Surgical extirpation is, and almost certainly will remain the fundamental treatment for Wilms' tumour. There is debate about the timing of surgical intervention, the place of percutaneous needle biopsy, and the use of pre-operative chemotherapy. US practice remains steadfastly in favour of immediate surgery followed by adjuvant therapy dictated by the surgical stage. In contrast, the SIOP group in Europe has conducted a series of trials based on the use of pre-operative therapy, and while it remains to be proven that the latter approach is superior, there is increasing recognition that pre-operative treatment may be of benefit in some circumstances.

In an attempt to resolve the issues posed by the findings from these two groups, the UKCCSG is currently conducting a prospective randomized trial comparing immediate surgery with six weeks of chemotherapy and delayed surgery.

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