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Objective: Wilms tumor is the most common pediatric renal malignancy and is responsive to appropriate multidisciplinary care. We analyzed the treatment of Wilms tumors in Uganda to identify quality improvement opportunities. Design: Review of prospectively collected pediatric surgical admissions (n=3,494) Setting: Mulago National Referral Hospital and the National Cancer Institute in Uganda, the only hospital in Uganda with dedicated pediatric surgery and oncology centers and radiation capabilities. Patients: Pediatric (<14 years) Wilms tumor patients (n=125) admitted January 2012-August 2016. Interventions: None Main Outcome Measure(s): Demographics, presenting complaints, distance traveled, operative intervention, length of stay, mortality. Results: 125 Wilms tumor patients, 36 (29.5%) underwent nephrectomy during admission. A subset (n=32) underwent chart review, revealing 0% with Stage I disease vs. 29% Stage II and 71% Stage III or IV. All children who underwent nephrectomy required chemotherapy and radiation (SIOP protocol) with 65.5% receiving this treatment and 31.0% receiving adjuvant chemotherapy. Patients often presented with a palpable flank or abdominal mass (77%), abdominal distention (38%), and abdominal pain (12%). Average distance travelled for treatment was 143km, well above the recommendation for access to care within 50km. There is a trend towards closer patients being more likely to undergo surgical management (37.8% vs. 24.7%, p=0.093), however the study is underpowered to confirm this difference. Outcomes included median hospitalization of 6 days and one inpatient post-nephrectomy mortality (3.2%). Conclusions: Favorable surgical outcomes in patients with Wilms tumors are possible with multidisciplinary care in Uganda, however patients travel much more than the recommended distance, which may increase the stage at presentation and limit surgical options. Some patients are unable to complete multidisciplinary treatment highlighting the need for additional capacity building.