ABSTRACT
The first successful nephrectomy for such a tumor in a child was carried out by British surgeon Thomas Richard Jessop in 1877. Radiotherapy was introduced later as adjunctive therapy in 1916 by Alfred Friedlander in Cincinnati. In the UK, the 2016 updated UMBRELLA SIOP-RTSG protocol is used, with pre-chemotherapy biopsy foregone in virtually all cases due to the risk of upstaging of tumors. Secondary deposits, caval tumor, bilateral disease, or tumor in solitary kidney are indications for chemotherapy and delayed surgery. Bleeding can occur if the tumor is particularly cystic, however tumor seeding into the track is rare. Minimally invasive laparoscopy has the potential of more active role, particularly in assessing and taking biopsies of intra-abdominal tumor spread. In a completely excised tumor that is confined to kidney with a low-risk histology, no further treatment may be necessary. Combination treatment with actinomycin and vincristine is usual however, with option to add doxorubicin with or without abdominal radiotherapy for higher-grade tumors.
