# Pediatric Oncology — GCMD Library living collection

Also covered as: Wilms tumor · neuroblastoma · hepatoblastoma · pulmonary metastases · hepatocellular carcinoma · osteosarcoma · rhabdomyosarcoma · favorable histology Wilms tumor

Experts: Dr. Todd Ponsky, Dr. Sophia Schermerhorn, Dr. Cecilia Gigena, Dr. Lizzie Lee

Updated: n/a · 692 episodes · 2298 cited statements

## Episodes
### Fundamentals
- [Unique Aspects of Pediatric Care Delivery Model: Pediatric Oncofertility 2017](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898) — video · 14:23 · [machine version](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898.md)
- [The widening knowledge base required for pediatric surgeons treating solid tumors](https://library.globalcastmd.com/watch/the-widening-knowledge-base-required-for-pediatric-surgeons-treating-solid-tumors-1903) — article · [machine version](https://library.globalcastmd.com/watch/the-widening-knowledge-base-required-for-pediatric-surgeons-treating-solid-tumors-1903.md)
- [Pediatric surgical oncology: a brief overview of where we have been and the challenges we face](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-a-brief-overview-of-where-we-have-been-and-the-challenges-we-face-1937) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-a-brief-overview-of-where-we-have-been-and-the-challenges-we-face-1937.md)
- [Wilms Tumor and Other Childhood Kidney Tumors PDQ®](https://library.globalcastmd.com/watch/wilms-tumor-and-other-childhood-kidney-tumors-pdq-2363) — article · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-and-other-childhood-kidney-tumors-pdq-2363.md)
- [Testicular Cancer PDQ®](https://library.globalcastmd.com/watch/testicular-cancer-pdq-2362) — article · [machine version](https://library.globalcastmd.com/watch/testicular-cancer-pdq-2362.md)
- [Adrenocortical Carcinoma PDQ®](https://library.globalcastmd.com/watch/adrenocortical-carcinoma-pdq-2365) — article · [machine version](https://library.globalcastmd.com/watch/adrenocortical-carcinoma-pdq-2365.md)
- [Childhood Cancer Genomics PDQ®](https://library.globalcastmd.com/watch/childhood-cancer-genomics-pdq-2370) — article · [machine version](https://library.globalcastmd.com/watch/childhood-cancer-genomics-pdq-2370.md)
- [Ewing Sarcoma PDQ®](https://library.globalcastmd.com/watch/ewing-sarcoma-pdq-2366) — article · [machine version](https://library.globalcastmd.com/watch/ewing-sarcoma-pdq-2366.md)
- [Osteosarcoma and Malignant Fibrous Histiocytoma of Bone PDQ®](https://library.globalcastmd.com/watch/osteosarcoma-and-malignant-fibrous-histiocytoma-of-bone-pdq-2367) — article · [machine version](https://library.globalcastmd.com/watch/osteosarcoma-and-malignant-fibrous-histiocytoma-of-bone-pdq-2367.md)
- [Gastrointestinal Carcinoid Tumors PDQ®](https://library.globalcastmd.com/watch/gastrointestinal-carcinoid-tumors-pdq-2372) — article · [machine version](https://library.globalcastmd.com/watch/gastrointestinal-carcinoid-tumors-pdq-2372.md)
- [Pleuropulmonary Blastoma PDQ®](https://library.globalcastmd.com/watch/pleuropulmonary-blastoma-pdq-2374) — article · [machine version](https://library.globalcastmd.com/watch/pleuropulmonary-blastoma-pdq-2374.md)
- [Hodgkin Lymphoma PDQ®](https://library.globalcastmd.com/watch/hodgkin-lymphoma-pdq-2379) — article · [machine version](https://library.globalcastmd.com/watch/hodgkin-lymphoma-pdq-2379.md)
- [Non-Hodgkin Lymphoma PDQ®](https://library.globalcastmd.com/watch/non-hodgkin-lymphoma-pdq-2380) — article · [machine version](https://library.globalcastmd.com/watch/non-hodgkin-lymphoma-pdq-2380.md)
- [Neuroblastoma PDQ®](https://library.globalcastmd.com/watch/neuroblastoma-pdq-2381) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-pdq-2381.md)
- [Melanoma PDQ®](https://library.globalcastmd.com/watch/melanoma-pdq-2383) — article · [machine version](https://library.globalcastmd.com/watch/melanoma-pdq-2383.md)
- [Rhabdomyosarcoma PDQ®](https://library.globalcastmd.com/watch/rhabdomyosarcoma-pdq-2385) — article · [machine version](https://library.globalcastmd.com/watch/rhabdomyosarcoma-pdq-2385.md)
- [Pheochromocytoma and Paraganglioma PDQ®](https://library.globalcastmd.com/watch/pheochromocytoma-and-paraganglioma-pdq-2388) — article · [machine version](https://library.globalcastmd.com/watch/pheochromocytoma-and-paraganglioma-pdq-2388.md)
- [A Novel Standard for Systematic Reporting of Neuroblastoma Surgery: The International Neuroblastoma Surgical Report Form (INSRF): A Joint Initiative by the Pediatric Oncological Cooperative Groups SIOPEN∗, COG∗∗, and GPOH∗∗∗](https://library.globalcastmd.com/watch/a-novel-standard-for-systematic-reporting-of-neuroblastoma-surgery-the-international-neuroblastoma-surgical-report-form-a-joint-initiative-by-the-pediatric-oncological-cooperative-groups-siopen-cog-and-gpoh-3094) — article · [machine version](https://library.globalcastmd.com/watch/a-novel-standard-for-systematic-reporting-of-neuroblastoma-surgery-the-international-neuroblastoma-surgical-report-form-a-joint-initiative-by-the-pediatric-oncological-cooperative-groups-siopen-cog-and-gpoh-3094.md)
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-3785) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-3785.md)
- [Predisposition to cancer in children and adolescents](https://library.globalcastmd.com/watch/predisposition-to-cancer-in-children-and-adolescents-3920) — article · [machine version](https://library.globalcastmd.com/watch/predisposition-to-cancer-in-children-and-adolescents-3920.md)
- [COG Neuroblastoma Handbook](https://library.globalcastmd.com/watch/cog-neuroblastoma-handbook-4233) — article · [machine version](https://library.globalcastmd.com/watch/cog-neuroblastoma-handbook-4233.md)
- [COG Rhabdomyosarcoma Handbook.](https://library.globalcastmd.com/watch/cog-rhabdomyosarcoma-handbook-4234) — article · [machine version](https://library.globalcastmd.com/watch/cog-rhabdomyosarcoma-handbook-4234.md)
- [COG Renal Tumors Handbook](https://library.globalcastmd.com/watch/cog-renal-tumors-handbook-4235) — article · [machine version](https://library.globalcastmd.com/watch/cog-renal-tumors-handbook-4235.md)
- [COG Liver Tumor Handbook](https://library.globalcastmd.com/watch/cog-liver-tumor-handbook-4236) — article · [machine version](https://library.globalcastmd.com/watch/cog-liver-tumor-handbook-4236.md)
- [COG Osteosarcoma Handbook](https://library.globalcastmd.com/watch/cog-osteosarcoma-handbook-4237) — article · [machine version](https://library.globalcastmd.com/watch/cog-osteosarcoma-handbook-4237.md)
- [COG Germ Cell Tumors Handbook](https://library.globalcastmd.com/watch/cog-germ-cell-tumors-handbook-4238) — article · [machine version](https://library.globalcastmd.com/watch/cog-germ-cell-tumors-handbook-4238.md)
- [APSA Renal Tumors Handbook](https://library.globalcastmd.com/watch/apsa-renal-tumors-handbook-4239) — article · [machine version](https://library.globalcastmd.com/watch/apsa-renal-tumors-handbook-4239.md)
- [APSA Liver Tumors Handbook](https://library.globalcastmd.com/watch/apsa-liver-tumors-handbook-4240) — article · [machine version](https://library.globalcastmd.com/watch/apsa-liver-tumors-handbook-4240.md)
- [APSA Rhabdomyosarcoma Handbook](https://library.globalcastmd.com/watch/apsa-rhabdomyosarcoma-handbook-4241) — article · [machine version](https://library.globalcastmd.com/watch/apsa-rhabdomyosarcoma-handbook-4241.md)
- [APSA Neuroblastoma Handbook](https://library.globalcastmd.com/watch/apsa-neuroblastoma-handbook-4242) — article · [machine version](https://library.globalcastmd.com/watch/apsa-neuroblastoma-handbook-4242.md)
- [APSA Germ Cell Tumors Handbook](https://library.globalcastmd.com/watch/apsa-germ-cell-tumors-handbook-4243) — article · [machine version](https://library.globalcastmd.com/watch/apsa-germ-cell-tumors-handbook-4243.md)
- [Algorithm for Management of Ovarian Masses (MWPSC)](https://library.globalcastmd.com/watch/algorithm-for-management-of-ovarian-masses-4244) — article · [machine version](https://library.globalcastmd.com/watch/algorithm-for-management-of-ovarian-masses-4244.md)
- [Pediatric Solid Tumors and Associated Cancer Predisposition Syndromes: Workup, Management, and Surveillance. A Summary from the APSA Cancer Committee](https://library.globalcastmd.com/watch/pediatric-solid-tumors-and-associated-cancer-predisposition-syndromes-workup-management-and-surveillance-a-summary-from-the-apsa-cancer-committee-4417) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-solid-tumors-and-associated-cancer-predisposition-syndromes-workup-management-and-surveillance-a-summary-from-the-apsa-cancer-committee-4417.md)
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-5378) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-5378.md)
- [Oncology Toolkit](https://library.globalcastmd.com/watch/oncology-toolkit-5705) — article · [machine version](https://library.globalcastmd.com/watch/oncology-toolkit-5705.md)
- [Cancer Articles of Interest](https://library.globalcastmd.com/watch/cancer-articles-of-interest-5718) — article · [machine version](https://library.globalcastmd.com/watch/cancer-articles-of-interest-5718.md)
- [Neuroblastoma PDQ](https://library.globalcastmd.com/watch/neuroblastoma-pdq-10946) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-pdq-10946.md)
- [Redefining Pediatric General Surgery: A Generational Paradigm Shift Toward Specialization](https://library.globalcastmd.com/watch/redefining-pediatric-general-surgery-a-generational-paradigm-shift-toward-specialization-10950) — article · [machine version](https://library.globalcastmd.com/watch/redefining-pediatric-general-surgery-a-generational-paradigm-shift-toward-specialization-10950.md)
- [Essential Knowledge and Skills for the Practice of Pediatric Surgical Oncology A Modified Delphi Consensus Study by the APSA Cancer Committee](https://library.globalcastmd.com/watch/essential-knowledge-and-skills-for-the-practice-of-pediatric-surgical-oncology-a-modified-delphi-consensus-study-by-the-apsa-cancer-committee-11401) — article · [machine version](https://library.globalcastmd.com/watch/essential-knowledge-and-skills-for-the-practice-of-pediatric-surgical-oncology-a-modified-delphi-consensus-study-by-the-apsa-cancer-committee-11401.md)
- [PDQ Neuroblastoma](https://library.globalcastmd.com/watch/pdq-neuroblastoma-11471) — article · [machine version](https://library.globalcastmd.com/watch/pdq-neuroblastoma-11471.md)
- [PDQ Wilms Tumor](https://library.globalcastmd.com/watch/pdq-wilms-tumor-11472) — article · [machine version](https://library.globalcastmd.com/watch/pdq-wilms-tumor-11472.md)
- [Essential Knowledge and Skills for the Practice of Pediatric Surgical Oncology- A Modified Delphi Consensus Study by the APSA Cancer Committee](https://library.globalcastmd.com/watch/essential-knowledge-and-skills-for-the-practice-of-pediatric-surgical-oncology-a-modified-delphi-consensus-study-by-the-apsa-cancer-committee-11476) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/essential-knowledge-and-skills-for-the-practice-of-pediatric-surgical-oncology-a-modified-delphi-consensus-study-by-the-apsa-cancer-committee-11476.md)

### Diagnosis & Workup
- [Evolving biopsy techniques for the diagnosis of neuroblastoma in children](https://library.globalcastmd.com/watch/evolving-biopsy-techniques-for-the-diagnosis-of-neuroblastoma-in-children-194) — article · [machine version](https://library.globalcastmd.com/watch/evolving-biopsy-techniques-for-the-diagnosis-of-neuroblastoma-in-children-194.md)
- [A novel image-based system for risk stratification in patients with desmoplastic small round cell tumor](https://library.globalcastmd.com/watch/a-novel-image-based-system-for-risk-stratification-in-patients-with-desmoplastic-small-round-cell-tumor-213) — article · [machine version](https://library.globalcastmd.com/watch/a-novel-image-based-system-for-risk-stratification-in-patients-with-desmoplastic-small-round-cell-tumor-213.md)
- [The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions](https://library.globalcastmd.com/watch/the-utility-of-magnetic-resonance-imaging-in-the-diagnosis-and-management-of-pediatric-benign-ovarian-lesions-238) — article · [machine version](https://library.globalcastmd.com/watch/the-utility-of-magnetic-resonance-imaging-in-the-diagnosis-and-management-of-pediatric-benign-ovarian-lesions-238.md)
- [Half-life of alpha-fetoprotein in neonatal sacrococcygeal teratoma](https://library.globalcastmd.com/watch/half-life-of-alpha-fetoprotein-in-neonatal-sacrococcygeal-teratoma-482) — article · [machine version](https://library.globalcastmd.com/watch/half-life-of-alpha-fetoprotein-in-neonatal-sacrococcygeal-teratoma-482.md)
- [Anterior mediastinal masses — A multidisciplinary pathway for safe diagnostic procedures](https://library.globalcastmd.com/watch/anterior-mediastinal-masses-a-multidisciplinary-pathway-for-safe-diagnostic-procedures-792) — article · [machine version](https://library.globalcastmd.com/watch/anterior-mediastinal-masses-a-multidisciplinary-pathway-for-safe-diagnostic-procedures-792.md)
- [Diagnostic ultrasound-guided cutting needle biopsies in neuroblastoma: A safe and efficient procedure](https://library.globalcastmd.com/watch/diagnostic-ultrasound-guided-cutting-needle-biopsies-in-neuroblastoma-a-safe-and-efficient-procedure-1142) — article · [machine version](https://library.globalcastmd.com/watch/diagnostic-ultrasound-guided-cutting-needle-biopsies-in-neuroblastoma-a-safe-and-efficient-procedure-1142.md)
- [Multicenter pre-operative assessment of pediatric ovarian malignancy](https://library.globalcastmd.com/watch/multicenter-pre-operative-assessment-of-pediatric-ovarian-malignancy-1241) — article · [machine version](https://library.globalcastmd.com/watch/multicenter-pre-operative-assessment-of-pediatric-ovarian-malignancy-1241.md)
- [Evaluation of the diagnostic biopsy approach for children with hepatoblastoma: A report from the Children’s Oncology Group AHEP 0731 Liver Tumor Committee](https://library.globalcastmd.com/watch/evaluation-of-the-diagnostic-biopsy-approach-for-children-with-hepatoblastoma-a-report-from-the-children-s-oncology-group-ahep-0731-liver-tumor-committee-1408) — article · [machine version](https://library.globalcastmd.com/watch/evaluation-of-the-diagnostic-biopsy-approach-for-children-with-hepatoblastoma-a-report-from-the-children-s-oncology-group-ahep-0731-liver-tumor-committee-1408.md)
- [Differentiating presacral masses in anorectal malformations and isolated sacrococcygeal teratomas](https://library.globalcastmd.com/watch/differentiating-presacral-masses-in-anorectal-malformations-and-isolated-sacrococcygeal-teratomas-1572) — article · [machine version](https://library.globalcastmd.com/watch/differentiating-presacral-masses-in-anorectal-malformations-and-isolated-sacrococcygeal-teratomas-1572.md)
- [Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms](https://library.globalcastmd.com/watch/understanding-the-value-of-tumor-markers-in-pediatric-ovarian-neoplasms-1777) — article · [machine version](https://library.globalcastmd.com/watch/understanding-the-value-of-tumor-markers-in-pediatric-ovarian-neoplasms-1777.md)
- [The role of preoperative imaging and tumor markers in predicting malignant ovarian masses in children](https://library.globalcastmd.com/watch/the-role-of-preoperative-imaging-and-tumor-markers-in-predicting-malignant-ovarian-masses-in-children-1835) — article · [machine version](https://library.globalcastmd.com/watch/the-role-of-preoperative-imaging-and-tumor-markers-in-predicting-malignant-ovarian-masses-in-children-1835.md)
- [MIBG in Neuroblastoma diagnosis and treatment](https://library.globalcastmd.com/watch/mibg-in-neuroblastoma-diagnosis-and-treatment-1924) — article · [machine version](https://library.globalcastmd.com/watch/mibg-in-neuroblastoma-diagnosis-and-treatment-1924.md)
- [SALL4 is a useful marker for pediatric yolk sac tumors](https://library.globalcastmd.com/watch/sall4-is-a-useful-marker-for-pediatric-yolk-sac-tumors-2436) — article · [machine version](https://library.globalcastmd.com/watch/sall4-is-a-useful-marker-for-pediatric-yolk-sac-tumors-2436.md)
- [A clinical review of ovarian tumors in children and adolescents](https://library.globalcastmd.com/watch/a-clinical-review-of-ovarian-tumors-in-children-and-adolescents-2526) — article · [machine version](https://library.globalcastmd.com/watch/a-clinical-review-of-ovarian-tumors-in-children-and-adolescents-2526.md)
- [The role of imaging in the initial investigation of paediatric renal tumours.](https://library.globalcastmd.com/watch/the-role-of-imaging-in-the-initial-investigation-of-paediatric-renal-tumours-2624) — article · [machine version](https://library.globalcastmd.com/watch/the-role-of-imaging-in-the-initial-investigation-of-paediatric-renal-tumours-2624.md)
- [Liver biopsy for hepatoblastoma: a single institution’s experience](https://library.globalcastmd.com/watch/liver-biopsy-for-hepatoblastoma-a-single-institution-s-experience-2712) — article · [machine version](https://library.globalcastmd.com/watch/liver-biopsy-for-hepatoblastoma-a-single-institution-s-experience-2712.md)
- [Utility of sonography for identifying metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation](https://library.globalcastmd.com/watch/utility-of-sonography-for-identifying-metastatic-cervical-adenopathy-in-children-with-differentiated-thyroid-carcinoma-at-presentation-3368) — article · [machine version](https://library.globalcastmd.com/watch/utility-of-sonography-for-identifying-metastatic-cervical-adenopathy-in-children-with-differentiated-thyroid-carcinoma-at-presentation-3368.md)
- [Utility of sonography for identifying metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation](https://library.globalcastmd.com/watch/utility-of-sonography-for-identifying-metastatic-cervical-adenopathy-in-children-with-differentiated-thyroid-carcinoma-at-presentation-3434) — article · [machine version](https://library.globalcastmd.com/watch/utility-of-sonography-for-identifying-metastatic-cervical-adenopathy-in-children-with-differentiated-thyroid-carcinoma-at-presentation-3434.md)
- [The diagnostic value of magnetic resonance imaging in differentiating benign and malignant pediatric ovarian tumors](https://library.globalcastmd.com/watch/the-diagnostic-value-of-magnetic-resonance-imaging-in-differentiating-benign-and-malignant-pediatric-ovarian-tumors-3478) — article · [machine version](https://library.globalcastmd.com/watch/the-diagnostic-value-of-magnetic-resonance-imaging-in-differentiating-benign-and-malignant-pediatric-ovarian-tumors-3478.md)
- [In vivo imaging of neuroblastomas using GD2-targeting graphene quantum dots](https://library.globalcastmd.com/watch/in-vivo-imaging-of-neuroblastomas-using-gd2-targeting-graphene-quantum-dots-3836) — article · [machine version](https://library.globalcastmd.com/watch/in-vivo-imaging-of-neuroblastomas-using-gd2-targeting-graphene-quantum-dots-3836.md)
- [(123)Iodine-metaiodobenzylguanidine scintigraphy versus whole-body magnetic resonance imaging with diffusion-weighted imaging in children with high-risk neuroblastoma - pilot study](https://library.globalcastmd.com/watch/iodine-metaiodobenzylguanidine-scintigraphy-versus-whole-body-magnetic-resonance-imaging-with-diffusion-weighted-imaging-in-children-with-high-risk-neuroblastoma-pilot-study-3949) — article · [machine version](https://library.globalcastmd.com/watch/iodine-metaiodobenzylguanidine-scintigraphy-versus-whole-body-magnetic-resonance-imaging-with-diffusion-weighted-imaging-in-children-with-high-risk-neuroblastoma-pilot-study-3949.md)
- [Sentinel lymph node biopsy in pediatric Wilms tumor](https://library.globalcastmd.com/watch/sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-4830) — article · [machine version](https://library.globalcastmd.com/watch/sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-4830.md)
- [Comparing Safety and Adequacy Between Surgical Biopsy Versus Core Needle Biopsy in Diagnosing Neuroblastoma](https://library.globalcastmd.com/watch/comparing-safety-and-adequacy-between-surgical-biopsy-versus-core-needle-biopsy-in-diagnosing-neuroblastoma-4831) — article · [machine version](https://library.globalcastmd.com/watch/comparing-safety-and-adequacy-between-surgical-biopsy-versus-core-needle-biopsy-in-diagnosing-neuroblastoma-4831.md)
- [Risk factors for lateral lymph node metastasis of papillary thyroid carcinoma in children](https://library.globalcastmd.com/watch/risk-factors-for-lateral-lymph-node-metastasis-of-papillary-thyroid-carcinoma-in-children-4902) — article · [machine version](https://library.globalcastmd.com/watch/risk-factors-for-lateral-lymph-node-metastasis-of-papillary-thyroid-carcinoma-in-children-4902.md)
- [Interhospital Variability in Localization Techniques for Small Pulmonary Nodules in Children: A Pediatric Surgical Oncology Research Collaborative Study](https://library.globalcastmd.com/watch/interhospital-variability-in-localization-techniques-for-small-pulmonary-nodules-in-children-a-pediatric-surgical-oncology-research-collaborative-study-5106) — article · [machine version](https://library.globalcastmd.com/watch/interhospital-variability-in-localization-techniques-for-small-pulmonary-nodules-in-children-a-pediatric-surgical-oncology-research-collaborative-study-5106.md)
- [Comparing safety and adequacy between surgical biopsy versus core needle biopsy in diagnosing neuroblastoma](https://library.globalcastmd.com/watch/comparing-safety-and-adequacy-between-surgical-biopsy-versus-core-needle-biopsy-in-diagnosing-neuroblastoma-5245) — article · [machine version](https://library.globalcastmd.com/watch/comparing-safety-and-adequacy-between-surgical-biopsy-versus-core-needle-biopsy-in-diagnosing-neuroblastoma-5245.md)
