title: Surgical complications after immediate nephrectomy versus preoperative chemotherapy in non-metastatic Wilms' tumour: findings from the 1991-2001 United Kingdom Children's Cancer Study Group UKW3 Trial.
abstract: OBJECTIVE
  To compare surgical complication rates after immediate nephrectomy versus delayed nephrectomy following preoperative chemotherapy in children with non-metastatic Wilms' tumour enrolled in UKW3, both in randomised patients and in those for whom the treatment approach was defined by parental or physician choice.
  
  
  METHODS
  Records for all patients enrolled into UKW3 were reviewed. Any record of tumour rupture or surgical complication was extracted and comparisons made between the two treatment strategies in both populations of randomised and non-randomised patients.
  
  
  RESULTS
  Of 525 children enrolled, 205 patients were randomised to either immediate nephrectomy (n=103) or pre-operative chemotherapy followed by delayed nephrectomy (n=102). Of the 320 children not randomised, data were available on 189 cases treated with immediate nephrectomy and 103 treated with pre-operative chemotherapy. There were significantly fewer surgical complications in randomised children given pre-operative chemotherapy before surgery compared to children undergoing immediate nephrectomy (1% vs. 20.4%, P<0.001); this difference was most marked for tumour rupture (0% vs. 14.6%, P<0.001).
  
  
  CONCLUSIONS
  Delayed nephrectomy for Wilms' tumour, preceded by pre-operative chemotherapy was associated with fewer surgical complications compared with immediate nephrectomy.
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals, Leeds, UK. Electronic address: mark.powis@leedsth.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Powis
authors.forename: Boo
authors.initials: B
authors.lastname: Messahel
authors.forename: Rachel
authors.initials: R
authors.lastname: Hobson
authors.forename: Peter
authors.initials: P
authors.lastname: Gornall
authors.forename: Jenny
authors.initials: J
authors.lastname: Walker
authors.forename: Kathy
authors.initials: K
authors.lastname: Pritchard-Jones
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D001706:Biopsy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007494:Ireland / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D020360:Neoadjuvant Therapy; D009366:Neoplasm Seeding; D009392:Nephrectomy; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012421:Rupture / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D009396:Wilms Tumor / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
keywords: Nephroblastoma; Surgical complications; Wilms’ tumour