Laparoscopy may be suggested to manage total nephrectomy in specific cases of Wilms’ tumor in children.
Minimal access surgery in pediatric oncology should remain extremely prudent. Some tumors can readily be treated laparoscopically since there is no risk of seeding. On the contrary, in case of seeding, the prognosis would be endangered during surgery for Wilms’ tumor.
Consequently, the decision as to whether or not choose laparoscopy should absolutely be discussed.
Indications for laparoscopic nephrectomy involve tumors treated according to the SIOP treatment guidelines, including primary chemotherapy.
Laparoscopy is mostly decided upon in the presence of a stage I tumor, more rarely in the presence of a stage II tumor without distant metastasis and without tumor thrombus of the renal vein and/or of the vena cava.
Patients with a bilateral tumor are excluded from such therapeutic strategy. Therefore, they will be offered an open nephron-sparing surgery.
Contraindications to laparoscopy include massive post-chemotherapy residual tumor sizes and tumors located proximal to the hilum, since the risk of injuring the tumor during the primary vascular dissection is high.