- [Circulating Tumor DNA as a Biomarker in Patients With Stage III and IV Wilms Tumor: Analysis From a Children's Oncology Group Trial, AREN0533](https://library.globalcastmd.com/watch/circulating-tumor-dna-as-a-biomarker-in-patients-with-stage-iii-and-iv-wilms-tumor-analysis-from-a-children-s-oncology-group-trial-aren0533-5606) — article · [machine version](https://library.globalcastmd.com/watch/circulating-tumor-dna-as-a-biomarker-in-patients-with-stage-iii-and-iv-wilms-tumor-analysis-from-a-children-s-oncology-group-trial-aren0533-5606.md)
- [Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study](https://library.globalcastmd.com/watch/interhospital-variability-in-localization-techniques-for-small-pulmonary-nodules-in-children-a-pediatric-surgical-oncology-research-collaborative-study-5880) — article · [machine version](https://library.globalcastmd.com/watch/interhospital-variability-in-localization-techniques-for-small-pulmonary-nodules-in-children-a-pediatric-surgical-oncology-research-collaborative-study-5880.md)
- [Molecular profiling identifies targeted therapy opportunities in pediatric solid cancer](https://library.globalcastmd.com/watch/molecular-profiling-identifies-targeted-therapy-opportunities-in-pediatric-solid-cancer-5946) — article · [machine version](https://library.globalcastmd.com/watch/molecular-profiling-identifies-targeted-therapy-opportunities-in-pediatric-solid-cancer-5946.md)
- [Hepatic benign and malignant masses in children: a single UK tertiary centre experience](https://library.globalcastmd.com/watch/hepatic-benign-and-malignant-masses-in-children-a-single-uk-tertiary-centre-experience-6102) — article · [machine version](https://library.globalcastmd.com/watch/hepatic-benign-and-malignant-masses-in-children-a-single-uk-tertiary-centre-experience-6102.md)
- [Sentinel lymph node biopsy in pediatric Wilms tumor](https://library.globalcastmd.com/watch/sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-6143) — article · [machine version](https://library.globalcastmd.com/watch/sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-6143.md)
- [La biopsia del ganglio centinela en el tumor de Wilms pediátrico](https://library.globalcastmd.com/watch/la-biopsia-del-ganglio-centinela-en-el-tumor-de-wilms-pedi-trico-6144) — article · [machine version](https://library.globalcastmd.com/watch/la-biopsia-del-ganglio-centinela-en-el-tumor-de-wilms-pedi-trico-6144.md)
- [Evaluation of the Molecular Landscape of Pediatric Thyroid Nodules and Use of a Multigene Genomic Classifier in Children](https://library.globalcastmd.com/watch/evaluation-of-the-molecular-landscape-of-pediatric-thyroid-nodules-and-use-of-a-multigene-genomic-classifier-in-children-6153) — article · [machine version](https://library.globalcastmd.com/watch/evaluation-of-the-molecular-landscape-of-pediatric-thyroid-nodules-and-use-of-a-multigene-genomic-classifier-in-children-6153.md)
- [Is molecular profiling useful for pediatric solid tumors?](https://library.globalcastmd.com/watch/is-molecular-profiling-useful-for-pediatric-solid-tumors-6219) — article · [machine version](https://library.globalcastmd.com/watch/is-molecular-profiling-useful-for-pediatric-solid-tumors-6219.md)
- [Correlation between image-defined risk factors and surgical complications in patients with neuroblastoma: a retrospective study](https://library.globalcastmd.com/watch/correlation-between-image-defined-risk-factors-and-surgical-complications-in-patients-with-neuroblastoma-a-retrospective-study-6258) — article · [machine version](https://library.globalcastmd.com/watch/correlation-between-image-defined-risk-factors-and-surgical-complications-in-patients-with-neuroblastoma-a-retrospective-study-6258.md)
- [A nomogram for the preoperative estimation of neuroblastoma risk despite inadequate biopsy information](https://library.globalcastmd.com/watch/a-nomogram-for-the-preoperative-estimation-of-neuroblastoma-risk-despite-inadequate-biopsy-information-6332) — article · [machine version](https://library.globalcastmd.com/watch/a-nomogram-for-the-preoperative-estimation-of-neuroblastoma-risk-despite-inadequate-biopsy-information-6332.md)
- [Should we reduce routine surveillance imaging in pediatric germ cell tumors?](https://library.globalcastmd.com/watch/should-we-reduce-routine-surveillance-imaging-in-pediatric-germ-cell-tumors-6453) — article · [machine version](https://library.globalcastmd.com/watch/should-we-reduce-routine-surveillance-imaging-in-pediatric-germ-cell-tumors-6453.md)
- [Beyond image defined risk factors (IDRFs): a delphi survey highlighting definition of the surgical complexity index (SCI) in neuroblastoma](https://library.globalcastmd.com/watch/beyond-image-defined-risk-factors-a-delphi-survey-highlighting-definition-of-the-surgical-complexity-index-in-neuroblastoma-6622) — article · [machine version](https://library.globalcastmd.com/watch/beyond-image-defined-risk-factors-a-delphi-survey-highlighting-definition-of-the-surgical-complexity-index-in-neuroblastoma-6622.md)
- [Update Course Rewind: Staging and Management of Neuroblastoma 2022](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710.md)
- [Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7930) — article · [machine version](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7930.md)
- [Biopsia quirúrgica o con aguja central guiada por imágenes para el diagnóstico de neuroblastoma en niños](https://library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-central-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7931) — article · [machine version](https://library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-central-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7931.md)
- [Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988.md)
- [Biopsia quirúrgica o con aguja guiada por imágenes para el diagnóstico de neuroblastoma en niños](https://library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7990) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7990.md)
- [Exosomal long non-coding RNA MALAT1: a candidate of liquid biopsy in monitoring of Wilms’ tumor](https://library.globalcastmd.com/watch/exosomal-long-non-coding-rna-malat1-a-candidate-of-liquid-biopsy-in-monitoring-of-wilms-tumor-7991) — article · [machine version](https://library.globalcastmd.com/watch/exosomal-long-non-coding-rna-malat1-a-candidate-of-liquid-biopsy-in-monitoring-of-wilms-tumor-7991.md)
- [Regional lymph node evaluation in pediatric conventional melanoma subtype: a single-center 10-year review](https://library.globalcastmd.com/watch/regional-lymph-node-evaluation-in-pediatric-conventional-melanoma-subtype-a-single-center-10-year-review-8045) — article · [machine version](https://library.globalcastmd.com/watch/regional-lymph-node-evaluation-in-pediatric-conventional-melanoma-subtype-a-single-center-10-year-review-8045.md)
- [Validating the Modified McGill Thyroid Nodule Score for Assessment of Preoperative Risk of Pediatric Thyroid Malignancy](https://library.globalcastmd.com/watch/validating-the-modified-mcgill-thyroid-nodule-score-for-assessment-of-preoperative-risk-of-pediatric-thyroid-malignancy-8126) — article · [machine version](https://library.globalcastmd.com/watch/validating-the-modified-mcgill-thyroid-nodule-score-for-assessment-of-preoperative-risk-of-pediatric-thyroid-malignancy-8126.md)
- [Correlation of CT Scan Response to Necrosis and Volume Changes With Histopathology in Children With Wilms' Tumor](https://library.globalcastmd.com/watch/correlation-of-ct-scan-response-to-necrosis-and-volume-changes-with-histopathology-in-children-with-wilms-tumor-8181) — article · [machine version](https://library.globalcastmd.com/watch/correlation-of-ct-scan-response-to-necrosis-and-volume-changes-with-histopathology-in-children-with-wilms-tumor-8181.md)
- [The Diagnostic Accuracy of Serum Alpha-Fetoprotein Levels in Follow-up for Recurrence of Sacrococcygeal Teratoma; a Nationwide Review of SCT Cases in the Netherlands](https://library.globalcastmd.com/watch/the-diagnostic-accuracy-of-serum-alpha-fetoprotein-levels-in-follow-up-for-recurrence-of-sacrococcygeal-teratoma-a-nationwide-review-of-sct-cases-in-the-netherlands-8214) — article · [machine version](https://library.globalcastmd.com/watch/the-diagnostic-accuracy-of-serum-alpha-fetoprotein-levels-in-follow-up-for-recurrence-of-sacrococcygeal-teratoma-a-nationwide-review-of-sct-cases-in-the-netherlands-8214.md)
- [The Irish Experience with Sacrococcygeal Teratomas: Are Type IV Lesions More Common than We Think?](https://library.globalcastmd.com/watch/the-irish-experience-with-sacrococcygeal-teratomas-are-type-iv-lesions-more-common-than-we-think-8426) — article · [machine version](https://library.globalcastmd.com/watch/the-irish-experience-with-sacrococcygeal-teratomas-are-type-iv-lesions-more-common-than-we-think-8426.md)
- [Percutaneous core needle biopsy of neuroblastoma in the pediatric population: what have we learned in the last decade](https://library.globalcastmd.com/watch/percutaneous-core-needle-biopsy-of-neuroblastoma-in-the-pediatric-population-what-have-we-learned-in-the-last-decade-8481) — article · [machine version](https://library.globalcastmd.com/watch/percutaneous-core-needle-biopsy-of-neuroblastoma-in-the-pediatric-population-what-have-we-learned-in-the-last-decade-8481.md)
- [The Role of Liquid Biopsy in Neuroblastoma: A Scoping Review](https://library.globalcastmd.com/watch/the-role-of-liquid-biopsy-in-neuroblastoma-a-scoping-review-9101) — article · [machine version](https://library.globalcastmd.com/watch/the-role-of-liquid-biopsy-in-neuroblastoma-a-scoping-review-9101.md)
- [A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee](https://library.globalcastmd.com/watch/a-comparison-of-commonly-utilized-diagnostic-biopsy-techniques-for-pediatric-patients-with-cancer-a-systematic-review-by-the-apsa-cancer-committee-9111) — article · [machine version](https://library.globalcastmd.com/watch/a-comparison-of-commonly-utilized-diagnostic-biopsy-techniques-for-pediatric-patients-with-cancer-a-systematic-review-by-the-apsa-cancer-committee-9111.md)
- [Evaluation of Image-Defined Risk Factor (IDRF) Assessment in Patients With Intermediate-risk Neuroblastoma: A Report From the Children's Oncology Group Study ANBL0531](https://library.globalcastmd.com/watch/evaluation-of-image-defined-risk-factor-assessment-in-patients-with-intermediate-risk-neuroblastoma-a-report-from-the-children-s-oncology-group-study-anbl0531-9125) — article · [machine version](https://library.globalcastmd.com/watch/evaluation-of-image-defined-risk-factor-assessment-in-patients-with-intermediate-risk-neuroblastoma-a-report-from-the-children-s-oncology-group-study-anbl0531-9125.md)
- [Identifying Novel Genetic Markers in Pediatric Rhabdomyosarcoma](https://library.globalcastmd.com/watch/identifying-novel-genetic-markers-in-pediatric-rhabdomyosarcoma-9163) — article · [machine version](https://library.globalcastmd.com/watch/identifying-novel-genetic-markers-in-pediatric-rhabdomyosarcoma-9163.md)
- [Preoperative Identification of Adamkiewicz Artery in Pediatric Posterior Thoracic Tumors: Fact or Fiction? A Systematic Review from the International Society of Pediatric Surgical Oncology (IPSO)](https://library.globalcastmd.com/watch/preoperative-identification-of-adamkiewicz-artery-in-pediatric-posterior-thoracic-tumors-fact-or-fiction-a-systematic-review-from-the-international-society-of-pediatric-surgical-oncology-9228) — article · [machine version](https://library.globalcastmd.com/watch/preoperative-identification-of-adamkiewicz-artery-in-pediatric-posterior-thoracic-tumors-fact-or-fiction-a-systematic-review-from-the-international-society-of-pediatric-surgical-oncology-9228.md)
- [A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee](https://library.globalcastmd.com/watch/a-comparison-of-commonly-utilized-diagnostic-biopsy-techniques-for-pediatric-patients-with-cancer-a-systematic-review-by-the-apsa-cancer-committee-9447) — article · [machine version](https://library.globalcastmd.com/watch/a-comparison-of-commonly-utilized-diagnostic-biopsy-techniques-for-pediatric-patients-with-cancer-a-systematic-review-by-the-apsa-cancer-committee-9447.md)
- [Development of a New Score Based on Image Defined Risk Factors to Standardize Surgical Risk in Neuroblastoma Resection - A SIOPEN Collaborative Study](https://library.globalcastmd.com/watch/development-of-a-new-score-based-on-image-defined-risk-factors-to-standardize-surgical-risk-in-neuroblastoma-resection-a-siopen-collaborative-study-9522) — article · [machine version](https://library.globalcastmd.com/watch/development-of-a-new-score-based-on-image-defined-risk-factors-to-standardize-surgical-risk-in-neuroblastoma-resection-a-siopen-collaborative-study-9522.md)
- [Fetiform teratoma: a systematic review with insights into concepts and controversies in differentiating it from fetus-in-fetu](https://library.globalcastmd.com/watch/fetiform-teratoma-a-systematic-review-with-insights-into-concepts-and-controversies-in-differentiating-it-from-fetus-in-fetu-10560) — article · [machine version](https://library.globalcastmd.com/watch/fetiform-teratoma-a-systematic-review-with-insights-into-concepts-and-controversies-in-differentiating-it-from-fetus-in-fetu-10560.md)
- [Early computed tomography after gross total resection of neuroblastoma with image defined risk factors to objectively assess extent of resection](https://library.globalcastmd.com/watch/early-computed-tomography-after-gross-total-resection-of-neuroblastoma-with-image-defined-risk-factors-to-objectively-assess-extent-of-resection-11444) — article · [machine version](https://library.globalcastmd.com/watch/early-computed-tomography-after-gross-total-resection-of-neuroblastoma-with-image-defined-risk-factors-to-objectively-assess-extent-of-resection-11444.md)
- [Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545) — video · 1:05 · [machine version](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545.md)
- [Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients](https://library.globalcastmd.com/watch/use-of-ovarian-tumor-markers-in-prediction-of-malignancy-risk-in-pediatric-and-adolescent-patients-11651) — article · [machine version](https://library.globalcastmd.com/watch/use-of-ovarian-tumor-markers-in-prediction-of-malignancy-risk-in-pediatric-and-adolescent-patients-11651.md)
- [The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727.md)
- [Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856.md)
- [Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients](https://library.globalcastmd.com/watch/use-of-ovarian-tumor-markers-in-prediction-of-malignancy-risk-in-pediatric-and-adolescent-patients-11862) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/use-of-ovarian-tumor-markers-in-prediction-of-malignancy-risk-in-pediatric-and-adolescent-patients-11862.md)

### Acute Management
- [Subcutaneous Analgesic System versus Epidural for Post-Operative Pain Control in Surgical Pediatric Oncology Patients](https://library.globalcastmd.com/watch/subcutaneous-analgesic-system-versus-epidural-for-post-operative-pain-control-in-surgical-pediatric-oncology-patients-3109) — article · [machine version](https://library.globalcastmd.com/watch/subcutaneous-analgesic-system-versus-epidural-for-post-operative-pain-control-in-surgical-pediatric-oncology-patients-3109.md)
- [Validating an opioid prescribing algorithm in post-operative pediatric surgical oncology patients](https://library.globalcastmd.com/watch/validating-an-opioid-prescribing-algorithm-in-post-operative-pediatric-surgical-oncology-patients-3122) — article · [machine version](https://library.globalcastmd.com/watch/validating-an-opioid-prescribing-algorithm-in-post-operative-pediatric-surgical-oncology-patients-3122.md)
- [Letter to the Editor Comment on: Opioid-sparing utility of subcutaneous analgesia systems in pediatric oncology patients following major tumor resection surgery: A matched case-control study](https://library.globalcastmd.com/watch/letter-to-the-editor-comment-on-opioid-sparing-utility-of-subcutaneous-analgesia-systems-in-pediatric-oncology-patients-following-major-tumor-resection-surgery-a-matched-case-control-study-11645) — article · [machine version](https://library.globalcastmd.com/watch/letter-to-the-editor-comment-on-opioid-sparing-utility-of-subcutaneous-analgesia-systems-in-pediatric-oncology-patients-following-major-tumor-resection-surgery-a-matched-case-control-study-11645.md)

### Medical Management
- [Effect of Wilms tumor histology on response to neoadjuvant chemotherapy](https://library.globalcastmd.com/watch/effect-of-wilms-tumor-histology-on-response-to-neoadjuvant-chemotherapy-158) — article · [machine version](https://library.globalcastmd.com/watch/effect-of-wilms-tumor-histology-on-response-to-neoadjuvant-chemotherapy-158.md)
- [Vincristine resistance in relapsed neuroblastoma can be efficiently overcome by Smac mimetic LCL161 treatment](https://library.globalcastmd.com/watch/vincristine-resistance-in-relapsed-neuroblastoma-can-be-efficiently-overcome-by-smac-mimetic-lcl161-treatment-234) — article · [machine version](https://library.globalcastmd.com/watch/vincristine-resistance-in-relapsed-neuroblastoma-can-be-efficiently-overcome-by-smac-mimetic-lcl161-treatment-234.md)
- [In vivo effects of short- and long-term MAPK pathway inhibition against neuroblastoma](https://library.globalcastmd.com/watch/in-vivo-effects-of-short-and-long-term-mapk-pathway-inhibition-against-neuroblastoma-471) — article · [machine version](https://library.globalcastmd.com/watch/in-vivo-effects-of-short-and-long-term-mapk-pathway-inhibition-against-neuroblastoma-471.md)
- [Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children](https://library.globalcastmd.com/watch/neoadjuvant-transcatheter-arterial-chemoembolization-and-systemic-chemotherapy-for-treatment-of-clear-cell-sarcoma-of-the-kidney-in-children-509) — article · [machine version](https://library.globalcastmd.com/watch/neoadjuvant-transcatheter-arterial-chemoembolization-and-systemic-chemotherapy-for-treatment-of-clear-cell-sarcoma-of-the-kidney-in-children-509.md)
- [Selumetinib in Children With Inoperable Plexiform Neurofibromas](https://library.globalcastmd.com/watch/selumetinib-in-children-with-inoperable-plexiform-neurofibromas-2561) — article · [machine version](https://library.globalcastmd.com/watch/selumetinib-in-children-with-inoperable-plexiform-neurofibromas-2561.md)
- [Sedation practices during high dose rate brachytherapy for children with urogenital and perianal rhabdomyosarcoma](https://library.globalcastmd.com/watch/sedation-practices-during-high-dose-rate-brachytherapy-for-children-with-urogenital-and-perianal-rhabdomyosarcoma-3250) — article · [machine version](https://library.globalcastmd.com/watch/sedation-practices-during-high-dose-rate-brachytherapy-for-children-with-urogenital-and-perianal-rhabdomyosarcoma-3250.md)
- [VS-5584, a PI3K/mTOR dual inhibitor, exerts antitumor effects on neuroblastomas in vitro and in vivo](https://library.globalcastmd.com/watch/vs-5584-a-pi3k-mtor-dual-inhibitor-exerts-antitumor-effects-on-neuroblastomas-in-vitro-and-in-vivo-3269) — article · [machine version](https://library.globalcastmd.com/watch/vs-5584-a-pi3k-mtor-dual-inhibitor-exerts-antitumor-effects-on-neuroblastomas-in-vitro-and-in-vivo-3269.md)
- [The SIOP-Renal Tumour Study Group consensus statement on flank target volume delineation for highly conformal radiotherapy](https://library.globalcastmd.com/watch/the-siop-renal-tumour-study-group-consensus-statement-on-flank-target-volume-delineation-for-highly-conformal-radiotherapy-3571) — article · [machine version](https://library.globalcastmd.com/watch/the-siop-renal-tumour-study-group-consensus-statement-on-flank-target-volume-delineation-for-highly-conformal-radiotherapy-3571.md)
- [Anaplastic Lymphoma Kinase Inhibitor Therapy in the Treatment of Inflammatory Myofibroblastic Tumors in Pediatric Patients: Case Reports and Literature Review](https://library.globalcastmd.com/watch/anaplastic-lymphoma-kinase-inhibitor-therapy-in-the-treatment-of-inflammatory-myofibroblastic-tumors-in-pediatric-patients-case-reports-and-literature-review-3662) — article · [machine version](https://library.globalcastmd.com/watch/anaplastic-lymphoma-kinase-inhibitor-therapy-in-the-treatment-of-inflammatory-myofibroblastic-tumors-in-pediatric-patients-case-reports-and-literature-review-3662.md)
- [PIM447 inhibits oncogenesis and potentiates cisplatin effects in hepatoblastoma](https://library.globalcastmd.com/watch/pim447-inhibits-oncogenesis-and-potentiates-cisplatin-effects-in-hepatoblastoma-3717) — article · [machine version](https://library.globalcastmd.com/watch/pim447-inhibits-oncogenesis-and-potentiates-cisplatin-effects-in-hepatoblastoma-3717.md)
- [Novel Second-Generation Rexinoid Induces Growth Arrest and Reduces Cancer Cell Stemness in Human Neuroblastoma Patient-Derived Xenografts](https://library.globalcastmd.com/watch/novel-second-generation-rexinoid-induces-growth-arrest-and-reduces-cancer-cell-stemness-in-human-neuroblastoma-patient-derived-xenografts-3729) — article · [machine version](https://library.globalcastmd.com/watch/novel-second-generation-rexinoid-induces-growth-arrest-and-reduces-cancer-cell-stemness-in-human-neuroblastoma-patient-derived-xenografts-3729.md)
