Laparoscopic Wilms Tumor Nephrectomy and Lymph Node Sampling: Oncotechnical Considerations

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A BSTRACT Wilms tumor (WT) is the most prevalent pediatric renal malignancy, with surgical intervention being a cornerstone of multimodal management. This report evaluates the surgical feasibility, oncotechnical considerations, and short-term outcomes of laparoscopic WT nephrectomy (LWTN) in 17 children following neoadjuvant chemotherapy (NACT). LWTN was successfully completed in 47.1% (8/17) of cases, with conversions primarily necessitated by intraoperative bleeding, efforts to prevent tumor rupture, and strict adherence to oncological principles. The primary advantages observed with LWTN versus laparoscopic converted to open surgery were reduced blood loss (median 20 ml vs. 40 ml, P = 0.014), shorter hospitalization duration (3.13 vs. 4.11 days, P = 0.023), and lower postoperative pain scores (3.50 vs. 5.56, P = 0.001). Lymph node yields (mean: 9.75 vs. 15.44; adequate yield defined as >7 nodes) and tumor rupture rates were similar between groups, supporting the oncological safety of LWTN. Overall, LWTN represents a technically demanding approach that provides perioperative benefits in selected patients without compromising short-term oncological outcomes.

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