Background: While patients with Wilms tumor (WT) have an overall survival greater than 90%, tumor rupture is associated with worse outcomes and can increase risk of abdominal recurrence to 20%1. Because our institutional rate of rupture is at least 2.5x higher than that found in literature, we conducted a retrospective chart review to understand the differences between our patient population and the population in literature2. Our aims were to 1) compare our patient demographics and outcomes, 2) describe correlations between preoperative, intraoperative, and pathologic diagnosis of rupture, and 3) compare our outcomes between upfront resection and neoadjuvant chemotherapy. Procedures: We reviewed charts from 2015 to 2019 and assessed: details of presentation, chemotherapy, operative and pathological findings, complications, and outcomes between patients with and without rupture. Results: Of 29 patients with WT, 9 had preoperative rupture by imaging and 8, all females, were confirmed surgically. Our rupture prevalence of 27.6% is higher than that in literature (11-13%.) Despite patients with rupture having more positive margins (50% vs. 19% non-ruptured), they had lower recurrence rates at one year (0 vs 19% non-ruptured) and improved survival mortality (100% vs. 90.5% non-ruptured). Neoadjuvant therapy and flank radiation compared to whole abdominal radiation did not change complication rates or outcomes. Conclusions: The high percentage of ruptured WT at our institution allowed for comprehensive review and revealed variations from literature. Patients with rupture had better outcomes than patients without rupture, with no difference comparing neoadjuvant chemotherapy to upfront resection and flank vs whole abdomen radiation.