- [Combining inhibitors of Brd4 and cyclin-dependent kinase can decrease tumor growth in neuroblastoma with MYCN amplification](https://library.globalcastmd.com/watch/combining-inhibitors-of-brd4-and-cyclin-dependent-kinase-can-decrease-tumor-growth-in-neuroblastoma-with-mycn-amplification-3844) — article · [machine version](https://library.globalcastmd.com/watch/combining-inhibitors-of-brd4-and-cyclin-dependent-kinase-can-decrease-tumor-growth-in-neuroblastoma-with-mycn-amplification-3844.md)
- [Anti-relapse effect of trametinib on a local minimal residual disease neuroblastoma mouse model](https://library.globalcastmd.com/watch/anti-relapse-effect-of-trametinib-on-a-local-minimal-residual-disease-neuroblastoma-mouse-model-3860) — article · [machine version](https://library.globalcastmd.com/watch/anti-relapse-effect-of-trametinib-on-a-local-minimal-residual-disease-neuroblastoma-mouse-model-3860.md)
- [Randomized Phase II Trial of MIBG Versus MIBG, Vincristine, and Irinotecan Versus MIBG and Vorinostat for Patients With Relapsed or Refractory Neuroblastoma: A Report From NANT Consortium](https://library.globalcastmd.com/watch/randomized-phase-ii-trial-of-mibg-versus-mibg-vincristine-and-irinotecan-versus-mibg-and-vorinostat-for-patients-with-relapsed-or-refractory-neuroblastoma-a-report-from-nant-consortium-4810) — article · [machine version](https://library.globalcastmd.com/watch/randomized-phase-ii-trial-of-mibg-versus-mibg-vincristine-and-irinotecan-versus-mibg-and-vorinostat-for-patients-with-relapsed-or-refractory-neuroblastoma-a-report-from-nant-consortium-4810.md)
- [Improved Outcome in Children With Newly Diagnosed High-Risk Neuroblastoma Treated With Chemoimmunotherapy: Updated Results of a Phase II Study Using hu14.18K322A](https://library.globalcastmd.com/watch/improved-outcome-in-children-with-newly-diagnosed-high-risk-neuroblastoma-treated-with-chemoimmunotherapy-updated-results-of-a-phase-ii-study-using-hu14-18k322a-5002) — article · [machine version](https://library.globalcastmd.com/watch/improved-outcome-in-children-with-newly-diagnosed-high-risk-neuroblastoma-treated-with-chemoimmunotherapy-updated-results-of-a-phase-ii-study-using-hu14-18k322a-5002.md)
- [Treatment optimization for recurrent hepatoblastoma: retrospective study from a hepatoblastoma cohort in Southern China](https://library.globalcastmd.com/watch/treatment-optimization-for-recurrent-hepatoblastoma-retrospective-study-from-a-hepatoblastoma-cohort-in-southern-china-5330) — article · [machine version](https://library.globalcastmd.com/watch/treatment-optimization-for-recurrent-hepatoblastoma-retrospective-study-from-a-hepatoblastoma-cohort-in-southern-china-5330.md)
- [Outcomes of children with well-differentiated fetal hepatoblastoma treated with surgery only: Report from Children's oncology group trial, AHEP0731](https://library.globalcastmd.com/watch/outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5651) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5651.md)
- [Postchemotherapy gross residual tumor in non-high-risk neuroblastoma: Clinical significance and the role of adjuvant therapy](https://library.globalcastmd.com/watch/postchemotherapy-gross-residual-tumor-in-non-high-risk-neuroblastoma-clinical-significance-and-the-role-of-adjuvant-therapy-5652) — article · [machine version](https://library.globalcastmd.com/watch/postchemotherapy-gross-residual-tumor-in-non-high-risk-neuroblastoma-clinical-significance-and-the-role-of-adjuvant-therapy-5652.md)
- [Progression-Free Survival and Patterns of Response in Patients With Relapsed High-Risk Neuroblastoma Treated With Irinotecan/Temozolomide/Dinutuximab/Granulocyte-Macrophage Colony-Stimulating Factor](https://library.globalcastmd.com/watch/progression-free-survival-and-patterns-of-response-in-patients-with-relapsed-high-risk-neuroblastoma-treated-with-irinotecan-temozolomide-dinutuximab-granulocyte-macrophage-colony-stimulating-factor-6209) — article · [machine version](https://library.globalcastmd.com/watch/progression-free-survival-and-patterns-of-response-in-patients-with-relapsed-high-risk-neuroblastoma-treated-with-irinotecan-temozolomide-dinutuximab-granulocyte-macrophage-colony-stimulating-factor-6209.md)
- [Efficacy analysis of multidisciplinary treatment for Wilms tumor in a single center](https://library.globalcastmd.com/watch/efficacy-analysis-of-multidisciplinary-treatment-for-wilms-tumor-in-a-single-center-6428) — article · [machine version](https://library.globalcastmd.com/watch/efficacy-analysis-of-multidisciplinary-treatment-for-wilms-tumor-in-a-single-center-6428.md)
- [Rhabdomyosarcoma with isolated lung metastases: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group](https://library.globalcastmd.com/watch/rhabdomyosarcoma-with-isolated-lung-metastases-a-report-from-the-soft-tissue-sarcoma-committee-of-the-children-s-oncology-group-6681) — article · [machine version](https://library.globalcastmd.com/watch/rhabdomyosarcoma-with-isolated-lung-metastases-a-report-from-the-soft-tissue-sarcoma-committee-of-the-children-s-oncology-group-6681.md)
- [Eflornithine as Postimmunotherapy Maintenance in High-Risk Neuroblastoma: Externally Controlled, Propensity Score-Matched Survival Outcome Comparisons](https://library.globalcastmd.com/watch/eflornithine-as-postimmunotherapy-maintenance-in-high-risk-neuroblastoma-externally-controlled-propensity-score-matched-survival-outcome-comparisons-7769) — article · [machine version](https://library.globalcastmd.com/watch/eflornithine-as-postimmunotherapy-maintenance-in-high-risk-neuroblastoma-externally-controlled-propensity-score-matched-survival-outcome-comparisons-7769.md)
- [PIM Kinase Inhibition Sensitizes Neuroblastoma to Doxorubicin](https://library.globalcastmd.com/watch/pim-kinase-inhibition-sensitizes-neuroblastoma-to-doxorubicin-8151) — article · [machine version](https://library.globalcastmd.com/watch/pim-kinase-inhibition-sensitizes-neuroblastoma-to-doxorubicin-8151.md)
- [CDK4/6 Inhibition With Lerociclib is a Potential Therapeutic Strategy for the Treatment of Pediatric Sarcomas](https://library.globalcastmd.com/watch/cdk4-6-inhibition-with-lerociclib-is-a-potential-therapeutic-strategy-for-the-treatment-of-pediatric-sarcomas-8340) — article · [machine version](https://library.globalcastmd.com/watch/cdk4-6-inhibition-with-lerociclib-is-a-potential-therapeutic-strategy-for-the-treatment-of-pediatric-sarcomas-8340.md)
- [Characterizing Sensitivity to Vincristine, Irinotecan, and Telomerase-targeted Therapy in Diffuse Anaplastic Wilms Tumor Patient-derived Xenografts☆](https://library.globalcastmd.com/watch/characterizing-sensitivity-to-vincristine-irinotecan-and-telomerase-targeted-therapy-in-diffuse-anaplastic-wilms-tumor-patient-derived-xenografts-9569) — article · [machine version](https://library.globalcastmd.com/watch/characterizing-sensitivity-to-vincristine-irinotecan-and-telomerase-targeted-therapy-in-diffuse-anaplastic-wilms-tumor-patient-derived-xenografts-9569.md)
- [Local Control for Pediatric Rhabdomyosarcoma of the Extremities: Is Radiotherapy Always Required After Adequate Surgical Resection? A CanSaRCC Study](https://library.globalcastmd.com/watch/local-control-for-pediatric-rhabdomyosarcoma-of-the-extremities-is-radiotherapy-always-required-after-adequate-surgical-resection-a-cansarcc-study-9614) — article · [machine version](https://library.globalcastmd.com/watch/local-control-for-pediatric-rhabdomyosarcoma-of-the-extremities-is-radiotherapy-always-required-after-adequate-surgical-resection-a-cansarcc-study-9614.md)
- [What Every Pediatric Surgeon Should Know About Common Systemic Therapies for the Treatment of Renal Tumors in Children and Adolescents](https://library.globalcastmd.com/watch/what-every-pediatric-surgeon-should-know-about-common-systemic-therapies-for-the-treatment-of-renal-tumors-in-children-and-adolescents-10587) — article · [machine version](https://library.globalcastmd.com/watch/what-every-pediatric-surgeon-should-know-about-common-systemic-therapies-for-the-treatment-of-renal-tumors-in-children-and-adolescents-10587.md)
- [Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394.md)
- [Hepatoblastoma Low Risk Management_Visual Abstract 2025](https://library.globalcastmd.com/watch/hepatoblastoma-low-risk-management-visual-abstract-2025-11477) — article · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-low-risk-management-visual-abstract-2025-11477.md)
- [Neuroblastoma_Intermediate Risk_Visual Abstract 2025](https://library.globalcastmd.com/watch/neuroblastoma-intermediate-risk-visual-abstract-2025-11482) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-intermediate-risk-visual-abstract-2025-11482.md)

### Nutritional Management
- [Clinical significance of sarcopenia in children with neuroblastic tumors](https://library.globalcastmd.com/watch/clinical-significance-of-sarcopenia-in-children-with-neuroblastic-tumors-9048) — article · [machine version](https://library.globalcastmd.com/watch/clinical-significance-of-sarcopenia-in-children-with-neuroblastic-tumors-9048.md)
- [Nutritional support in children treated for advanced adrenocortical carcinoma](https://library.globalcastmd.com/watch/nutritional-support-in-children-treated-for-advanced-adrenocortical-carcinoma-9693) — article · [machine version](https://library.globalcastmd.com/watch/nutritional-support-in-children-treated-for-advanced-adrenocortical-carcinoma-9693.md)

### Surgical Management
- [Laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation in children](https://library.globalcastmd.com/watch/laparoscopic-unilateral-oophorectomy-for-ovarian-tissue-cryopreservation-in-children-131) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-unilateral-oophorectomy-for-ovarian-tissue-cryopreservation-in-children-131.md)
- [Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature](https://library.globalcastmd.com/watch/caval-replacement-strategy-in-pediatric-retroperitoneal-tumors-encasing-the-vena-cava-a-single-center-experience-and-review-of-literature-139) — article · [machine version](https://library.globalcastmd.com/watch/caval-replacement-strategy-in-pediatric-retroperitoneal-tumors-encasing-the-vena-cava-a-single-center-experience-and-review-of-literature-139.md)
- [Surgical management of follicular thyroid carcinoma in children and adolescents: A study of 30 cases](https://library.globalcastmd.com/watch/surgical-management-of-follicular-thyroid-carcinoma-in-children-and-adolescents-a-study-of-30-cases-153) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-follicular-thyroid-carcinoma-in-children-and-adolescents-a-study-of-30-cases-153.md)
- [Laparoscopic adrenalectomy in children: A 25-case series and review of the literature](https://library.globalcastmd.com/watch/laparoscopic-adrenalectomy-in-children-a-25-case-series-and-review-of-the-literature-267) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-adrenalectomy-in-children-a-25-case-series-and-review-of-the-literature-267.md)
- [Pediatric Endoscopic Skull Base Surgery: Collaborative Approaches and Techniques](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374) — video · 24:46 · [machine version](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374.md)
- [Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380) — video · 21:33 · [machine version](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380.md)
- [Pediatric Endonasal Skull Base Surgery: Pediatric Endoscopic Neurosurgery 2018](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379) — video · 24:46 · [machine version](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379.md)
- [Minimally Disruptive Subcortical Neurosurgery in Children - Concepts of the...](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387) — video · 21:32 · [machine version](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387.md)
- [The surgical choice for unilateral thyroid carcinoma in pediatrics: Lobectomy or total thyroidectomy?](https://library.globalcastmd.com/watch/the-surgical-choice-for-unilateral-thyroid-carcinoma-in-pediatrics-lobectomy-or-total-thyroidectomy-456) — article · [machine version](https://library.globalcastmd.com/watch/the-surgical-choice-for-unilateral-thyroid-carcinoma-in-pediatrics-lobectomy-or-total-thyroidectomy-456.md)
- [Surgical risk factors of retroperitoneal teratoma resection in children](https://library.globalcastmd.com/watch/surgical-risk-factors-of-retroperitoneal-teratoma-resection-in-children-570) — article · [machine version](https://library.globalcastmd.com/watch/surgical-risk-factors-of-retroperitoneal-teratoma-resection-in-children-570.md)
- [Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature](https://library.globalcastmd.com/watch/multidisciplinary-management-of-congenital-giant-head-and-neck-masses-our-experience-and-review-of-the-literature-571) — article · [machine version](https://library.globalcastmd.com/watch/multidisciplinary-management-of-congenital-giant-head-and-neck-masses-our-experience-and-review-of-the-literature-571.md)
- [Rubber tourniquet technique: A simple, safe, and cost-effective method of hepatic resection in neonates and infants](https://library.globalcastmd.com/watch/rubber-tourniquet-technique-a-simple-safe-and-cost-effective-method-of-hepatic-resection-in-neonates-and-infants-611) — article · [machine version](https://library.globalcastmd.com/watch/rubber-tourniquet-technique-a-simple-safe-and-cost-effective-method-of-hepatic-resection-in-neonates-and-infants-611.md)
- [Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation: A series of three consecutive children](https://library.globalcastmd.com/watch/combined-management-of-perianal-rhabdomyosarcoma-with-chemotherapy-radical-surgery-and-irradiation-a-series-of-three-consecutive-children-786) — article · [machine version](https://library.globalcastmd.com/watch/combined-management-of-perianal-rhabdomyosarcoma-with-chemotherapy-radical-surgery-and-irradiation-a-series-of-three-consecutive-children-786.md)
- [Posterior retroperitoneoscopic adrenalectomy for pediatric adrenal tumors](https://library.globalcastmd.com/watch/posterior-retroperitoneoscopic-adrenalectomy-for-pediatric-adrenal-tumors-1243) — article · [machine version](https://library.globalcastmd.com/watch/posterior-retroperitoneoscopic-adrenalectomy-for-pediatric-adrenal-tumors-1243.md)
- [Retroperitoneoscopic resection of a T11-L2 right-sided ganglioneuroma](https://library.globalcastmd.com/watch/retroperitoneoscopic-resection-of-a-t11-l2-right-sided-ganglioneuroma-1245) — article · [machine version](https://library.globalcastmd.com/watch/retroperitoneoscopic-resection-of-a-t11-l2-right-sided-ganglioneuroma-1245.md)
- [Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center](https://library.globalcastmd.com/watch/surgical-management-of-pediatric-thyroid-disease-complication-rates-after-thyroidectomy-at-the-children-s-hospital-of-philadelphia-high-volume-pediatric-thyroid-center-1285) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-pediatric-thyroid-disease-complication-rates-after-thyroidectomy-at-the-children-s-hospital-of-philadelphia-high-volume-pediatric-thyroid-center-1285.md)
- [Error traps and culture of safety in Pediatric Surgical Oncology](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1348) — article · [machine version](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1348.md)
- [A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors](https://library.globalcastmd.com/watch/a-decision-tree-to-guide-long-term-venous-access-placement-in-children-and-adolescents-undergoing-surgery-for-renal-tumors-1414) — article · [machine version](https://library.globalcastmd.com/watch/a-decision-tree-to-guide-long-term-venous-access-placement-in-children-and-adolescents-undergoing-surgery-for-renal-tumors-1414.md)
- [Partial and radical nephrectomy in children, adolescents, and young adults: Equivalent readmissions and postoperative complications](https://library.globalcastmd.com/watch/partial-and-radical-nephrectomy-in-children-adolescents-and-young-adults-equivalent-readmissions-and-postoperative-complications-1437) — article · [machine version](https://library.globalcastmd.com/watch/partial-and-radical-nephrectomy-in-children-adolescents-and-young-adults-equivalent-readmissions-and-postoperative-complications-1437.md)
- [Wilms Tumor Protocol Violations: 2018 Pediatric Surgery Practice Gap #3](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460) — video · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460.md)
- [How Many Lymph Nodes Are Enough? Assessing the Adequacy of Lymph Node Yield for Staging in Favorable Histology Wilms Tumor](https://library.globalcastmd.com/watch/how-many-lymph-nodes-are-enough-assessing-the-adequacy-of-lymph-node-yield-for-staging-in-favorable-histology-wilms-tumor-1464) — article · [machine version](https://library.globalcastmd.com/watch/how-many-lymph-nodes-are-enough-assessing-the-adequacy-of-lymph-node-yield-for-staging-in-favorable-histology-wilms-tumor-1464.md)
- [Clinical application and technical standardization of indocyanine green (ICG) fluorescence imaging in pediatric minimally invasive surgery](https://library.globalcastmd.com/watch/clinical-application-and-technical-standardization-of-indocyanine-green-fluorescence-imaging-in-pediatric-minimally-invasive-surgery-1504) — article · [machine version](https://library.globalcastmd.com/watch/clinical-application-and-technical-standardization-of-indocyanine-green-fluorescence-imaging-in-pediatric-minimally-invasive-surgery-1504.md)
- [Vessel adherent growth represents a major challenge in the surgical resection of neuroblastoma and is associated with adverse outcome](https://library.globalcastmd.com/watch/vessel-adherent-growth-represents-a-major-challenge-in-the-surgical-resection-of-neuroblastoma-and-is-associated-with-adverse-outcome-1591) — article · [machine version](https://library.globalcastmd.com/watch/vessel-adherent-growth-represents-a-major-challenge-in-the-surgical-resection-of-neuroblastoma-and-is-associated-with-adverse-outcome-1591.md)
- [Error Traps and Culture of Safety in Pediatric Surgical Oncology](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703) — video · [machine version](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703.md)
- [Pancreatectomies for Pediatric Pancreatic Tumors: A Single Institute Experience from 2007 to 2018](https://library.globalcastmd.com/watch/pancreatectomies-for-pediatric-pancreatic-tumors-a-single-institute-experience-from-2007-to-2018-1705) — article · [machine version](https://library.globalcastmd.com/watch/pancreatectomies-for-pediatric-pancreatic-tumors-a-single-institute-experience-from-2007-to-2018-1705.md)
- [Definitive Tumor Resection after Myeloablative High Dose Chemotherapy Is a Feasible and Effective Option in the Multimodal Treatment of High-Risk Neuroblastoma: A Single Institution Experience](https://library.globalcastmd.com/watch/definitive-tumor-resection-after-myeloablative-high-dose-chemotherapy-is-a-feasible-and-effective-option-in-the-multimodal-treatment-of-high-risk-neuroblastoma-a-single-institution-experience-1706) — article · [machine version](https://library.globalcastmd.com/watch/definitive-tumor-resection-after-myeloablative-high-dose-chemotherapy-is-a-feasible-and-effective-option-in-the-multimodal-treatment-of-high-risk-neuroblastoma-a-single-institution-experience-1706.md)
- [How to Safely Perform Laparoscopic Liver Resection for Children: A Case Series of 19 Patients](https://library.globalcastmd.com/watch/how-to-safely-perform-laparoscopic-liver-resection-for-children-a-case-series-of-19-patients-1709) — article · [machine version](https://library.globalcastmd.com/watch/how-to-safely-perform-laparoscopic-liver-resection-for-children-a-case-series-of-19-patients-1709.md)
- [Adrenalectomy for non-neuroblastic pathology in children](https://library.globalcastmd.com/watch/adrenalectomy-for-non-neuroblastic-pathology-in-children-1798) — article · [machine version](https://library.globalcastmd.com/watch/adrenalectomy-for-non-neuroblastic-pathology-in-children-1798.md)
- [Surgical management of locally-advanced and metastatic hepatoblastoma](https://library.globalcastmd.com/watch/surgical-management-of-locally-advanced-and-metastatic-hepatoblastoma-1896) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-locally-advanced-and-metastatic-hepatoblastoma-1896.md)
- [Technical aspects of Nephron-Sparing Surgery (NSS) in children with bilateral centrally located renal tumors](https://library.globalcastmd.com/watch/technical-aspects-of-nephron-sparing-surgery-in-children-with-bilateral-centrally-located-renal-tumors-1897) — article · [machine version](https://library.globalcastmd.com/watch/technical-aspects-of-nephron-sparing-surgery-in-children-with-bilateral-centrally-located-renal-tumors-1897.md)
- [Operative management of pediatric ovarian tumors and the challenge of fertility-preservation: Results from the UK CCLG Surgeons Cancer Group Nationwide Study](https://library.globalcastmd.com/watch/operative-management-of-pediatric-ovarian-tumors-and-the-challenge-of-fertility-preservation-results-from-the-uk-cclg-surgeons-cancer-group-nationwide-study-2438) — article · [machine version](https://library.globalcastmd.com/watch/operative-management-of-pediatric-ovarian-tumors-and-the-challenge-of-fertility-preservation-results-from-the-uk-cclg-surgeons-cancer-group-nationwide-study-2438.md)
- [Single-site retroperitoneoscopy in pediatric metastatic lymphadenopathy](https://library.globalcastmd.com/watch/single-site-retroperitoneoscopy-in-pediatric-metastatic-lymphadenopathy-2481) — article · [machine version](https://library.globalcastmd.com/watch/single-site-retroperitoneoscopy-in-pediatric-metastatic-lymphadenopathy-2481.md)
