Controversies in the management of Wilms tumour - immediate nephrectomy or delayed nephrectomy?

Wilms tumour is the paradigm for the treatment of a malignant solid tumour of children and adolescents. Dramatic improvements in survival have occurred as the result of advances in anaesthetic and surgical management, radiation therapy technique and the availability of several very effective chemotherapeutic agents. Despite these successes, controversy exists regarding the initial management of children with unilateral, favourable histology Wilms tumour. Two different approaches have been recommended by different investigators - immediate nephrectomy or pre-nephrectomy chemotherapy followed by delayed nephrectomy. The results of randomised trials will be reviewed and the benefits and risks of each approach discussed.