Surgical Management and Outcomes of Wilms Tumor in Rwanda: A Retrospective Study of Patients Operated on at the University Teaching Hospital of Kigali-Rwanda

BACKGROUND: Wilms tumor is the most common renal tumor in children and accounts for 6-8% of all childhood malignancies and has a variable survival rate worldwide. The aim of this study was to describe the surgical management and outcomes of care for Wilms tumor patients operated at the University Teaching Hospital of Kigali (CHUK).
METHODS: This is a retrospective chart review conducted at CHUK in Rwanda. It includes all children who had a confirmed Wilms tumor diagnosis operated from July 2012 to June 2016. Patient’s demographics, staging, surgical management, and outcomes were analyzed.
RESULTS: A total of 58 patients diagnosed with Wilms tumor were identified. 52.6% were female. The median age was four years, interquartile range (IQR): 1-10 years. The majority of the children were stage II (39.7%) and the minority being stage V (5.2%). Treatment offered was in accordance with the Societe Internationale d’ Oncologie Pediatrique (SIOP) protocol; 91.2% of patients received four weeks of preoperative chemotherapy and a median of 15 weeks postoperative chemotherapy (IQR: 8,26). The resection rate was 100% for those with unilateral tumors. The spillage rate was 15.8%. At the time of the study, the mortality rate was 19.3%, recurrence was 7%, and 12.3% were lost to follow-up.
CONCLUSION: The introduction of a single national protocol for treating Wilms tumor in Rwanda with a dedicated management team, including the surgical and pediatric oncology services, has led to early outcomes approaching the ones in high-income countries, but efforts also need to include earlier detection of this tumor.