- [Alternative approaches to retroperitoneal lymph node dissection for paratesticular rhabdomyosarcoma](https://library.globalcastmd.com/watch/alternative-approaches-to-retroperitoneal-lymph-node-dissection-for-paratesticular-rhabdomyosarcoma-2514) — article · [machine version](https://library.globalcastmd.com/watch/alternative-approaches-to-retroperitoneal-lymph-node-dissection-for-paratesticular-rhabdomyosarcoma-2514.md)
- [Lymph node yield in pediatric, adolescent and young adult Renal Cell Carcinoma – How many are enough?](https://library.globalcastmd.com/watch/lymph-node-yield-in-pediatric-adolescent-and-young-adult-renal-cell-carcinoma-how-many-are-enough-2553) — article · [machine version](https://library.globalcastmd.com/watch/lymph-node-yield-in-pediatric-adolescent-and-young-adult-renal-cell-carcinoma-how-many-are-enough-2553.md)
- [Limb sparing surgery with vascular reconstruction for nonrhabdomyosarcoma soft tissue sarcoma in infants: A novel solution using allogenic vein graft from the parent](https://library.globalcastmd.com/watch/limb-sparing-surgery-with-vascular-reconstruction-for-nonrhabdomyosarcoma-soft-tissue-sarcoma-in-infants-a-novel-solution-using-allogenic-vein-graft-from-the-parent-2555) — article · [machine version](https://library.globalcastmd.com/watch/limb-sparing-surgery-with-vascular-reconstruction-for-nonrhabdomyosarcoma-soft-tissue-sarcoma-in-infants-a-novel-solution-using-allogenic-vein-graft-from-the-parent-2555.md)
- [Pneumonectomy for Pediatric Tumors-a Pediatric Surgical Oncology Research Collaborative Study.](https://library.globalcastmd.com/watch/pneumonectomy-for-pediatric-tumors-a-pediatric-surgical-oncology-research-collaborative-study-2564) — article · [machine version](https://library.globalcastmd.com/watch/pneumonectomy-for-pediatric-tumors-a-pediatric-surgical-oncology-research-collaborative-study-2564.md)
- [Feasibility of Nonanatomical Liver Resection in Diligently Selected Patients with Hepatoblastoma and Comparison of Outcomes with Anatomic Resection](https://library.globalcastmd.com/watch/feasibility-of-nonanatomical-liver-resection-in-diligently-selected-patients-with-hepatoblastoma-and-comparison-of-outcomes-with-anatomic-resection-2586) — article · [machine version](https://library.globalcastmd.com/watch/feasibility-of-nonanatomical-liver-resection-in-diligently-selected-patients-with-hepatoblastoma-and-comparison-of-outcomes-with-anatomic-resection-2586.md)
- [Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children](https://library.globalcastmd.com/watch/trapdoor-anterior-thoracotomy-for-cervicothoracic-and-apical-thoracic-neuroblastoma-in-children-2659) — article · [machine version](https://library.globalcastmd.com/watch/trapdoor-anterior-thoracotomy-for-cervicothoracic-and-apical-thoracic-neuroblastoma-in-children-2659.md)
- [Population-Based Analysis of Hepatocellular Carcinoma in Children: Identifying Optimal Surgical Treatment](https://library.globalcastmd.com/watch/population-based-analysis-of-hepatocellular-carcinoma-in-children-identifying-optimal-surgical-treatment-2693) — article · [machine version](https://library.globalcastmd.com/watch/population-based-analysis-of-hepatocellular-carcinoma-in-children-identifying-optimal-surgical-treatment-2693.md)
- [Gastric tumors in children: single-center study with emphasis on treatment of repeated recurrence](https://library.globalcastmd.com/watch/gastric-tumors-in-children-single-center-study-with-emphasis-on-treatment-of-repeated-recurrence-2694) — article · [machine version](https://library.globalcastmd.com/watch/gastric-tumors-in-children-single-center-study-with-emphasis-on-treatment-of-repeated-recurrence-2694.md)
- [Surgical management of pediatric hepatocellular carcinoma: An analysis of the National Cancer Database](https://library.globalcastmd.com/watch/surgical-management-of-pediatric-hepatocellular-carcinoma-an-analysis-of-the-national-cancer-database-2772) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-pediatric-hepatocellular-carcinoma-an-analysis-of-the-national-cancer-database-2772.md)
- [The feasibility of adrenal-sparing surgery in bilateral adrenal neuroblastoma](https://library.globalcastmd.com/watch/the-feasibility-of-adrenal-sparing-surgery-in-bilateral-adrenal-neuroblastoma-2808) — article · [machine version](https://library.globalcastmd.com/watch/the-feasibility-of-adrenal-sparing-surgery-in-bilateral-adrenal-neuroblastoma-2808.md)
- [Left Nephrectomy Davidoff-Mansfield](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873) — video · 5:14 · [machine version](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873.md)
- [Standardizing lymph nodal sampling for Wilms tumor: A feasibility study with outcomes](https://library.globalcastmd.com/watch/standardizing-lymph-nodal-sampling-for-wilms-tumor-a-feasibility-study-with-outcomes-2931) — article · [machine version](https://library.globalcastmd.com/watch/standardizing-lymph-nodal-sampling-for-wilms-tumor-a-feasibility-study-with-outcomes-2931.md)
- [Massive, benign, cystic ovarian tumors: A technical modification for minimally invasive resection](https://library.globalcastmd.com/watch/massive-benign-cystic-ovarian-tumors-a-technical-modification-for-minimally-invasive-resection-3037) — article · [machine version](https://library.globalcastmd.com/watch/massive-benign-cystic-ovarian-tumors-a-technical-modification-for-minimally-invasive-resection-3037.md)
- [Management of functioning pediatric adrenal tumors](https://library.globalcastmd.com/watch/management-of-functioning-pediatric-adrenal-tumors-3048) — article · [machine version](https://library.globalcastmd.com/watch/management-of-functioning-pediatric-adrenal-tumors-3048.md)
- [Current surgical management of children with osteosarcoma and pulmonary metastatic disease: a survey of the AMERICAN pediatric surgical association](https://library.globalcastmd.com/watch/current-surgical-management-of-children-with-osteosarcoma-and-pulmonary-metastatic-disease-a-survey-of-the-american-pediatric-surgical-association-3117) — article · [machine version](https://library.globalcastmd.com/watch/current-surgical-management-of-children-with-osteosarcoma-and-pulmonary-metastatic-disease-a-survey-of-the-american-pediatric-surgical-association-3117.md)
- [Laparoscopic resection of liver tumors in children](https://library.globalcastmd.com/watch/laparoscopic-resection-of-liver-tumors-in-children-3167) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-resection-of-liver-tumors-in-children-3167.md)
- [Laparoscopic Assisted Extracorporeal Ovarian Harvest: A Novel Technique to Optimize Ovarian Tissue for Cryopreservation in Young Females with Cancer.](https://library.globalcastmd.com/watch/laparoscopic-assisted-extracorporeal-ovarian-harvest-a-novel-technique-to-optimize-ovarian-tissue-for-cryopreservation-in-young-females-with-cancer-3319) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-assisted-extracorporeal-ovarian-harvest-a-novel-technique-to-optimize-ovarian-tissue-for-cryopreservation-in-young-females-with-cancer-3319.md)
- [Testis-sparing surgery for testicular tumors in children: a 20 year single center experience and systematic review of the literature](https://library.globalcastmd.com/watch/testis-sparing-surgery-for-testicular-tumors-in-children-a-20-year-single-center-experience-and-systematic-review-of-the-literature-3548) — article · [machine version](https://library.globalcastmd.com/watch/testis-sparing-surgery-for-testicular-tumors-in-children-a-20-year-single-center-experience-and-systematic-review-of-the-literature-3548.md)
- [Zero-ischemia testis-sparing surgery for probably benign pediatric testicular tumors](https://library.globalcastmd.com/watch/zero-ischemia-testis-sparing-surgery-for-probably-benign-pediatric-testicular-tumors-3749) — article · [machine version](https://library.globalcastmd.com/watch/zero-ischemia-testis-sparing-surgery-for-probably-benign-pediatric-testicular-tumors-3749.md)
- [Management And Results Of Thyroidectomies In Pediatric Patients With Men 2 Syndrome](https://library.globalcastmd.com/watch/management-and-results-of-thyroidectomies-in-pediatric-patients-with-men-2-syndrome-3755) — article · [machine version](https://library.globalcastmd.com/watch/management-and-results-of-thyroidectomies-in-pediatric-patients-with-men-2-syndrome-3755.md)
- [Laparoscopic Adrenal-sparing Approach for Children with Bilateral Pheochromocytoma in Von Hippel-Lindau Disease](https://library.globalcastmd.com/watch/laparoscopic-adrenal-sparing-approach-for-children-with-bilateral-pheochromocytoma-in-von-hippel-lindau-disease-3942) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-adrenal-sparing-approach-for-children-with-bilateral-pheochromocytoma-in-von-hippel-lindau-disease-3942.md)
- [Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer](https://library.globalcastmd.com/watch/appendectomy-versus-observation-for-appendicitis-in-neutropenic-children-with-cancer-3946) — article · [machine version](https://library.globalcastmd.com/watch/appendectomy-versus-observation-for-appendicitis-in-neutropenic-children-with-cancer-3946.md)
- [Pathologic Correlation with Near Infrared-Indocyanine Green Guided Surgery for Pediatric Liver Cancer.](https://library.globalcastmd.com/watch/pathologic-correlation-with-near-infrared-indocyanine-green-guided-surgery-for-pediatric-liver-cancer-3964) — article · [machine version](https://library.globalcastmd.com/watch/pathologic-correlation-with-near-infrared-indocyanine-green-guided-surgery-for-pediatric-liver-cancer-3964.md)
- [CONTROLLED ASPIRATION OF LARGE PAEDIATRIC OVARIAN CYSTIC TUMOURS](https://library.globalcastmd.com/watch/controlled-aspiration-of-large-paediatric-ovarian-cystic-tumours-4332) — article · [machine version](https://library.globalcastmd.com/watch/controlled-aspiration-of-large-paediatric-ovarian-cystic-tumours-4332.md)
- [IPEG Academy: Laparoscopic Right Adrenalectomy](https://library.globalcastmd.com/watch/ipeg-academy-laparoscopic-right-adrenalectomy-4339) — video · [machine version](https://library.globalcastmd.com/watch/ipeg-academy-laparoscopic-right-adrenalectomy-4339.md)
- [Computed tomography-guided marking using a dye-staining method for preoperative localization of tiny pulmonary lesions in children](https://library.globalcastmd.com/watch/computed-tomography-guided-marking-using-a-dye-staining-method-for-preoperative-localization-of-tiny-pulmonary-lesions-in-children-4381) — article · [machine version](https://library.globalcastmd.com/watch/computed-tomography-guided-marking-using-a-dye-staining-method-for-preoperative-localization-of-tiny-pulmonary-lesions-in-children-4381.md)
- [Management of Intravascular Thrombus in Cases of Bilateral Wilms Tumor or Horseshoe Kidney](https://library.globalcastmd.com/watch/management-of-intravascular-thrombus-in-cases-of-bilateral-wilms-tumor-or-horseshoe-kidney-4389) — article · [machine version](https://library.globalcastmd.com/watch/management-of-intravascular-thrombus-in-cases-of-bilateral-wilms-tumor-or-horseshoe-kidney-4389.md)
- [Indocyanine Green–Guided Nephron-Sparing Surgery for Pediatric Renal Tumors](https://library.globalcastmd.com/watch/indocyanine-green-guided-nephron-sparing-surgery-for-pediatric-renal-tumors-4414) — article · [machine version](https://library.globalcastmd.com/watch/indocyanine-green-guided-nephron-sparing-surgery-for-pediatric-renal-tumors-4414.md)
- [Intraoperative Electromagnetic Navigation Bronchoscopy (IENB) to Localize Peripheral Lung Lesions: A New Technique in the Pediatric Oncology Population](https://library.globalcastmd.com/watch/intraoperative-electromagnetic-navigation-bronchoscopy-to-localize-peripheral-lung-lesions-a-new-technique-in-the-pediatric-oncology-population-4665) — article · [machine version](https://library.globalcastmd.com/watch/intraoperative-electromagnetic-navigation-bronchoscopy-to-localize-peripheral-lung-lesions-a-new-technique-in-the-pediatric-oncology-population-4665.md)
- [Pre-Operative Lumbar Drain Placement: A Technique for Minimizing Ischemic Spinal Cord Injury During Neuroblastoma Resection](https://library.globalcastmd.com/watch/pre-operative-lumbar-drain-placement-a-technique-for-minimizing-ischemic-spinal-cord-injury-during-neuroblastoma-resection-4716) — article · [machine version](https://library.globalcastmd.com/watch/pre-operative-lumbar-drain-placement-a-technique-for-minimizing-ischemic-spinal-cord-injury-during-neuroblastoma-resection-4716.md)
- [Surgical considerations for neuroblastoma-associated opsoclonus–myoclonus–ataxia syndrome: a series of 14 patients from a single institution](https://library.globalcastmd.com/watch/surgical-considerations-for-neuroblastoma-associated-opsoclonus-myoclonus-ataxia-syndrome-a-series-of-14-patients-from-a-single-institution-4849) — article · [machine version](https://library.globalcastmd.com/watch/surgical-considerations-for-neuroblastoma-associated-opsoclonus-myoclonus-ataxia-syndrome-a-series-of-14-patients-from-a-single-institution-4849.md)
- [Sacrococcygeal teratomas: midline reconstruction improves cosmesis without compromising outcomes](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-midline-reconstruction-improves-cosmesis-without-compromising-outcomes-5156) — article · [machine version](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-midline-reconstruction-improves-cosmesis-without-compromising-outcomes-5156.md)
- [Paediatric thyroidectomy: When and why? A 25-year institutional experience](https://library.globalcastmd.com/watch/paediatric-thyroidectomy-when-and-why-a-25-year-institutional-experience-5171) — article · [machine version](https://library.globalcastmd.com/watch/paediatric-thyroidectomy-when-and-why-a-25-year-institutional-experience-5171.md)
- [Limb Salvage Surgery has a Higher Complication Rate than Amputation but is Still Beneficial for Patients Younger than 10 Years Old with Osteosarcoma of an Extremity](https://library.globalcastmd.com/watch/limb-salvage-surgery-has-a-higher-complication-rate-than-amputation-but-is-still-beneficial-for-patients-younger-than-10-years-old-with-osteosarcoma-of-an-extremity-5298) — article · [machine version](https://library.globalcastmd.com/watch/limb-salvage-surgery-has-a-higher-complication-rate-than-amputation-but-is-still-beneficial-for-patients-younger-than-10-years-old-with-osteosarcoma-of-an-extremity-5298.md)
- [Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study](https://library.globalcastmd.com/watch/surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-5347) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-5347.md)
- [Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417) — video · [machine version](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417.md)
- [An Enhanced Recovery after Surgery Protocol in Children Who Undergo Nephrectomy for Wilms Tumor Safely Shortens Hospital Stay](https://library.globalcastmd.com/watch/an-enhanced-recovery-after-surgery-protocol-in-children-who-undergo-nephrectomy-for-wilms-tumor-safely-shortens-hospital-stay-5482) — article · [machine version](https://library.globalcastmd.com/watch/an-enhanced-recovery-after-surgery-protocol-in-children-who-undergo-nephrectomy-for-wilms-tumor-safely-shortens-hospital-stay-5482.md)
- [Fluorescence-guided lymph node sampling is feasible during up-front or delayed nephrectomy for Wilms tumor.](https://library.globalcastmd.com/watch/fluorescence-guided-lymph-node-sampling-is-feasible-during-up-front-or-delayed-nephrectomy-for-wilms-tumor-5488) — article · [machine version](https://library.globalcastmd.com/watch/fluorescence-guided-lymph-node-sampling-is-feasible-during-up-front-or-delayed-nephrectomy-for-wilms-tumor-5488.md)
- [Image Guided Surgery Video Series, Episode 2 - Lung Nodule Localization &...](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526) — podcast · 17:19 · [machine version](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526.md)
- [Image Guided Surgery Video Series, Episode 2 - Lung Nodule Localization &...](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537) — podcast · 10:15 · [machine version](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537.md)
- [Comparison of splenic vessel preserving distal pancreatectomy and the Warshaw technique for solid pseudopapillary neoplasm in children](https://library.globalcastmd.com/watch/comparison-of-splenic-vessel-preserving-distal-pancreatectomy-and-the-warshaw-technique-for-solid-pseudopapillary-neoplasm-in-children-5545) — article · [machine version](https://library.globalcastmd.com/watch/comparison-of-splenic-vessel-preserving-distal-pancreatectomy-and-the-warshaw-technique-for-solid-pseudopapillary-neoplasm-in-children-5545.md)
- [Surgical approach to pediatric mediastinal masses based on imaging characteristics](https://library.globalcastmd.com/watch/surgical-approach-to-pediatric-mediastinal-masses-based-on-imaging-characteristics-5546) — article · [machine version](https://library.globalcastmd.com/watch/surgical-approach-to-pediatric-mediastinal-masses-based-on-imaging-characteristics-5546.md)
- [Laparoscopic approach of pediatric adrenal tumors](https://library.globalcastmd.com/watch/laparoscopic-approach-of-pediatric-adrenal-tumors-5600) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-approach-of-pediatric-adrenal-tumors-5600.md)
- [Comparison of splenic vessel preserving distal pancreatectomy and the Warshaw technique for solid pseudopapillary neoplasm in children](https://library.globalcastmd.com/watch/comparison-of-splenic-vessel-preserving-distal-pancreatectomy-and-the-warshaw-technique-for-solid-pseudopapillary-neoplasm-in-children-5604) — article · [machine version](https://library.globalcastmd.com/watch/comparison-of-splenic-vessel-preserving-distal-pancreatectomy-and-the-warshaw-technique-for-solid-pseudopapillary-neoplasm-in-children-5604.md)
- [Update Course Rewind: Thoracotomy vs VATS for Lung Metastases](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632) — video · 9:40 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632.md)
- [Surgical approach to pediatric mediastinal masses based on imaging characteristics](https://library.globalcastmd.com/watch/surgical-approach-to-pediatric-mediastinal-masses-based-on-imaging-characteristics-5688) — article · [machine version](https://library.globalcastmd.com/watch/surgical-approach-to-pediatric-mediastinal-masses-based-on-imaging-characteristics-5688.md)
- [Laparoscopic approach of pediatric adrenal tumors](https://library.globalcastmd.com/watch/laparoscopic-approach-of-pediatric-adrenal-tumors-5843) — article · [machine version](https://library.globalcastmd.com/watch/laparoscopic-approach-of-pediatric-adrenal-tumors-5843.md)
- [Surgical Factors Influencing Local Relapse and Outcome in the Treatment of Unilateral Nephroblastoma](https://library.globalcastmd.com/watch/surgical-factors-influencing-local-relapse-and-outcome-in-the-treatment-of-unilateral-nephroblastoma-5947) — article · [machine version](https://library.globalcastmd.com/watch/surgical-factors-influencing-local-relapse-and-outcome-in-the-treatment-of-unilateral-nephroblastoma-5947.md)
- [Management of Intravascular Thrombus in Bilateral Wilms Tumor or Horseshoe Kidney](https://library.globalcastmd.com/watch/management-of-intravascular-thrombus-in-bilateral-wilms-tumor-or-horseshoe-kidney-6220) — article · [machine version](https://library.globalcastmd.com/watch/management-of-intravascular-thrombus-in-bilateral-wilms-tumor-or-horseshoe-kidney-6220.md)
- [Commentary on “Laparoscopic approach of pediatric adrenal tumors”](https://library.globalcastmd.com/watch/commentary-on-laparoscopic-approach-of-pediatric-adrenal-tumors-6269) — article · [machine version](https://library.globalcastmd.com/watch/commentary-on-laparoscopic-approach-of-pediatric-adrenal-tumors-6269.md)
- [Surgical management in hepatoblastoma: points to take](https://library.globalcastmd.com/watch/surgical-management-in-hepatoblastoma-points-to-take-6276) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-in-hepatoblastoma-points-to-take-6276.md)
- [Feasibility and safety of laparoscopic tumor resection in children with abdominal neuroblastomas](https://library.globalcastmd.com/watch/feasibility-and-safety-of-laparoscopic-tumor-resection-in-children-with-abdominal-neuroblastomas-6309) — article · [machine version](https://library.globalcastmd.com/watch/feasibility-and-safety-of-laparoscopic-tumor-resection-in-children-with-abdominal-neuroblastomas-6309.md)
- [Treatment of bilateral Wilms’ tumor in children: how to improve the application of nephron-sparing surgery](https://library.globalcastmd.com/watch/treatment-of-bilateral-wilms-tumor-in-children-how-to-improve-the-application-of-nephron-sparing-surgery-6434) — article · [machine version](https://library.globalcastmd.com/watch/treatment-of-bilateral-wilms-tumor-in-children-how-to-improve-the-application-of-nephron-sparing-surgery-6434.md)
- [Multicenter retrospective study on benign testicular tumors in children: save as much as you can……please](https://library.globalcastmd.com/watch/multicenter-retrospective-study-on-benign-testicular-tumors-in-children-save-as-much-as-you-can-please-6522) — article · [machine version](https://library.globalcastmd.com/watch/multicenter-retrospective-study-on-benign-testicular-tumors-in-children-save-as-much-as-you-can-please-6522.md)
- [The utility of intraoperative neuromonitoring in pediatric surgical oncology](https://library.globalcastmd.com/watch/the-utility-of-intraoperative-neuromonitoring-in-pediatric-surgical-oncology-6564) — article · [machine version](https://library.globalcastmd.com/watch/the-utility-of-intraoperative-neuromonitoring-in-pediatric-surgical-oncology-6564.md)
