomes.4 Efforts to
address resource limitations include workforce training and shared
advocacy to establish sustainable resources required for multimodality
therapy and family support. Although guidance from high-income countries
is available, it may be difficult to implement in low- and middle-income
countries (LMICs) due to differences in resources and health systems.
For WT, a limited capacity to manage intraoperative bleeding and limited
access to diagnostics and radiation therapy are key factors
necessitating the adaptation of guidelines to address specific
challenges in LMICs. The aim of this work is to provide
resource-sensitive recommendations for the surgical management of
pediatric WT in limited-resource settings.