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.