- [Effectiveness of indocyanine green fluorescence imaging in resection of hepatoblastoma](https://library.globalcastmd.com/watch/effectiveness-of-indocyanine-green-fluorescence-imaging-in-resection-of-hepatoblastoma-6573) — article · [machine version](https://library.globalcastmd.com/watch/effectiveness-of-indocyanine-green-fluorescence-imaging-in-resection-of-hepatoblastoma-6573.md)
- [It is all about form and function: a new approach to giant neonatal sacrococcygeal teratomas](https://library.globalcastmd.com/watch/it-is-all-about-form-and-function-a-new-approach-to-giant-neonatal-sacrococcygeal-teratomas-6577) — article · [machine version](https://library.globalcastmd.com/watch/it-is-all-about-form-and-function-a-new-approach-to-giant-neonatal-sacrococcygeal-teratomas-6577.md)
- [Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned from a 20-year experience](https://library.globalcastmd.com/watch/multi-disciplinary-care-in-patients-with-complex-pediatric-general-and-thoracic-surgical-pathology-lessons-learned-from-a-20-year-experience-6584) — article · [machine version](https://library.globalcastmd.com/watch/multi-disciplinary-care-in-patients-with-complex-pediatric-general-and-thoracic-surgical-pathology-lessons-learned-from-a-20-year-experience-6584.md)
- [Multicenter retrospective study on benign testicular tumors in children: save as much as you can……please](https://library.globalcastmd.com/watch/multicenter-retrospective-study-on-benign-testicular-tumors-in-children-save-as-much-as-you-can-please-6684) — article · [machine version](https://library.globalcastmd.com/watch/multicenter-retrospective-study-on-benign-testicular-tumors-in-children-save-as-much-as-you-can-please-6684.md)
- [Retroperitoneal localized neuroblastoma in children: a comparison of enhanced recovery after surgery versus traditional care](https://library.globalcastmd.com/watch/retroperitoneal-localized-neuroblastoma-in-children-a-comparison-of-enhanced-recovery-after-surgery-versus-traditional-care-6696) — article · [machine version](https://library.globalcastmd.com/watch/retroperitoneal-localized-neuroblastoma-in-children-a-comparison-of-enhanced-recovery-after-surgery-versus-traditional-care-6696.md)
- [Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-7770) — article · [machine version](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-7770.md)
- [Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-7800) — article · [machine version](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-7800.md)
- [Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor: a systematic review and meta-analysis](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-a-systematic-review-and-meta-analysis-7844) — article · [machine version](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-a-systematic-review-and-meta-analysis-7844.md)
- [Use of pedicled flaps after oncologic resections in pediatric patients](https://library.globalcastmd.com/watch/use-of-pedicled-flaps-after-oncologic-resections-in-pediatric-patients-8037) — article · [machine version](https://library.globalcastmd.com/watch/use-of-pedicled-flaps-after-oncologic-resections-in-pediatric-patients-8037.md)
- [Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8069) — article · [machine version](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8069.md)
- [Eficacia y efectos renales tardíos de la cirugía conservadora de nefronas en el tratamiento del tumor de Wilms unilateral](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-8073) — article · [machine version](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-8073.md)
- [Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee](https://library.globalcastmd.com/watch/central-venous-catheter-consideration-in-pediatric-oncology-a-systematic-review-and-meta-analysis-from-the-american-pediatric-surgical-association-cancer-committee-8122) — article · [machine version](https://library.globalcastmd.com/watch/central-venous-catheter-consideration-in-pediatric-oncology-a-systematic-review-and-meta-analysis-from-the-american-pediatric-surgical-association-cancer-committee-8122.md)
- [Nephron-Sparing Surgery in Pediatric Renal Tumors Arising From a Horseshoe Kidney: Proposal of a Lacking Definition](https://library.globalcastmd.com/watch/nephron-sparing-surgery-in-pediatric-renal-tumors-arising-from-a-horseshoe-kidney-proposal-of-a-lacking-definition-8134) — article · [machine version](https://library.globalcastmd.com/watch/nephron-sparing-surgery-in-pediatric-renal-tumors-arising-from-a-horseshoe-kidney-proposal-of-a-lacking-definition-8134.md)
- [Utility of Indocyanine Green for Sentinel Lymph Node Biopsy in Pediatric Sarcoma and Melanoma](https://library.globalcastmd.com/watch/utility-of-indocyanine-green-for-sentinel-lymph-node-biopsy-in-pediatric-sarcoma-and-melanoma-8161) — article · [machine version](https://library.globalcastmd.com/watch/utility-of-indocyanine-green-for-sentinel-lymph-node-biopsy-in-pediatric-sarcoma-and-melanoma-8161.md)
- [Impact of Surgical Timing (Primary, Delayed, or Second Look) on Surgical Morbidity and Outcomes in Malignant Germ Cell Tumor of the Ovary in Children](https://library.globalcastmd.com/watch/impact-of-surgical-timing-on-surgical-morbidity-and-outcomes-in-malignant-germ-cell-tumor-of-the-ovary-in-children-8174) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-surgical-timing-on-surgical-morbidity-and-outcomes-in-malignant-germ-cell-tumor-of-the-ovary-in-children-8174.md)
- [Multi-modal 3-Dimensional Visualization of Pediatric Neuroblastoma: Aiding Surgical Planning Beyond Anatomical Information](https://library.globalcastmd.com/watch/multi-modal-3-dimensional-visualization-of-pediatric-neuroblastoma-aiding-surgical-planning-beyond-anatomical-information-8186) — article · [machine version](https://library.globalcastmd.com/watch/multi-modal-3-dimensional-visualization-of-pediatric-neuroblastoma-aiding-surgical-planning-beyond-anatomical-information-8186.md)
- [The Use of a High Flow PICC Catheter for Stem Cell and Lymphocyte Apheresis: The Initial Experience of a Pediatric Oncology Center in Brazil](https://library.globalcastmd.com/watch/the-use-of-a-high-flow-picc-catheter-for-stem-cell-and-lymphocyte-apheresis-the-initial-experience-of-a-pediatric-oncology-center-in-brazil-8189) — article · [machine version](https://library.globalcastmd.com/watch/the-use-of-a-high-flow-picc-catheter-for-stem-cell-and-lymphocyte-apheresis-the-initial-experience-of-a-pediatric-oncology-center-in-brazil-8189.md)
- [Systematic Lymphatic Repair for Reduction of Postoperative Lymphatic Leak Following Neuroblastoma Resection](https://library.globalcastmd.com/watch/systematic-lymphatic-repair-for-reduction-of-postoperative-lymphatic-leak-following-neuroblastoma-resection-8191) — article · [machine version](https://library.globalcastmd.com/watch/systematic-lymphatic-repair-for-reduction-of-postoperative-lymphatic-leak-following-neuroblastoma-resection-8191.md)
- [Nephrectomy for Pediatric Renal Tumors: A Modified Surgical Approach to Minimize Post-operative Intestinal Obstruction](https://library.globalcastmd.com/watch/nephrectomy-for-pediatric-renal-tumors-a-modified-surgical-approach-to-minimize-post-operative-intestinal-obstruction-8310) — article · [machine version](https://library.globalcastmd.com/watch/nephrectomy-for-pediatric-renal-tumors-a-modified-surgical-approach-to-minimize-post-operative-intestinal-obstruction-8310.md)
- [Efficacy of Neoadjuvant Chemotherapy on Nephron-Sparing Surgery for Wilms Tumor in Horseshoe Kidney](https://library.globalcastmd.com/watch/efficacy-of-neoadjuvant-chemotherapy-on-nephron-sparing-surgery-for-wilms-tumor-in-horseshoe-kidney-8508) — article · [machine version](https://library.globalcastmd.com/watch/efficacy-of-neoadjuvant-chemotherapy-on-nephron-sparing-surgery-for-wilms-tumor-in-horseshoe-kidney-8508.md)
- [Exploring the frontier in robotic pediatric cancer surgery: when to move forward and when to stop](https://library.globalcastmd.com/watch/exploring-the-frontier-in-robotic-pediatric-cancer-surgery-when-to-move-forward-and-when-to-stop-8665) — article · [machine version](https://library.globalcastmd.com/watch/exploring-the-frontier-in-robotic-pediatric-cancer-surgery-when-to-move-forward-and-when-to-stop-8665.md)
- [Evaluation of surgical strategies and long-term outcomes in pediatric hepatocellular carcinoma](https://library.globalcastmd.com/watch/evaluation-of-surgical-strategies-and-long-term-outcomes-in-pediatric-hepatocellular-carcinoma-8673) — article · [machine version](https://library.globalcastmd.com/watch/evaluation-of-surgical-strategies-and-long-term-outcomes-in-pediatric-hepatocellular-carcinoma-8673.md)
- [Surgical management of ovarian masses in children and adolescents: experience of an academic institution in France](https://library.globalcastmd.com/watch/surgical-management-of-ovarian-masses-in-children-and-adolescents-experience-of-an-academic-institution-in-france-8710) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-ovarian-masses-in-children-and-adolescents-experience-of-an-academic-institution-in-france-8710.md)
- [Surgery for hepatoblastoma in children with trisomy 18: a monocentric study](https://library.globalcastmd.com/watch/surgery-for-hepatoblastoma-in-children-with-trisomy-18-a-monocentric-study-9000) — article · [machine version](https://library.globalcastmd.com/watch/surgery-for-hepatoblastoma-in-children-with-trisomy-18-a-monocentric-study-9000.md)
- [Single-Incision Retroperitoneal Laparoscopic Resection of Adrenal Tumors in Children](https://library.globalcastmd.com/watch/single-incision-retroperitoneal-laparoscopic-resection-of-adrenal-tumors-in-children-9032) — article · [machine version](https://library.globalcastmd.com/watch/single-incision-retroperitoneal-laparoscopic-resection-of-adrenal-tumors-in-children-9032.md)
- [The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma – An Argument for a More Conservative Approach](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-9136) — article · [machine version](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-9136.md)
- [An Enhanced Recovery Program for Pediatric, Adolescent, and Young Adult Surgical Oncology Patients Improves Outcomes After Surgery](https://library.globalcastmd.com/watch/an-enhanced-recovery-program-for-pediatric-adolescent-and-young-adult-surgical-oncology-patients-improves-outcomes-after-surgery-9149) — article · [machine version](https://library.globalcastmd.com/watch/an-enhanced-recovery-program-for-pediatric-adolescent-and-young-adult-surgical-oncology-patients-improves-outcomes-after-surgery-9149.md)
- [Central Liver Segments Resections vs Extended Hepatectomies in Children: Single-Center Experience](https://library.globalcastmd.com/watch/central-liver-segments-resections-vs-extended-hepatectomies-in-children-single-center-experience-9164) — article · [machine version](https://library.globalcastmd.com/watch/central-liver-segments-resections-vs-extended-hepatectomies-in-children-single-center-experience-9164.md)
- [IPEG Academy: Robotic Right Adrenalectomy](https://library.globalcastmd.com/watch/ipeg-academy-robotic-right-adrenalectomy-9314) — video · [machine version](https://library.globalcastmd.com/watch/ipeg-academy-robotic-right-adrenalectomy-9314.md)
- [Perioperative Antibiotic Use in Pediatric Solid Tumor Resection: A Two-center Retrospective Cohort Study](https://library.globalcastmd.com/watch/perioperative-antibiotic-use-in-pediatric-solid-tumor-resection-a-two-center-retrospective-cohort-study-9316) — article · [machine version](https://library.globalcastmd.com/watch/perioperative-antibiotic-use-in-pediatric-solid-tumor-resection-a-two-center-retrospective-cohort-study-9316.md)
- [Pathological Insights into Non-Neoplastic Renal Parenchyma in Wilms Tumor: Implications for Nephron-Sparing Surgery](https://library.globalcastmd.com/watch/pathological-insights-into-non-neoplastic-renal-parenchyma-in-wilms-tumor-implications-for-nephron-sparing-surgery-9318) — article · [machine version](https://library.globalcastmd.com/watch/pathological-insights-into-non-neoplastic-renal-parenchyma-in-wilms-tumor-implications-for-nephron-sparing-surgery-9318.md)
- [Robotic Surgery in Paediatric Oncology: Expanding Boundaries and Defining Relevant Indications](https://library.globalcastmd.com/watch/robotic-surgery-in-paediatric-oncology-expanding-boundaries-and-defining-relevant-indications-9331) — article · [machine version](https://library.globalcastmd.com/watch/robotic-surgery-in-paediatric-oncology-expanding-boundaries-and-defining-relevant-indications-9331.md)
- [Approaches to the Diagnosis and Management of Paediatric Ovarian Tumours and Oncological Outcomes in a Single-centre Study. Evidence in Support Of IPSO Reccomendations](https://library.globalcastmd.com/watch/approaches-to-the-diagnosis-and-management-of-paediatric-ovarian-tumours-and-oncological-outcomes-in-a-single-centre-study-evidence-in-support-of-ipso-reccomendations-9332) — article · [machine version](https://library.globalcastmd.com/watch/approaches-to-the-diagnosis-and-management-of-paediatric-ovarian-tumours-and-oncological-outcomes-in-a-single-centre-study-evidence-in-support-of-ipso-reccomendations-9332.md)
- [How Many Lymph Nodes are Enough in Paratesticular Rhabdomyosarcoma?](https://library.globalcastmd.com/watch/how-many-lymph-nodes-are-enough-in-paratesticular-rhabdomyosarcoma-9357) — article · [machine version](https://library.globalcastmd.com/watch/how-many-lymph-nodes-are-enough-in-paratesticular-rhabdomyosarcoma-9357.md)
- [Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas](https://library.globalcastmd.com/watch/promoting-application-of-enhanced-recovery-after-surgery-protocols-during-perioperative-localized-abdominal-and-thoracic-neuroblastomas-9374) — article · [machine version](https://library.globalcastmd.com/watch/promoting-application-of-enhanced-recovery-after-surgery-protocols-during-perioperative-localized-abdominal-and-thoracic-neuroblastomas-9374.md)
- [Update Course Rewind: Lipiodol for Lung Metastases 2024](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484.md)
- [Surgical management of children with Burkitt's lymphoma involving the gastrointestinal tract](https://library.globalcastmd.com/watch/surgical-management-of-children-with-burkitt-s-lymphoma-involving-the-gastrointestinal-tract-9563) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-children-with-burkitt-s-lymphoma-involving-the-gastrointestinal-tract-9563.md)
- [Impact of the relationship between renal pedicles and tumors on surgical outcomes for non-high-risk abdominal neuroblastoma](https://library.globalcastmd.com/watch/impact-of-the-relationship-between-renal-pedicles-and-tumors-on-surgical-outcomes-for-non-high-risk-abdominal-neuroblastoma-9572) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-the-relationship-between-renal-pedicles-and-tumors-on-surgical-outcomes-for-non-high-risk-abdominal-neuroblastoma-9572.md)
- [Nephron-sparing Surgery for Pediatric Renal Tumors After Centralization of Pediatric Oncology Care in the Netherlands: Improved Outcomes With 3D Modeling](https://library.globalcastmd.com/watch/nephron-sparing-surgery-for-pediatric-renal-tumors-after-centralization-of-pediatric-oncology-care-in-the-netherlands-improved-outcomes-with-3d-modeling-9581) — article · [machine version](https://library.globalcastmd.com/watch/nephron-sparing-surgery-for-pediatric-renal-tumors-after-centralization-of-pediatric-oncology-care-in-the-netherlands-improved-outcomes-with-3d-modeling-9581.md)
- [Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-9646) — video · 1:46 · [machine version](https://library.globalcastmd.com/watch/reducing-unnecessary-oophorectomies-for-benign-ovarian-neoplasms-in-pediatric-patients-9646.md)
- [Dr. Chiara Oreglio - Best of the Best in Pediatric Surgery 2025](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042) — video · 9:18 · [machine version](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042.md)
- [Surgical practices and oncological outcomes of Wilms tumor in a resource limited setting: a risk-adapted approach](https://library.globalcastmd.com/watch/surgical-practices-and-oncological-outcomes-of-wilms-tumor-in-a-resource-limited-setting-a-risk-adapted-approach-10237) — article · [machine version](https://library.globalcastmd.com/watch/surgical-practices-and-oncological-outcomes-of-wilms-tumor-in-a-resource-limited-setting-a-risk-adapted-approach-10237.md)
- [Direct balloon trocar technique for closed decompression of large predominantly cystic ovarian tumors in adolescents](https://library.globalcastmd.com/watch/direct-balloon-trocar-technique-for-closed-decompression-of-large-predominantly-cystic-ovarian-tumors-in-adolescents-10337) — article · [machine version](https://library.globalcastmd.com/watch/direct-balloon-trocar-technique-for-closed-decompression-of-large-predominantly-cystic-ovarian-tumors-in-adolescents-10337.md)
- [The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma - An Argument for a More Conservative Approach](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-10418) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-10418.md)
- [The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma – An Argument for a More Conservative Approach](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-10470) — article · [machine version](https://library.globalcastmd.com/watch/the-impact-of-surgical-margin-in-wide-local-excision-of-pediatric-melanoma-an-argument-for-a-more-conservative-approach-10470.md)
- [Sacrococcygeal Teratomas in Currarino Syndrome: A Multicenter Review of Tumor Characteristics, Surgical Outcomes, and Recurrence](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-10584) — article · [machine version](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-10584.md)
- [Enucleation Versus Conventional Pancreatic Resection in Pediatric Solid Pseudopapillary Neoplasm: A Retrospective Analysis of Short- and Long-Term Outcomes](https://library.globalcastmd.com/watch/enucleation-versus-conventional-pancreatic-resection-in-pediatric-solid-pseudopapillary-neoplasm-a-retrospective-analysis-of-short-and-long-term-outcomes-10592) — article · [machine version](https://library.globalcastmd.com/watch/enucleation-versus-conventional-pancreatic-resection-in-pediatric-solid-pseudopapillary-neoplasm-a-retrospective-analysis-of-short-and-long-term-outcomes-10592.md)
- [Risk Factors for Adverse Surgical Outcomes After Liver Resection for Hepatoblastoma – A Review of 30 years of Experience](https://library.globalcastmd.com/watch/risk-factors-for-adverse-surgical-outcomes-after-liver-resection-for-hepatoblastoma-a-review-of-30-years-of-experience-10606) — article · [machine version](https://library.globalcastmd.com/watch/risk-factors-for-adverse-surgical-outcomes-after-liver-resection-for-hepatoblastoma-a-review-of-30-years-of-experience-10606.md)
- [A journey full of surprises: surgical insights from pediatric undifferentiated embryonal liver sarcomas](https://library.globalcastmd.com/watch/a-journey-full-of-surprises-surgical-insights-from-pediatric-undifferentiated-embryonal-liver-sarcomas-10607) — article · [machine version](https://library.globalcastmd.com/watch/a-journey-full-of-surprises-surgical-insights-from-pediatric-undifferentiated-embryonal-liver-sarcomas-10607.md)
- [Robotic assisted versus conventional laparoscopic adrenalectomy for local adrenal neuroblastoma in children: a comparative study](https://library.globalcastmd.com/watch/robotic-assisted-versus-conventional-laparoscopic-adrenalectomy-for-local-adrenal-neuroblastoma-in-children-a-comparative-study-10617) — article · [machine version](https://library.globalcastmd.com/watch/robotic-assisted-versus-conventional-laparoscopic-adrenalectomy-for-local-adrenal-neuroblastoma-in-children-a-comparative-study-10617.md)
- [Selective use of minimally invasive surgery in Wilms tumours: supporting evidence and cautionary notes](https://library.globalcastmd.com/watch/selective-use-of-minimally-invasive-surgery-in-wilms-tumours-supporting-evidence-and-cautionary-notes-10619) — article · [machine version](https://library.globalcastmd.com/watch/selective-use-of-minimally-invasive-surgery-in-wilms-tumours-supporting-evidence-and-cautionary-notes-10619.md)
- [Surgical Management of Paediatric Appendiceal Neuroendocrine Tumors: A 26-year Danish Nationwide retrospective cohort study](https://library.globalcastmd.com/watch/surgical-management-of-paediatric-appendiceal-neuroendocrine-tumors-a-26-year-danish-nationwide-retrospective-cohort-study-10764) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-paediatric-appendiceal-neuroendocrine-tumors-a-26-year-danish-nationwide-retrospective-cohort-study-10764.md)
- [Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix in a National Cohort: A Call to Further Decrease Colectomy](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-in-a-national-cohort-a-call-to-further-decrease-colectomy-10824) — article · [machine version](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-in-a-national-cohort-a-call-to-further-decrease-colectomy-10824.md)
- [Too Many Cooks in the Kitchen or an Organized Brigade? A Success Story of Collaboration Between Pediatric Urology and Surgery to Treat Children With Renal Tumors](https://library.globalcastmd.com/watch/too-many-cooks-in-the-kitchen-or-an-organized-brigade-a-success-story-of-collaboration-between-pediatric-urology-and-surgery-to-treat-children-with-renal-tumors-10873) — article · [machine version](https://library.globalcastmd.com/watch/too-many-cooks-in-the-kitchen-or-an-organized-brigade-a-success-story-of-collaboration-between-pediatric-urology-and-surgery-to-treat-children-with-renal-tumors-10873.md)
