Background: The surgical management of pediatric unilateral Wilms’ tumor (uWT) remains a subject of ongoing debate, particularly regarding the criteria for lymph node (LN) sampling. To address this, we implemented a modified radical nephrectomy (MRN) technique, incorporating ipsilateral perivascular lymph node dissection following nephrectomy to optimize the surgical approach. This study evaluates the safety and feasibility of MRN in the treatment of uWT. Methods: We retrospectively analysis of 105 uWT cases treated with MRN between January 2016 and June 2023. Clinical characteristics, treatment regimens, and patient outcomes were assessed. Results: All 105 patients underwent MRN successfully. Of these, 48 had upfront surgery, while 57 received neoadjuvant chemotherapy. Following nephrectomy, regional LN dissection was performed, with a median of 9 nodes removed. Lymph node metastasis was identified in 6 patients (5.7%). Tumor spillage occurred in 6 cases, predominantly during upfront surgery. Surgical complications were noted in 6 patients, all of which were managed conservatively. Recurrence was observed in 8 patients, including two local recurrences. The 3-year event-free survival and overall survival rates were 91.3% and 95.6%, respectively. Conclusion: The MRN technique demonstrated both safety and feasibility in the surgical treatment of pediatric uWT, with manageable postoperative complications. The findings suggest that MRN provides enhanced access for surgeons and facilitates more accurate staging, beyond the goal of simply removing the recommended number of LNs. This approach may improve both staging accuracy and long-term outcomes in pediatric uWT.