Surgical Practices in the Management of Pediatric Renal Tumors in Low- and Middle-Income Countries in the Asia Pacific Region

PURPOSE: To profile the surgical management of pediatric renal tumors rendered in low- and middle-income countries (LMICs) of the Asia Pacific region, which are not currently affiliated to any pediatric renal tumor cooperative group.

METHODS: An online survey was conducted among surgeons and urologists identified through the St. Jude Global Online Community Asia Pacific Pediatric Surgical Collaborations Group and participants of the St. Jude-VIVA Pediatric Surgical Oncology Symposium 2024.

RESULTS: Ninety-six of 99 respondents provided replies, together representing 11 countries and 51 institutions. The majority (n = 90, 93.8%) were pediatric surgeons, with 26.7% having had subspecialty training in urology or oncology; 60% had experience managing Wilms tumors for more than 5 years, though 64% performed less than three nephrectomies per year. A chemotherapy-first approach was specified by 31% of institutions, but employed by 40% of respondents in actual practice. Of those who practiced a chemotherapy-first approach, 44.8% did so without an initial biopsy. Notably, 38% of respondents and 55% of institutions did not adhere to a consistent protocol. Lymph node biopsy practices varied widely, with only 40.6% sampling routinely and 56.3% had ever experienced a tumor rupture during nephrectomy. Most (90%) perceived that Wilms tumors comprised 90% of all renal tumors in Asian children-contrary to known demographic data.

CONCLUSION: There is substantial variation in the upfront surgical management of renal tumors in Asia Pacific LMICs. Considering the unique epidemiology of renal tumors in Asians and limited surgical capabilities, there is a great need for regional collaboration to better standardize the initial surgical management approach.