- [Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941) — video · 0:49 · [machine version](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941.md)
- [Lobectomy or total thyroidectomy in pediatric differentiated thyroid cancer? A systematic review and meta-analysis](https://library.globalcastmd.com/watch/lobectomy-or-total-thyroidectomy-in-pediatric-differentiated-thyroid-cancer-a-systematic-review-and-meta-analysis-10954) — article · [machine version](https://library.globalcastmd.com/watch/lobectomy-or-total-thyroidectomy-in-pediatric-differentiated-thyroid-cancer-a-systematic-review-and-meta-analysis-10954.md)
- [Implementation of Comprehensive Surgical Guidelines for Hepatoblastoma](https://library.globalcastmd.com/watch/implementation-of-comprehensive-surgical-guidelines-for-hepatoblastoma-11244) — article · [machine version](https://library.globalcastmd.com/watch/implementation-of-comprehensive-surgical-guidelines-for-hepatoblastoma-11244.md)
- [Surgical resection of giant hepatoblastoma involving second and third hepatic portals: a study of 59 cases](https://library.globalcastmd.com/watch/surgical-resection-of-giant-hepatoblastoma-involving-second-and-third-hepatic-portals-a-study-of-59-cases-11250) — article · [machine version](https://library.globalcastmd.com/watch/surgical-resection-of-giant-hepatoblastoma-involving-second-and-third-hepatic-portals-a-study-of-59-cases-11250.md)
- [Sacrococcygeal Teratomas in Currarino Syndrome: A Multicenter Review of Tumor Characteristics, Surgical Outcomes, and Recurrence](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278.md)
- [Outcomes of major liver resection for children with hepatoblastoma weighing less than 10 kg: avoiding liver transplantation with extended or extreme resection](https://library.globalcastmd.com/watch/outcomes-of-major-liver-resection-for-children-with-hepatoblastoma-weighing-less-than-10-kg-avoiding-liver-transplantation-with-extended-or-extreme-resection-11282) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-major-liver-resection-for-children-with-hepatoblastoma-weighing-less-than-10-kg-avoiding-liver-transplantation-with-extended-or-extreme-resection-11282.md)
- [Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416.md)
- [Hepatoblastoma Resection Timing_Visual Abstract 2025](https://library.globalcastmd.com/watch/hepatoblastoma-resection-timing-visual-abstract-2025-11478) — article · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-resection-timing-visual-abstract-2025-11478.md)
- [Ovarian Germ Cell Tumors_Visual Abstract 2025](https://library.globalcastmd.com/watch/ovarian-germ-cell-tumors-visual-abstract-2025-11483) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-germ-cell-tumors-visual-abstract-2025-11483.md)
- [Wilms LN Tempalte_Visual Abstract 2025](https://library.globalcastmd.com/watch/wilms-ln-tempalte-visual-abstract-2025-11487) — article · [machine version](https://library.globalcastmd.com/watch/wilms-ln-tempalte-visual-abstract-2025-11487.md)
- [Sarcoma SLNB_Visual Abstract 2025](https://library.globalcastmd.com/watch/sarcoma-slnb-visual-abstract-2025-11488) — article · [machine version](https://library.globalcastmd.com/watch/sarcoma-slnb-visual-abstract-2025-11488.md)
- [Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522.md)
- [Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11632) — article · [machine version](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11632.md)
- [Modern Imaging Guidelines for 3-D Modeling of Pediatric Solid Tumors: A New Era of Surgical Oncology Operative Planning](https://library.globalcastmd.com/watch/modern-imaging-guidelines-for-3-d-modeling-of-pediatric-solid-tumors-a-new-era-of-surgical-oncology-operative-planning-11633) — article · [machine version](https://library.globalcastmd.com/watch/modern-imaging-guidelines-for-3-d-modeling-of-pediatric-solid-tumors-a-new-era-of-surgical-oncology-operative-planning-11633.md)
- [Characteristics of Transfusion & Association w/ Oncologic Outcomes in Hepatoblastoma Resection](https://library.globalcastmd.com/watch/characteristics-of-transfusion-association-w-oncologic-outcomes-in-hepatoblastoma-resection-11635) — article · [machine version](https://library.globalcastmd.com/watch/characteristics-of-transfusion-association-w-oncologic-outcomes-in-hepatoblastoma-resection-11635.md)
- [ROBOTIC SURGERY OF WILMS TUMOUR: TIME TO EXPAND THE FRONTIERS OF MINIMALLY INVASIVE SURGERY?](https://library.globalcastmd.com/watch/robotic-surgery-of-wilms-tumour-time-to-expand-the-frontiers-of-minimally-invasive-surgery-11730) — article · [machine version](https://library.globalcastmd.com/watch/robotic-surgery-of-wilms-tumour-time-to-expand-the-frontiers-of-minimally-invasive-surgery-11730.md)
- [ASO Visual Abstract: Surgical Management and Outcomes in Pediatric Adrenocortical Carcinoma: A Pediatric Surgical Oncology Research Collaborative Study](https://library.globalcastmd.com/watch/aso-visual-abstract-surgical-management-and-outcomes-in-pediatric-adrenocortical-carcinoma-a-pediatric-surgical-oncology-research-collaborative-study-11754) — video · 0:46 · [machine version](https://library.globalcastmd.com/watch/aso-visual-abstract-surgical-management-and-outcomes-in-pediatric-adrenocortical-carcinoma-a-pediatric-surgical-oncology-research-collaborative-study-11754.md)
- [Modern Imaging Guidelines for 3-D Modeling of Pediatric Solid Tumors: A New Era of Surgical Oncology Operative Planning](https://library.globalcastmd.com/watch/modern-imaging-guidelines-for-3-d-modeling-of-pediatric-solid-tumors-a-new-era-of-surgical-oncology-operative-planning-11756) — video · 1:01 · [machine version](https://library.globalcastmd.com/watch/modern-imaging-guidelines-for-3-d-modeling-of-pediatric-solid-tumors-a-new-era-of-surgical-oncology-operative-planning-11756.md)
- [Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811.md)
- [Comparison of Robotic and Laparoscopic liver resection for pediatric liver tumor: a multicenter study](https://library.globalcastmd.com/watch/comparison-of-robotic-and-laparoscopic-liver-resection-for-pediatric-liver-tumor-a-multicenter-study-11857) — article · [machine version](https://library.globalcastmd.com/watch/comparison-of-robotic-and-laparoscopic-liver-resection-for-pediatric-liver-tumor-a-multicenter-study-11857.md)
- [Deep learning-based Wilms tumor segmentation to create 3D models for surgical planning: Implementation in the clinical workflow](https://library.globalcastmd.com/watch/deep-learning-based-wilms-tumor-segmentation-to-create-3d-models-for-surgical-planning-implementation-in-the-clinical-workflow-11869) — article · [machine version](https://library.globalcastmd.com/watch/deep-learning-based-wilms-tumor-segmentation-to-create-3d-models-for-surgical-planning-implementation-in-the-clinical-workflow-11869.md)
- [Intraoperative Ultrasound In Nephron-Sparing Surgery For Paediatric Renal Tumours: A Single-Centre Cohort Study](https://library.globalcastmd.com/watch/intraoperative-ultrasound-in-nephron-sparing-surgery-for-paediatric-renal-tumours-a-single-centre-cohort-study-11881) — article · [machine version](https://library.globalcastmd.com/watch/intraoperative-ultrasound-in-nephron-sparing-surgery-for-paediatric-renal-tumours-a-single-centre-cohort-study-11881.md)
- [LLL for metastatic Osteosacoma](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927) — video · 6:17 · [machine version](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927.md)
- [Narrated R Adrenal Coolseal](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947) — video · 8:34 · [machine version](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947.md)
- [Oncologic Outcomes of Parenchyma-Sparing Resection for Hepatoblastoma](https://library.globalcastmd.com/watch/oncologic-outcomes-of-parenchyma-sparing-resection-for-hepatoblastoma-12001) — article · [machine version](https://library.globalcastmd.com/watch/oncologic-outcomes-of-parenchyma-sparing-resection-for-hepatoblastoma-12001.md)
- [Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056) — video · 1:13 · [machine version](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056.md)
- [Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577) — video · 6:20 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577.md)

### Complications
- [Acquired Urethrovaginal Fistula and Urethral Atresia in a Patient with a Sacrococcygeal Teratoma](https://library.globalcastmd.com/watch/acquired-urethrovaginal-fistula-and-urethral-atresia-in-a-patient-with-a-sacrococcygeal-teratoma-450) — article · [machine version](https://library.globalcastmd.com/watch/acquired-urethrovaginal-fistula-and-urethral-atresia-in-a-patient-with-a-sacrococcygeal-teratoma-450.md)
- [Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study](https://library.globalcastmd.com/watch/incidence-severity-and-outcome-of-central-line-related-complications-in-pediatric-oncology-patients-a-single-center-study-615) — article · [machine version](https://library.globalcastmd.com/watch/incidence-severity-and-outcome-of-central-line-related-complications-in-pediatric-oncology-patients-a-single-center-study-615.md)
- [Children are at a High Risk of Hypocalcaemia and Hypoparathyroidism after Total Thyroidectomy](https://library.globalcastmd.com/watch/children-are-at-a-high-risk-of-hypocalcaemia-and-hypoparathyroidism-after-total-thyroidectomy-1574) — article · [machine version](https://library.globalcastmd.com/watch/children-are-at-a-high-risk-of-hypocalcaemia-and-hypoparathyroidism-after-total-thyroidectomy-1574.md)
- [Complications Following Nephron-Sparing Surgery for Wilms Tumor](https://library.globalcastmd.com/watch/complications-following-nephron-sparing-surgery-for-wilms-tumor-1860) — article · [machine version](https://library.globalcastmd.com/watch/complications-following-nephron-sparing-surgery-for-wilms-tumor-1860.md)
- [Complications of Biologic Therapy for Pediatric Cancer – What the Surgeon Needs to Know](https://library.globalcastmd.com/watch/complications-of-biologic-therapy-for-pediatric-cancer-what-the-surgeon-needs-to-know-1936) — article · [machine version](https://library.globalcastmd.com/watch/complications-of-biologic-therapy-for-pediatric-cancer-what-the-surgeon-needs-to-know-1936.md)
- [Management of pancreatic pseudocysts in pediatric oncology patients](https://library.globalcastmd.com/watch/management-of-pancreatic-pseudocysts-in-pediatric-oncology-patients-2087) — article · [machine version](https://library.globalcastmd.com/watch/management-of-pancreatic-pseudocysts-in-pediatric-oncology-patients-2087.md)
- [Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?](https://library.globalcastmd.com/watch/lymphatic-leakage-after-surgery-for-neuroblastoma-a-rare-complication-2106) — article · [machine version](https://library.globalcastmd.com/watch/lymphatic-leakage-after-surgery-for-neuroblastoma-a-rare-complication-2106.md)
- [Risk for deep venous thrombosis in pediatric cancer patients undergoing surgery](https://library.globalcastmd.com/watch/risk-for-deep-venous-thrombosis-in-pediatric-cancer-patients-undergoing-surgery-3677) — article · [machine version](https://library.globalcastmd.com/watch/risk-for-deep-venous-thrombosis-in-pediatric-cancer-patients-undergoing-surgery-3677.md)
- [Arterial constriction after resection of neuroblastic tumors in children: Two-center retrospective study](https://library.globalcastmd.com/watch/arterial-constriction-after-resection-of-neuroblastic-tumors-in-children-two-center-retrospective-study-4004) — article · [machine version](https://library.globalcastmd.com/watch/arterial-constriction-after-resection-of-neuroblastic-tumors-in-children-two-center-retrospective-study-4004.md)
- [Early postoperative complications in pediatric abdominal solid tumor surgery according to Clavian–Dindo classification](https://library.globalcastmd.com/watch/early-postoperative-complications-in-pediatric-abdominal-solid-tumor-surgery-according-to-clavian-dindo-classification-5563) — article · [machine version](https://library.globalcastmd.com/watch/early-postoperative-complications-in-pediatric-abdominal-solid-tumor-surgery-according-to-clavian-dindo-classification-5563.md)
- [Early postoperative complications in pediatric abdominal solid tumor surgery according to Clavian–Dindo classification](https://library.globalcastmd.com/watch/early-postoperative-complications-in-pediatric-abdominal-solid-tumor-surgery-according-to-clavian-dindo-classification-5671) — article · [machine version](https://library.globalcastmd.com/watch/early-postoperative-complications-in-pediatric-abdominal-solid-tumor-surgery-according-to-clavian-dindo-classification-5671.md)
- [Characteristics of ovarian necrosis in the neonatal ovarian tumor: a single-center retrospective study and review of literature](https://library.globalcastmd.com/watch/characteristics-of-ovarian-necrosis-in-the-neonatal-ovarian-tumor-a-single-center-retrospective-study-and-review-of-literature-6202) — article · [machine version](https://library.globalcastmd.com/watch/characteristics-of-ovarian-necrosis-in-the-neonatal-ovarian-tumor-a-single-center-retrospective-study-and-review-of-literature-6202.md)
- [Relationship between the timing of chemotherapy and surgical complications following surgical biopsy in children with malignant solid tumors](https://library.globalcastmd.com/watch/relationship-between-the-timing-of-chemotherapy-and-surgical-complications-following-surgical-biopsy-in-children-with-malignant-solid-tumors-6208) — article · [machine version](https://library.globalcastmd.com/watch/relationship-between-the-timing-of-chemotherapy-and-surgical-complications-following-surgical-biopsy-in-children-with-malignant-solid-tumors-6208.md)
- [Clinical risk factors for patients with ruptured hepatoblastoma in children: a retrospective study from a single center in China](https://library.globalcastmd.com/watch/clinical-risk-factors-for-patients-with-ruptured-hepatoblastoma-in-children-a-retrospective-study-from-a-single-center-in-china-6268) — article · [machine version](https://library.globalcastmd.com/watch/clinical-risk-factors-for-patients-with-ruptured-hepatoblastoma-in-children-a-retrospective-study-from-a-single-center-in-china-6268.md)
- [Use of Vacuum-Assisted Closure to Reduce the Likelihood of Wound Complications After Limb-Sparing Resection of Pediatric Primary Bone Sarcomas of the Femur](https://library.globalcastmd.com/watch/use-of-vacuum-assisted-closure-to-reduce-the-likelihood-of-wound-complications-after-limb-sparing-resection-of-pediatric-primary-bone-sarcomas-of-the-femur-8171) — article · [machine version](https://library.globalcastmd.com/watch/use-of-vacuum-assisted-closure-to-reduce-the-likelihood-of-wound-complications-after-limb-sparing-resection-of-pediatric-primary-bone-sarcomas-of-the-femur-8171.md)
- [Impaired Aortic Growth in Neuroblastoma Patients After Intensive Treatment](https://library.globalcastmd.com/watch/impaired-aortic-growth-in-neuroblastoma-patients-after-intensive-treatment-8261) — article · [machine version](https://library.globalcastmd.com/watch/impaired-aortic-growth-in-neuroblastoma-patients-after-intensive-treatment-8261.md)
- [When neuroblastoma steals a kidney: understanding autonephrectomy risks](https://library.globalcastmd.com/watch/when-neuroblastoma-steals-a-kidney-understanding-autonephrectomy-risks-10473) — article · [machine version](https://library.globalcastmd.com/watch/when-neuroblastoma-steals-a-kidney-understanding-autonephrectomy-risks-10473.md)
- [Outcome analysis of surgical complications in pediatric solid tumors: a retrospective clinical study](https://library.globalcastmd.com/watch/outcome-analysis-of-surgical-complications-in-pediatric-solid-tumors-a-retrospective-clinical-study-10626) — article · [machine version](https://library.globalcastmd.com/watch/outcome-analysis-of-surgical-complications-in-pediatric-solid-tumors-a-retrospective-clinical-study-10626.md)
- [Management of hypoparathyroidism after total thyroidectomy for differentiated thyroid cancer in children and young adolescents: Experiences from a multicenter cohort in China](https://library.globalcastmd.com/watch/management-of-hypoparathyroidism-after-total-thyroidectomy-for-differentiated-thyroid-cancer-in-children-and-young-adolescents-experiences-from-a-multicenter-cohort-in-china-10729) — article · [machine version](https://library.globalcastmd.com/watch/management-of-hypoparathyroidism-after-total-thyroidectomy-for-differentiated-thyroid-cancer-in-children-and-young-adolescents-experiences-from-a-multicenter-cohort-in-china-10729.md)
- [Letter to the Editor “Early postoperative fever in pediatric oncology patients undergoing solid tumor resection”](https://library.globalcastmd.com/watch/letter-to-the-editor-early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11087) — article · [machine version](https://library.globalcastmd.com/watch/letter-to-the-editor-early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11087.md)
- [Early postoperative fever in pediatric oncology patients undergoing solid tumor resection](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11245) — article · [machine version](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11245.md)
- [Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11248) — article · [machine version](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11248.md)
- [Pancreatitis in Pediatric Patients with Pancreatic Solid Pseudopapillary Neoplasms: A Single Center Experience](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11340) — article · [machine version](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11340.md)
- [Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354.md)
- [Pancreatitis in Pediatric Patients with Pancreatic Solid Pseudopapillary Neoplasms: A Single Center Experience](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11403) — article · [machine version](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11403.md)
- [Pancreatitis in pediatric patients with pancreatic solid pseudopapillary neoplasms- a single center experience](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847.md)
- [Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866.md)
- [Incidence, Predictive Factors, and Proposed Classification of Wound Complications in Pediatric Extremity Bone Sarcoma Patients Following Extirpative Surgery](https://library.globalcastmd.com/watch/incidence-predictive-factors-and-proposed-classification-of-wound-complications-in-pediatric-extremity-bone-sarcoma-patients-following-extirpative-surgery-11868) — article · [machine version](https://library.globalcastmd.com/watch/incidence-predictive-factors-and-proposed-classification-of-wound-complications-in-pediatric-extremity-bone-sarcoma-patients-following-extirpative-surgery-11868.md)

### Evidence & Research
- [Prognostic Factors for Liver Transplantation in Unresectable Hepatoblastoma](https://library.globalcastmd.com/watch/prognostic-factors-for-liver-transplantation-in-unresectable-hepatoblastoma-19) — article · [machine version](https://library.globalcastmd.com/watch/prognostic-factors-for-liver-transplantation-in-unresectable-hepatoblastoma-19.md)
- [Review of Early Postoperative Metrics for Children Undergoing Resection of Congenital Pulmonary Airway Malformations and Report of Pleuropulmonary Blastoma at a Single Institution](https://library.globalcastmd.com/watch/review-of-early-postoperative-metrics-for-children-undergoing-resection-of-congenital-pulmonary-airway-malformations-and-report-of-pleuropulmonary-blastoma-at-a-single-institution-26) — article · [machine version](https://library.globalcastmd.com/watch/review-of-early-postoperative-metrics-for-children-undergoing-resection-of-congenital-pulmonary-airway-malformations-and-report-of-pleuropulmonary-blastoma-at-a-single-institution-26.md)
- [Long term outcomes after concurrent ipsilateral nephrectomy versus kidney-sparing surgery for high-risk, intraabdominal neuroblastoma](https://library.globalcastmd.com/watch/long-term-outcomes-after-concurrent-ipsilateral-nephrectomy-versus-kidney-sparing-surgery-for-high-risk-intraabdominal-neuroblastoma-114) — article · [machine version](https://library.globalcastmd.com/watch/long-term-outcomes-after-concurrent-ipsilateral-nephrectomy-versus-kidney-sparing-surgery-for-high-risk-intraabdominal-neuroblastoma-114.md)
- [Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients](https://library.globalcastmd.com/watch/effect-of-timing-of-pulmonary-metastasis-occurrence-on-the-outcome-of-metastasectomy-in-osteosarcoma-patients-126) — article · [machine version](https://library.globalcastmd.com/watch/effect-of-timing-of-pulmonary-metastasis-occurrence-on-the-outcome-of-metastasectomy-in-osteosarcoma-patients-126.md)
- [Incidence and outcomes of pediatric extremity melanoma: A propensity score matched SEER study](https://library.globalcastmd.com/watch/incidence-and-outcomes-of-pediatric-extremity-melanoma-a-propensity-score-matched-seer-study-216) — article · [machine version](https://library.globalcastmd.com/watch/incidence-and-outcomes-of-pediatric-extremity-melanoma-a-propensity-score-matched-seer-study-216.md)
