The morbidity and outcome of surgery in children with large pre-treated Wilms' tumour: size matters.

Sixty-seven patients with resected Wilms' tumour>1.0 kg are reported. Surgery in this group is difficult, may result in the sacrifice of adjacent structures, and frequently upstages the patient. Mortality is related to tumour burden. Whilst there is little agreement on the therapeutic implications of failure to respond to neoadjuvant therapy, these surgical and anaesthetic hazards must be recognized, and alternative stratagems considered, prior to attempting a surgical procedure.