Robotic surgery of Wilms tumour: Time to expand the frontiers of minimally invasive surgery?

OBJECTIVES

To evaluate the feasibility, safety, and oncological outcomes of robotic-assisted surgery (RAS) for pediatric Wilms' tumour, including cases treated beyond current SIOP-RTSG UMBRELLA criteria for minimally invasive surgery.

SUBJECTS/PATIENTS AND

METHODS

A retrospective review was conducted of all pediatric patients who underwent RAS for histologically confirmed Wilms' tumour at a tertiary referral centre between 2020 and 2024. Perioperative, pathological, and follow-up outcomes were analysed. Patients were stratified according to whether their tumours met or did not meet the SIOP-RTSG UMBRELLA 2016 criteria for minimally invasive surgery, and subgroup comparisons were performed.

RESULTS

Nineteen children underwent robotic-assisted surgery. Median age at diagnosis was 55 months (IQR 17-80), and 74% received preoperative chemotherapy. Median tumour volume decreased from 503.0 mL to 220.5 mL following treatment (median regression 44.5%). Seventeen patients underwent radical nephrectomy, one partial nephrectomy, and one tumourectomy. Median operative time was 265 min. Lymph node sampling was performed in 95% of cases (median three nodes), and conversion to open surgery occurred in one patient (5%). Two postoperative complications were observed (Clavien-Madadi grade IB and IIIA), with no intraoperative adverse events. Final pathology showed stage I disease in 74% and intermediate-risk histology in 79% of patients. Two patients developed distant metastatic relapse (hepatic and pulmonary), with no local recurrence. At a median follow-up of 32 months, overall survival was 100%, and event-free survival at one and three years was 94.7% and 89.5%, respectively. Six patients (32%) had one or more formal contraindications to minimally invasive surgery; despite longer operative time and hospital stay, no significant differences were observed in complications, conversion rate, margin status, or recurrence.

CONCLUSION

Robotic-assisted surgery for Wilms' tumour is feasible and oncologically safe in selected pediatric patients, including carefully chosen cases beyond current minimally invasive surgery criteria.