- [The incidence of associated abnormalities in patients with sacrococcygeal teratoma](https://library.globalcastmd.com/watch/the-incidence-of-associated-abnormalities-in-patients-with-sacrococcygeal-teratoma-236) — article · [machine version](https://library.globalcastmd.com/watch/the-incidence-of-associated-abnormalities-in-patients-with-sacrococcygeal-teratoma-236.md)
- [Controversies in the management of ovarian tumours in prepubertal children — A BAPS and UK CCLG Surgeons Cancer Group National Survey](https://library.globalcastmd.com/watch/controversies-in-the-management-of-ovarian-tumours-in-prepubertal-children-a-baps-and-uk-cclg-surgeons-cancer-group-national-survey-248) — article · [machine version](https://library.globalcastmd.com/watch/controversies-in-the-management-of-ovarian-tumours-in-prepubertal-children-a-baps-and-uk-cclg-surgeons-cancer-group-national-survey-248.md)
- [Excellent prognosis of patients with intermediate-risk neuroblastoma and residual tumor postchemotherapy](https://library.globalcastmd.com/watch/excellent-prognosis-of-patients-with-intermediate-risk-neuroblastoma-and-residual-tumor-postchemotherapy-273) — article · [machine version](https://library.globalcastmd.com/watch/excellent-prognosis-of-patients-with-intermediate-risk-neuroblastoma-and-residual-tumor-postchemotherapy-273.md)
- [Testicular tumors in prepubescent patients](https://library.globalcastmd.com/watch/testicular-tumors-in-prepubescent-patients-281) — article · [machine version](https://library.globalcastmd.com/watch/testicular-tumors-in-prepubescent-patients-281.md)
- [Nonmetastatic Nonrhabdomyosarcoma Soft Tissue Sarcoma](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326) — video · 3:50 · [machine version](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326.md)
- [Impact of extent of resection on survival in high-risk neuroblastoma: A systematic review and meta-analysis](https://library.globalcastmd.com/watch/impact-of-extent-of-resection-on-survival-in-high-risk-neuroblastoma-a-systematic-review-and-meta-analysis-475) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-extent-of-resection-on-survival-in-high-risk-neuroblastoma-a-systematic-review-and-meta-analysis-475.md)
- [A population-based analysis of pediatric breast cancer](https://library.globalcastmd.com/watch/a-population-based-analysis-of-pediatric-breast-cancer-546) — article · [machine version](https://library.globalcastmd.com/watch/a-population-based-analysis-of-pediatric-breast-cancer-546.md)
- [Lymph node ratio predicts recurrence in pediatric papillary thyroid cancer](https://library.globalcastmd.com/watch/lymph-node-ratio-predicts-recurrence-in-pediatric-papillary-thyroid-cancer-554) — article · [machine version](https://library.globalcastmd.com/watch/lymph-node-ratio-predicts-recurrence-in-pediatric-papillary-thyroid-cancer-554.md)
- [Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients](https://library.globalcastmd.com/watch/neutropenia-at-the-time-of-subcutaneous-port-insertion-may-not-be-a-risk-factor-for-early-infectious-complications-in-pediatric-oncology-patients-575) — article · [machine version](https://library.globalcastmd.com/watch/neutropenia-at-the-time-of-subcutaneous-port-insertion-may-not-be-a-risk-factor-for-early-infectious-complications-in-pediatric-oncology-patients-575.md)
- [Corruption of neuroblastoma patient derived xenografts with human T cell lymphoma](https://library.globalcastmd.com/watch/corruption-of-neuroblastoma-patient-derived-xenografts-with-human-t-cell-lymphoma-601) — article · [machine version](https://library.globalcastmd.com/watch/corruption-of-neuroblastoma-patient-derived-xenografts-with-human-t-cell-lymphoma-601.md)
- [Volume and function of the operated kidney after nephron-sparing surgery for unilateral renal tumor](https://library.globalcastmd.com/watch/volume-and-function-of-the-operated-kidney-after-nephron-sparing-surgery-for-unilateral-renal-tumor-796) — article · [machine version](https://library.globalcastmd.com/watch/volume-and-function-of-the-operated-kidney-after-nephron-sparing-surgery-for-unilateral-renal-tumor-796.md)
- [Presacral masses and sacrococcygeal teratomas in patients with and without anorectal malformations: A single institution comparative study](https://library.globalcastmd.com/watch/presacral-masses-and-sacrococcygeal-teratomas-in-patients-with-and-without-anorectal-malformations-a-single-institution-comparative-study-852) — article · [machine version](https://library.globalcastmd.com/watch/presacral-masses-and-sacrococcygeal-teratomas-in-patients-with-and-without-anorectal-malformations-a-single-institution-comparative-study-852.md)
- [Multifocal hepatoblastoma: What is the risk of recurrent disease in the remnant liver?](https://library.globalcastmd.com/watch/multifocal-hepatoblastoma-what-is-the-risk-of-recurrent-disease-in-the-remnant-liver-1204) — article · [machine version](https://library.globalcastmd.com/watch/multifocal-hepatoblastoma-what-is-the-risk-of-recurrent-disease-in-the-remnant-liver-1204.md)
- [The relationships of surgeon volume and specialty with outcomes following pediatric thyroidectomy](https://library.globalcastmd.com/watch/the-relationships-of-surgeon-volume-and-specialty-with-outcomes-following-pediatric-thyroidectomy-1251) — article · [machine version](https://library.globalcastmd.com/watch/the-relationships-of-surgeon-volume-and-specialty-with-outcomes-following-pediatric-thyroidectomy-1251.md)
- [Down-regulation of MYCN protein by CX-5461 leads to neuroblastoma tumor growth suppression](https://library.globalcastmd.com/watch/down-regulation-of-mycn-protein-by-cx-5461-leads-to-neuroblastoma-tumor-growth-suppression-1253) — article · [machine version](https://library.globalcastmd.com/watch/down-regulation-of-mycn-protein-by-cx-5461-leads-to-neuroblastoma-tumor-growth-suppression-1253.md)
- [Association between image-defined risk factors and neuroblastoma outcomes](https://library.globalcastmd.com/watch/association-between-image-defined-risk-factors-and-neuroblastoma-outcomes-1265) — article · [machine version](https://library.globalcastmd.com/watch/association-between-image-defined-risk-factors-and-neuroblastoma-outcomes-1265.md)
- [FXR1 expression domain in Wilms tumor](https://library.globalcastmd.com/watch/fxr1-expression-domain-in-wilms-tumor-1279) — article · [machine version](https://library.globalcastmd.com/watch/fxr1-expression-domain-in-wilms-tumor-1279.md)
- [The presence of PIM3 increases hepatoblastoma tumorigenesis and tumor initiating cell phenotype and is associated with decreased patient survival](https://library.globalcastmd.com/watch/the-presence-of-pim3-increases-hepatoblastoma-tumorigenesis-and-tumor-initiating-cell-phenotype-and-is-associated-with-decreased-patient-survival-1280) — article · [machine version](https://library.globalcastmd.com/watch/the-presence-of-pim3-increases-hepatoblastoma-tumorigenesis-and-tumor-initiating-cell-phenotype-and-is-associated-with-decreased-patient-survival-1280.md)
- [Pediatric ovarian immature teratoma: Histological grading and clinical characteristics](https://library.globalcastmd.com/watch/pediatric-ovarian-immature-teratoma-histological-grading-and-clinical-characteristics-1416) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-ovarian-immature-teratoma-histological-grading-and-clinical-characteristics-1416.md)
- [Surgically Managed Ovarian Masses at the Royal Children’s Hospital, Melbourne –19 Year Experience](https://library.globalcastmd.com/watch/surgically-managed-ovarian-masses-at-the-royal-children-s-hospital-melbourne-19-year-experience-1429) — article · [machine version](https://library.globalcastmd.com/watch/surgically-managed-ovarian-masses-at-the-royal-children-s-hospital-melbourne-19-year-experience-1429.md)
- [Interventional Radiology-Guided Procedures in the Treatment of Pediatric Solid Tumors: A Systematic Review and Meta-Analysis from the Group of Young Pediatric Surgeons of Europe](https://library.globalcastmd.com/watch/interventional-radiology-guided-procedures-in-the-treatment-of-pediatric-solid-tumors-a-systematic-review-and-meta-analysis-from-the-group-of-young-pediatric-surgeons-of-europe-1455) — article · [machine version](https://library.globalcastmd.com/watch/interventional-radiology-guided-procedures-in-the-treatment-of-pediatric-solid-tumors-a-systematic-review-and-meta-analysis-from-the-group-of-young-pediatric-surgeons-of-europe-1455.md)
- [Diagnosis and Treatment of Pleuropulmonary Blastoma in Children: A Single-Center Report of 41 Cases](https://library.globalcastmd.com/watch/diagnosis-and-treatment-of-pleuropulmonary-blastoma-in-children-a-single-center-report-of-41-cases-1498) — article · [machine version](https://library.globalcastmd.com/watch/diagnosis-and-treatment-of-pleuropulmonary-blastoma-in-children-a-single-center-report-of-41-cases-1498.md)
- [Portal Venous Deprivation in Patients with Portosystemic Shunts and Its Effect on Liver Tumors](https://library.globalcastmd.com/watch/portal-venous-deprivation-in-patients-with-portosystemic-shunts-and-its-effect-on-liver-tumors-1503) — article · [machine version](https://library.globalcastmd.com/watch/portal-venous-deprivation-in-patients-with-portosystemic-shunts-and-its-effect-on-liver-tumors-1503.md)
- [Diagnosis and treatment of pancreatoblastoma in children: a retrospective study in a single pediatric center](https://library.globalcastmd.com/watch/diagnosis-and-treatment-of-pancreatoblastoma-in-children-a-retrospective-study-in-a-single-pediatric-center-1543) — article · [machine version](https://library.globalcastmd.com/watch/diagnosis-and-treatment-of-pancreatoblastoma-in-children-a-retrospective-study-in-a-single-pediatric-center-1543.md)
- [Replicating and identifying large cell neuroblastoma using high-dose intra-tumoral chemotherapy and automated digital analysis](https://library.globalcastmd.com/watch/replicating-and-identifying-large-cell-neuroblastoma-using-high-dose-intra-tumoral-chemotherapy-and-automated-digital-analysis-1655) — article · [machine version](https://library.globalcastmd.com/watch/replicating-and-identifying-large-cell-neuroblastoma-using-high-dose-intra-tumoral-chemotherapy-and-automated-digital-analysis-1655.md)
- [Prognostic Factor Analysis of Stage 4S Neuroblastoma in Infant Patients: A Single Center Study](https://library.globalcastmd.com/watch/prognostic-factor-analysis-of-stage-4s-neuroblastoma-in-infant-patients-a-single-center-study-1664) — article · [machine version](https://library.globalcastmd.com/watch/prognostic-factor-analysis-of-stage-4s-neuroblastoma-in-infant-patients-a-single-center-study-1664.md)
- [The Association between lncRNA LINC01296 and the Clinical Characteristics in Neuroblastoma](https://library.globalcastmd.com/watch/the-association-between-lncrna-linc01296-and-the-clinical-characteristics-in-neuroblastoma-1663) — article · [machine version](https://library.globalcastmd.com/watch/the-association-between-lncrna-linc01296-and-the-clinical-characteristics-in-neuroblastoma-1663.md)
- [Factors responsible for stage III disease in patients with Wilms tumor enrolled in the JWiTS-2 study](https://library.globalcastmd.com/watch/factors-responsible-for-stage-iii-disease-in-patients-with-wilms-tumor-enrolled-in-the-jwits-2-study-1694) — article · [machine version](https://library.globalcastmd.com/watch/factors-responsible-for-stage-iii-disease-in-patients-with-wilms-tumor-enrolled-in-the-jwits-2-study-1694.md)
- [Management of pediatric appendiceal carcinoid: a single institution experience from 5000 appendectomies](https://library.globalcastmd.com/watch/management-of-pediatric-appendiceal-carcinoid-a-single-institution-experience-from-5000-appendectomies-1697) — article · [machine version](https://library.globalcastmd.com/watch/management-of-pediatric-appendiceal-carcinoid-a-single-institution-experience-from-5000-appendectomies-1697.md)
- [Epidermal growth factor receptor/heme oxygenase-1 axis is involved in chemoresistance to cisplatin and pirarubicin in HepG2 cell lines and hepatoblastoma specimens](https://library.globalcastmd.com/watch/epidermal-growth-factor-receptor-heme-oxygenase-1-axis-is-involved-in-chemoresistance-to-cisplatin-and-pirarubicin-in-hepg2-cell-lines-and-hepatoblastoma-specimens-1701) — article · [machine version](https://library.globalcastmd.com/watch/epidermal-growth-factor-receptor-heme-oxygenase-1-axis-is-involved-in-chemoresistance-to-cisplatin-and-pirarubicin-in-hepg2-cell-lines-and-hepatoblastoma-specimens-1701.md)
- [Impact of MYCN Status on Response of High-Risk Neuroblastoma to Neoadjuvant Chemotherapy](https://library.globalcastmd.com/watch/impact-of-mycn-status-on-response-of-high-risk-neuroblastoma-to-neoadjuvant-chemotherapy-1786) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-mycn-status-on-response-of-high-risk-neuroblastoma-to-neoadjuvant-chemotherapy-1786.md)
- [Enhanced metastatic growth after local tumor resection in the presence of synchronous metastasis in a mouse allograft model of neuroblastoma](https://library.globalcastmd.com/watch/enhanced-metastatic-growth-after-local-tumor-resection-in-the-presence-of-synchronous-metastasis-in-a-mouse-allograft-model-of-neuroblastoma-1796) — article · [machine version](https://library.globalcastmd.com/watch/enhanced-metastatic-growth-after-local-tumor-resection-in-the-presence-of-synchronous-metastasis-in-a-mouse-allograft-model-of-neuroblastoma-1796.md)
- [Increased Lymph Node Ratio Predicts Poor Survival in Pediatric Rhabdomyosarcoma](https://library.globalcastmd.com/watch/increased-lymph-node-ratio-predicts-poor-survival-in-pediatric-rhabdomyosarcoma-1813) — article · [machine version](https://library.globalcastmd.com/watch/increased-lymph-node-ratio-predicts-poor-survival-in-pediatric-rhabdomyosarcoma-1813.md)
- [Approaches to the Management of Pediatric Ovarian Masses in the 21st Century: Systematic Review and Meta-Analysis](https://library.globalcastmd.com/watch/approaches-to-the-management-of-pediatric-ovarian-masses-in-the-21st-century-systematic-review-and-meta-analysis-1814) — article · [machine version](https://library.globalcastmd.com/watch/approaches-to-the-management-of-pediatric-ovarian-masses-in-the-21st-century-systematic-review-and-meta-analysis-1814.md)
- [CO2 Pneumoperitoneum Effects on Molecular Markers of Tumor Invasiveness in SH-SY5Y Neuroblastoma Cells](https://library.globalcastmd.com/watch/co2-pneumoperitoneum-effects-on-molecular-markers-of-tumor-invasiveness-in-sh-sy5y-neuroblastoma-cells-1880) — article · [machine version](https://library.globalcastmd.com/watch/co2-pneumoperitoneum-effects-on-molecular-markers-of-tumor-invasiveness-in-sh-sy5y-neuroblastoma-cells-1880.md)
- [The Impact of Cooperative Group Studies on Childhood Cancer: Improving Outcomes and Quality and International Collaboration](https://library.globalcastmd.com/watch/the-impact-of-cooperative-group-studies-on-childhood-cancer-improving-outcomes-and-quality-and-international-collaboration-1902) — article · [machine version](https://library.globalcastmd.com/watch/the-impact-of-cooperative-group-studies-on-childhood-cancer-improving-outcomes-and-quality-and-international-collaboration-1902.md)
- [Ovarian tumors in children: how common are lesion recurrence and metachronous disease? A UK CCLG Surgeons Cancer Group nationwide study](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-how-common-are-lesion-recurrence-and-metachronous-disease-a-uk-cclg-surgeons-cancer-group-nationwide-study-2008) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-how-common-are-lesion-recurrence-and-metachronous-disease-a-uk-cclg-surgeons-cancer-group-nationwide-study-2008.md)
- [Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study.](https://library.globalcastmd.com/watch/investigating-wilms-tumours-worldwide-a-report-of-the-oxplore-collaboration-a-cross-sectional-observational-study-2035) — article · [machine version](https://library.globalcastmd.com/watch/investigating-wilms-tumours-worldwide-a-report-of-the-oxplore-collaboration-a-cross-sectional-observational-study-2035.md)
- [Potential role of the PD-L1 expression and tumor-infiltrating lymphocytes on neuroblastoma](https://library.globalcastmd.com/watch/potential-role-of-the-pd-l1-expression-and-tumor-infiltrating-lymphocytes-on-neuroblastoma-2067) — article · [machine version](https://library.globalcastmd.com/watch/potential-role-of-the-pd-l1-expression-and-tumor-infiltrating-lymphocytes-on-neuroblastoma-2067.md)
- [Treatment patterns and outcomes for pancreatic tumors in children: an analysis of the National Cancer Database](https://library.globalcastmd.com/watch/treatment-patterns-and-outcomes-for-pancreatic-tumors-in-children-an-analysis-of-the-national-cancer-database-2129) — article · [machine version](https://library.globalcastmd.com/watch/treatment-patterns-and-outcomes-for-pancreatic-tumors-in-children-an-analysis-of-the-national-cancer-database-2129.md)
- [Analysis of factors related to recurrence of paediatric hepatoblastoma - a single Centre retrospective study.](https://library.globalcastmd.com/watch/analysis-of-factors-related-to-recurrence-of-paediatric-hepatoblastoma-a-single-centre-retrospective-study-2162) — article · [machine version](https://library.globalcastmd.com/watch/analysis-of-factors-related-to-recurrence-of-paediatric-hepatoblastoma-a-single-centre-retrospective-study-2162.md)
- [The Thyroid Nodules in Kids study (ThyNK study): An evaluation of clinical practice variation](https://library.globalcastmd.com/watch/the-thyroid-nodules-in-kids-study-an-evaluation-of-clinical-practice-variation-2194) — article · [machine version](https://library.globalcastmd.com/watch/the-thyroid-nodules-in-kids-study-an-evaluation-of-clinical-practice-variation-2194.md)
- [The importance of local control management in high-risk neuroblastoma in South Africa](https://library.globalcastmd.com/watch/the-importance-of-local-control-management-in-high-risk-neuroblastoma-in-south-africa-2281) — article · [machine version](https://library.globalcastmd.com/watch/the-importance-of-local-control-management-in-high-risk-neuroblastoma-in-south-africa-2281.md)
- [APSA 2018 Practice Gaps](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310) — video · [machine version](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310.md)
- [Minimally invasive surgery for abdominal and thoracic neuroblastic tumors: A systematic review by the APSA Cancer committee](https://library.globalcastmd.com/watch/minimally-invasive-surgery-for-abdominal-and-thoracic-neuroblastic-tumors-a-systematic-review-by-the-apsa-cancer-committee-2328) — article · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-surgery-for-abdominal-and-thoracic-neuroblastic-tumors-a-systematic-review-by-the-apsa-cancer-committee-2328.md)
- [EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature](https://library.globalcastmd.com/watch/exit-surgery-for-the-management-of-fetal-airway-obstruction-a-systematic-review-of-the-literature-2332) — article · [machine version](https://library.globalcastmd.com/watch/exit-surgery-for-the-management-of-fetal-airway-obstruction-a-systematic-review-of-the-literature-2332.md)
- [Novel retinoic acid derivative induces differentiation and growth arrest in neuroblastoma](https://library.globalcastmd.com/watch/novel-retinoic-acid-derivative-induces-differentiation-and-growth-arrest-in-neuroblastoma-2350) — article · [machine version](https://library.globalcastmd.com/watch/novel-retinoic-acid-derivative-induces-differentiation-and-growth-arrest-in-neuroblastoma-2350.md)
- [Bilateral papillary thyroid cancer in children: Risk factors and frequency of postoperative diagnosis](https://library.globalcastmd.com/watch/bilateral-papillary-thyroid-cancer-in-children-risk-factors-and-frequency-of-postoperative-diagnosis-2358) — article · [machine version](https://library.globalcastmd.com/watch/bilateral-papillary-thyroid-cancer-in-children-risk-factors-and-frequency-of-postoperative-diagnosis-2358.md)
- [Health disparities among Tennessee pediatric renal tumor patients](https://library.globalcastmd.com/watch/health-disparities-among-tennessee-pediatric-renal-tumor-patients-2396) — article · [machine version](https://library.globalcastmd.com/watch/health-disparities-among-tennessee-pediatric-renal-tumor-patients-2396.md)
- [A risk-based treatment strategy for non-rhabdomyosarcoma soft-tissue sarcomas in patients younger than 30 years (ARST0332): a Children's Oncology Group prospective study.](https://library.globalcastmd.com/watch/a-risk-based-treatment-strategy-for-non-rhabdomyosarcoma-soft-tissue-sarcomas-in-patients-younger-than-30-years-a-children-s-oncology-group-prospective-study-2525) — article · [machine version](https://library.globalcastmd.com/watch/a-risk-based-treatment-strategy-for-non-rhabdomyosarcoma-soft-tissue-sarcomas-in-patients-younger-than-30-years-a-children-s-oncology-group-prospective-study-2525.md)
- [Diagnostic accuracy of serum alpha-fetoprotein levels in diagnosing recurrent sacrococcygeal teratoma: A systematic review](https://library.globalcastmd.com/watch/diagnostic-accuracy-of-serum-alpha-fetoprotein-levels-in-diagnosing-recurrent-sacrococcygeal-teratoma-a-systematic-review-2537) — article · [machine version](https://library.globalcastmd.com/watch/diagnostic-accuracy-of-serum-alpha-fetoprotein-levels-in-diagnosing-recurrent-sacrococcygeal-teratoma-a-systematic-review-2537.md)
- [Minimally invasive surgery for pediatric renal tumors: A systematic review by the APSA Cancer Committee](https://library.globalcastmd.com/watch/minimally-invasive-surgery-for-pediatric-renal-tumors-a-systematic-review-by-the-apsa-cancer-committee-2544) — article · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-surgery-for-pediatric-renal-tumors-a-systematic-review-by-the-apsa-cancer-committee-2544.md)
- [Intracellular localization of beta-catenin expression plays a possible prognostic role on the outcome of hepatoblastoma patients](https://library.globalcastmd.com/watch/intracellular-localization-of-beta-catenin-expression-plays-a-possible-prognostic-role-on-the-outcome-of-hepatoblastoma-patients-2597) — article · [machine version](https://library.globalcastmd.com/watch/intracellular-localization-of-beta-catenin-expression-plays-a-possible-prognostic-role-on-the-outcome-of-hepatoblastoma-patients-2597.md)
- [How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis](https://library.globalcastmd.com/watch/how-well-do-image-defined-risk-factors-predict-surgical-outcomes-and-survival-in-patients-with-neuroblastoma-a-systematic-review-and-meta-analysis-2671) — article · [machine version](https://library.globalcastmd.com/watch/how-well-do-image-defined-risk-factors-predict-surgical-outcomes-and-survival-in-patients-with-neuroblastoma-a-systematic-review-and-meta-analysis-2671.md)
- [Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: a retrospective analysis](https://library.globalcastmd.com/watch/outcomes-of-children-with-hepatoblastoma-who-underwent-liver-resection-at-a-tertiary-hospital-in-china-a-retrospective-analysis-2765) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-children-with-hepatoblastoma-who-underwent-liver-resection-at-a-tertiary-hospital-in-china-a-retrospective-analysis-2765.md)
- [Radiation therapy is an important factor to improve survival in pediatric patients with head and neck rhabdomyosarcoma by enhancing local control: a historical cohort study from a single center](https://library.globalcastmd.com/watch/radiation-therapy-is-an-important-factor-to-improve-survival-in-pediatric-patients-with-head-and-neck-rhabdomyosarcoma-by-enhancing-local-control-a-historical-cohort-study-from-a-single-center-2776) — article · [machine version](https://library.globalcastmd.com/watch/radiation-therapy-is-an-important-factor-to-improve-survival-in-pediatric-patients-with-head-and-neck-rhabdomyosarcoma-by-enhancing-local-control-a-historical-cohort-study-from-a-single-center-2776.md)
- [Upregulation of human endogenous retrovirus-K (HML-2) mRNAs in hepatoblastoma: Identification of potential new immunotherapeutic targets and biomarkers](https://library.globalcastmd.com/watch/upregulation-of-human-endogenous-retrovirus-k-mrnas-in-hepatoblastoma-identification-of-potential-new-immunotherapeutic-targets-and-biomarkers-2788) — article · [machine version](https://library.globalcastmd.com/watch/upregulation-of-human-endogenous-retrovirus-k-mrnas-in-hepatoblastoma-identification-of-potential-new-immunotherapeutic-targets-and-biomarkers-2788.md)
- [Surgical resection and outcome of malignant ovarian germ cell tumors in children—a national multicentric study compared to international results](https://library.globalcastmd.com/watch/surgical-resection-and-outcome-of-malignant-ovarian-germ-cell-tumors-in-children-a-national-multicentric-study-compared-to-international-results-2802) — article · [machine version](https://library.globalcastmd.com/watch/surgical-resection-and-outcome-of-malignant-ovarian-germ-cell-tumors-in-children-a-national-multicentric-study-compared-to-international-results-2802.md)
- [Reply to Letter to the Editor](https://library.globalcastmd.com/watch/reply-to-letter-to-the-editor-2803) — article · [machine version](https://library.globalcastmd.com/watch/reply-to-letter-to-the-editor-2803.md)
- [Sindbis viral structural protein cytotoxicity on human neuroblastoma cells](https://library.globalcastmd.com/watch/sindbis-viral-structural-protein-cytotoxicity-on-human-neuroblastoma-cells-2811) — article · [machine version](https://library.globalcastmd.com/watch/sindbis-viral-structural-protein-cytotoxicity-on-human-neuroblastoma-cells-2811.md)
- [Re: How many lymph nodes are enough? Assessing the adequacy of lymph node yield for staging in favorable histology Wilms tumor](https://library.globalcastmd.com/watch/re-how-many-lymph-nodes-are-enough-assessing-the-adequacy-of-lymph-node-yield-for-staging-in-favorable-histology-wilms-tumor-2827) — article · [machine version](https://library.globalcastmd.com/watch/re-how-many-lymph-nodes-are-enough-assessing-the-adequacy-of-lymph-node-yield-for-staging-in-favorable-histology-wilms-tumor-2827.md)
- [Prognostic significance of MYCN related genes in pediatric neuroblastoma: a study based on TARGET and GEO datasets](https://library.globalcastmd.com/watch/prognostic-significance-of-mycn-related-genes-in-pediatric-neuroblastoma-a-study-based-on-target-and-geo-datasets-2915) — article · [machine version](https://library.globalcastmd.com/watch/prognostic-significance-of-mycn-related-genes-in-pediatric-neuroblastoma-a-study-based-on-target-and-geo-datasets-2915.md)
- [Treating papillary and follicular thyroid cancer in children and young people: Single UK-center experience between 2003 and 2018](https://library.globalcastmd.com/watch/treating-papillary-and-follicular-thyroid-cancer-in-children-and-young-people-single-uk-center-experience-between-2003-and-2018-2925) — article · [machine version](https://library.globalcastmd.com/watch/treating-papillary-and-follicular-thyroid-cancer-in-children-and-young-people-single-uk-center-experience-between-2003-and-2018-2925.md)
- [Role of image-defined risk factors in predicting surgical complications of localized neuroblastoma](https://library.globalcastmd.com/watch/role-of-image-defined-risk-factors-in-predicting-surgical-complications-of-localized-neuroblastoma-2938) — article · [machine version](https://library.globalcastmd.com/watch/role-of-image-defined-risk-factors-in-predicting-surgical-complications-of-localized-neuroblastoma-2938.md)
- [Implication of Image-Defined Risk Factors for the Extent of Surgical Resection and Clinical Outcome in Patients with Pelvic Neuroblastoma](https://library.globalcastmd.com/watch/implication-of-image-defined-risk-factors-for-the-extent-of-surgical-resection-and-clinical-outcome-in-patients-with-pelvic-neuroblastoma-2947) — article · [machine version](https://library.globalcastmd.com/watch/implication-of-image-defined-risk-factors-for-the-extent-of-surgical-resection-and-clinical-outcome-in-patients-with-pelvic-neuroblastoma-2947.md)
- [Re: Lymph node sampling in Wilms tumor—Getting risk based therapy right](https://library.globalcastmd.com/watch/re-lymph-node-sampling-in-wilms-tumor-getting-risk-based-therapy-right-2956) — article · [machine version](https://library.globalcastmd.com/watch/re-lymph-node-sampling-in-wilms-tumor-getting-risk-based-therapy-right-2956.md)
- [Stage 4S Neuroblastoma: What Are the Outcomes? A Systematic Review of Published Studies](https://library.globalcastmd.com/watch/stage-4s-neuroblastoma-what-are-the-outcomes-a-systematic-review-of-published-studies-3009) — article · [machine version](https://library.globalcastmd.com/watch/stage-4s-neuroblastoma-what-are-the-outcomes-a-systematic-review-of-published-studies-3009.md)
- [Surgical Resection of Hepatoblastoma: Factors Affecting Local Recurrence](https://library.globalcastmd.com/watch/surgical-resection-of-hepatoblastoma-factors-affecting-local-recurrence-3042) — article · [machine version](https://library.globalcastmd.com/watch/surgical-resection-of-hepatoblastoma-factors-affecting-local-recurrence-3042.md)
- [Ovarian Sparing Surgery in Mature Ovarian Teratomas in Children: A 20-Year Single-Center Experience](https://library.globalcastmd.com/watch/ovarian-sparing-surgery-in-mature-ovarian-teratomas-in-children-a-20-year-single-center-experience-3044) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-sparing-surgery-in-mature-ovarian-teratomas-in-children-a-20-year-single-center-experience-3044.md)
- [LncRNA HCP5 promotes neuroblastoma proliferation by regulating miR-186-5p/MAP3K2 signal axis](https://library.globalcastmd.com/watch/lncrna-hcp5-promotes-neuroblastoma-proliferation-by-regulating-mir-186-5p-map3k2-signal-axis-3193) — article · [machine version](https://library.globalcastmd.com/watch/lncrna-hcp5-promotes-neuroblastoma-proliferation-by-regulating-mir-186-5p-map3k2-signal-axis-3193.md)
- [Resection of primary tumor in stage 4S neuroblastoma: a second study by the Italian Neuroblastoma Group](https://library.globalcastmd.com/watch/resection-of-primary-tumor-in-stage-4s-neuroblastoma-a-second-study-by-the-italian-neuroblastoma-group-3243) — article · [machine version](https://library.globalcastmd.com/watch/resection-of-primary-tumor-in-stage-4s-neuroblastoma-a-second-study-by-the-italian-neuroblastoma-group-3243.md)
- [Association between clinical and tumor features with postoperative thyroglobulin in pediatric papillary thyroid cancer](https://library.globalcastmd.com/watch/association-between-clinical-and-tumor-features-with-postoperative-thyroglobulin-in-pediatric-papillary-thyroid-cancer-3260) — article · [machine version](https://library.globalcastmd.com/watch/association-between-clinical-and-tumor-features-with-postoperative-thyroglobulin-in-pediatric-papillary-thyroid-cancer-3260.md)
- [Retrospective analysis of outcomes in patients with clear cell sarcoma of the kidney: A tertiary single-institution experience](https://library.globalcastmd.com/watch/retrospective-analysis-of-outcomes-in-patients-with-clear-cell-sarcoma-of-the-kidney-a-tertiary-single-institution-experience-3363) — article · [machine version](https://library.globalcastmd.com/watch/retrospective-analysis-of-outcomes-in-patients-with-clear-cell-sarcoma-of-the-kidney-a-tertiary-single-institution-experience-3363.md)
- [Clinical Assessment of Pediatric Patients with Differentiated Thyroid Carcinoma: A 30-Year Experience at a Single Institution](https://library.globalcastmd.com/watch/clinical-assessment-of-pediatric-patients-with-differentiated-thyroid-carcinoma-a-30-year-experience-at-a-single-institution-3390) — article · [machine version](https://library.globalcastmd.com/watch/clinical-assessment-of-pediatric-patients-with-differentiated-thyroid-carcinoma-a-30-year-experience-at-a-single-institution-3390.md)
- [Clinical Assessment of Pediatric Patients with Differentiated Thyroid Carcinoma: A 30-Year Experience at a Single Institution](https://library.globalcastmd.com/watch/clinical-assessment-of-pediatric-patients-with-differentiated-thyroid-carcinoma-a-30-year-experience-at-a-single-institution-3426) — article · [machine version](https://library.globalcastmd.com/watch/clinical-assessment-of-pediatric-patients-with-differentiated-thyroid-carcinoma-a-30-year-experience-at-a-single-institution-3426.md)
- [Immunohistochemical staining of phosphorylated-ERK in post-chemotherapeutic samples is a potential predictor of the prognosis of neuroblastoma](https://library.globalcastmd.com/watch/immunohistochemical-staining-of-phosphorylated-erk-in-post-chemotherapeutic-samples-is-a-potential-predictor-of-the-prognosis-of-neuroblastoma-3480) — article · [machine version](https://library.globalcastmd.com/watch/immunohistochemical-staining-of-phosphorylated-erk-in-post-chemotherapeutic-samples-is-a-potential-predictor-of-the-prognosis-of-neuroblastoma-3480.md)
- [Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children with Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study](https://library.globalcastmd.com/watch/implications-of-tumor-characteristics-and-treatment-modality-on-local-recurrence-and-functional-outcomes-in-children-with-chest-wall-sarcoma-a-pediatric-surgical-oncology-research-collaborative-study-3529) — article · [machine version](https://library.globalcastmd.com/watch/implications-of-tumor-characteristics-and-treatment-modality-on-local-recurrence-and-functional-outcomes-in-children-with-chest-wall-sarcoma-a-pediatric-surgical-oncology-research-collaborative-study-3529.md)
- [Lineage-Independent Tumors in Bilateral Neuroblastoma](https://library.globalcastmd.com/watch/lineage-independent-tumors-in-bilateral-neuroblastoma-3567) — article · [machine version](https://library.globalcastmd.com/watch/lineage-independent-tumors-in-bilateral-neuroblastoma-3567.md)
- [Bilateral Wilms’ Tumour: An International Comparison of Treatments and Outcomes](https://library.globalcastmd.com/watch/bilateral-wilms-tumour-an-international-comparison-of-treatments-and-outcomes-3609) — article · [machine version](https://library.globalcastmd.com/watch/bilateral-wilms-tumour-an-international-comparison-of-treatments-and-outcomes-3609.md)
- [Changes in FXR1 Expression After Chemotherapy for Rhabdomyosarcoma](https://library.globalcastmd.com/watch/changes-in-fxr1-expression-after-chemotherapy-for-rhabdomyosarcoma-3715) — article · [machine version](https://library.globalcastmd.com/watch/changes-in-fxr1-expression-after-chemotherapy-for-rhabdomyosarcoma-3715.md)
- [Race Disparities in Genetic Alterations Within Wilms Tumor Specimens](https://library.globalcastmd.com/watch/race-disparities-in-genetic-alterations-within-wilms-tumor-specimens-3739) — article · [machine version](https://library.globalcastmd.com/watch/race-disparities-in-genetic-alterations-within-wilms-tumor-specimens-3739.md)
- [Management and outcome of paediatric testicular tumours – A 20 year experience](https://library.globalcastmd.com/watch/management-and-outcome-of-paediatric-testicular-tumours-a-20-year-experience-3762) — article · [machine version](https://library.globalcastmd.com/watch/management-and-outcome-of-paediatric-testicular-tumours-a-20-year-experience-3762.md)
- [Management of hepatoblastoma in the United States: Can we do better?](https://library.globalcastmd.com/watch/management-of-hepatoblastoma-in-the-united-states-can-we-do-better-3810) — article · [machine version](https://library.globalcastmd.com/watch/management-of-hepatoblastoma-in-the-united-states-can-we-do-better-3810.md)
- [Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management](https://library.globalcastmd.com/watch/papillary-thyroid-carcinoma-in-children-clinicopathological-profile-and-outcomes-of-management-3914) — article · [machine version](https://library.globalcastmd.com/watch/papillary-thyroid-carcinoma-in-children-clinicopathological-profile-and-outcomes-of-management-3914.md)
- [Influence of body mass index at diagnosis on outcome of thyroid cancer in children and adolescents](https://library.globalcastmd.com/watch/influence-of-body-mass-index-at-diagnosis-on-outcome-of-thyroid-cancer-in-children-and-adolescents-3945) — article · [machine version](https://library.globalcastmd.com/watch/influence-of-body-mass-index-at-diagnosis-on-outcome-of-thyroid-cancer-in-children-and-adolescents-3945.md)
- [Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses](https://library.globalcastmd.com/watch/gastrointestinal-and-oncologic-outcomes-of-pediatric-gastrointestinal-lymphoma-following-upfront-resection-or-biopsy-of-bowel-masses-4006) — article · [machine version](https://library.globalcastmd.com/watch/gastrointestinal-and-oncologic-outcomes-of-pediatric-gastrointestinal-lymphoma-following-upfront-resection-or-biopsy-of-bowel-masses-4006.md)
- [Establishment and characterization of an ovarian yolk sac tumor patient-derived xenograft model](https://library.globalcastmd.com/watch/establishment-and-characterization-of-an-ovarian-yolk-sac-tumor-patient-derived-xenograft-model-4071) — article · [machine version](https://library.globalcastmd.com/watch/establishment-and-characterization-of-an-ovarian-yolk-sac-tumor-patient-derived-xenograft-model-4071.md)
- [Total Thyroidectomy vs Thyroid Lobectomy for Localized Papillary Thyroid Cancer in Children: A Propensity-Matched Survival Analysis](https://library.globalcastmd.com/watch/total-thyroidectomy-vs-thyroid-lobectomy-for-localized-papillary-thyroid-cancer-in-children-a-propensity-matched-survival-analysis-4152) — article · [machine version](https://library.globalcastmd.com/watch/total-thyroidectomy-vs-thyroid-lobectomy-for-localized-papillary-thyroid-cancer-in-children-a-propensity-matched-survival-analysis-4152.md)
- [Surgery of pancreas tumors in pediatric and adolescent patients: a single institution experience in South America](https://library.globalcastmd.com/watch/surgery-of-pancreas-tumors-in-pediatric-and-adolescent-patients-a-single-institution-experience-in-south-america-4301) — article · [machine version](https://library.globalcastmd.com/watch/surgery-of-pancreas-tumors-in-pediatric-and-adolescent-patients-a-single-institution-experience-in-south-america-4301.md)
- [Characteristics of Benign Neuroblastic Tumors: Is Surgery Always Necessary?](https://library.globalcastmd.com/watch/characteristics-of-benign-neuroblastic-tumors-is-surgery-always-necessary-4307) — article · [machine version](https://library.globalcastmd.com/watch/characteristics-of-benign-neuroblastic-tumors-is-surgery-always-necessary-4307.md)
- [Pediatric Thyroidectomy: Surgical Extension Does Not Affect Survival](https://library.globalcastmd.com/watch/pediatric-thyroidectomy-surgical-extension-does-not-affect-survival-4337) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-thyroidectomy-surgical-extension-does-not-affect-survival-4337.md)
- [Integration of A Dedicated Management Protocol in the Care of Pediatric Liver Cancer: From Specialized Providers to Complication Reduction](https://library.globalcastmd.com/watch/integration-of-a-dedicated-management-protocol-in-the-care-of-pediatric-liver-cancer-from-specialized-providers-to-complication-reduction-4357) — article · [machine version](https://library.globalcastmd.com/watch/integration-of-a-dedicated-management-protocol-in-the-care-of-pediatric-liver-cancer-from-specialized-providers-to-complication-reduction-4357.md)
- [Paediatric non-rhabdomyosarcoma soft tissue sarcomas: the prospective NRSTS 2005 study by the European Pediatric Soft Tissue Sarcoma Study Group (EpSSG)](https://library.globalcastmd.com/watch/paediatric-non-rhabdomyosarcoma-soft-tissue-sarcomas-the-prospective-nrsts-2005-study-by-the-european-pediatric-soft-tissue-sarcoma-study-group-4404) — article · [machine version](https://library.globalcastmd.com/watch/paediatric-non-rhabdomyosarcoma-soft-tissue-sarcomas-the-prospective-nrsts-2005-study-by-the-european-pediatric-soft-tissue-sarcoma-study-group-4404.md)
- [Surgical management and outcomes of paediatric ovarian tumours—a 25-year UK single centre experience](https://library.globalcastmd.com/watch/surgical-management-and-outcomes-of-paediatric-ovarian-tumours-a-25-year-uk-single-centre-experience-4429) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-and-outcomes-of-paediatric-ovarian-tumours-a-25-year-uk-single-centre-experience-4429.md)
- [SURGICAL MANAGEMENT, STAGING, AND OUTCOMES OF WILMS TUMOURS WITH INTRAVASCULAR EXTENSION: RESULTS OF THE IMPORT STUDY](https://library.globalcastmd.com/watch/surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-4458) — article · [machine version](https://library.globalcastmd.com/watch/surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-4458.md)
- [Commentary-Surgical Management, Staging, and Outcomes of Wilms Tumours with Intravascular Extension: Results of the Import Study](https://library.globalcastmd.com/watch/commentary-surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-4468) — article · [machine version](https://library.globalcastmd.com/watch/commentary-surgical-management-staging-and-outcomes-of-wilms-tumours-with-intravascular-extension-results-of-the-import-study-4468.md)
- [The clinical impact of extrathyroidal extensions on prognoses in pediatric differentiated thyroid cancers](https://library.globalcastmd.com/watch/the-clinical-impact-of-extrathyroidal-extensions-on-prognoses-in-pediatric-differentiated-thyroid-cancers-4511) — article · [machine version](https://library.globalcastmd.com/watch/the-clinical-impact-of-extrathyroidal-extensions-on-prognoses-in-pediatric-differentiated-thyroid-cancers-4511.md)
- [Timing of adjuvant chemotherapy after laparotomy for Wilms tumor and neuroblastoma](https://library.globalcastmd.com/watch/timing-of-adjuvant-chemotherapy-after-laparotomy-for-wilms-tumor-and-neuroblastoma-4568) — article · [machine version](https://library.globalcastmd.com/watch/timing-of-adjuvant-chemotherapy-after-laparotomy-for-wilms-tumor-and-neuroblastoma-4568.md)
- [Results of mass screening for neuroblastoma in 18-month-old infants in Osaka area, Japan](https://library.globalcastmd.com/watch/results-of-mass-screening-for-neuroblastoma-in-18-month-old-infants-in-osaka-area-japan-4623) — article · [machine version](https://library.globalcastmd.com/watch/results-of-mass-screening-for-neuroblastoma-in-18-month-old-infants-in-osaka-area-japan-4623.md)
- [Current thoracoscopic approach for mediastinal neuroblastoma in Japan–results from nationwide multicenter survey](https://library.globalcastmd.com/watch/current-thoracoscopic-approach-for-mediastinal-neuroblastoma-in-japan-results-from-nationwide-multicenter-survey-4627) — article · [machine version](https://library.globalcastmd.com/watch/current-thoracoscopic-approach-for-mediastinal-neuroblastoma-in-japan-results-from-nationwide-multicenter-survey-4627.md)
- [Exosomal miR-214-3p as a potential novel biomarker for rhabdoid tumor of the kidney](https://library.globalcastmd.com/watch/exosomal-mir-214-3p-as-a-potential-novel-biomarker-for-rhabdoid-tumor-of-the-kidney-4628) — article · [machine version](https://library.globalcastmd.com/watch/exosomal-mir-214-3p-as-a-potential-novel-biomarker-for-rhabdoid-tumor-of-the-kidney-4628.md)
- [Urinary N1,N12-diacetylspermine as a biomarker for pediatric cancer: a case–control study](https://library.globalcastmd.com/watch/urinary-n1-n12-diacetylspermine-as-a-biomarker-for-pediatric-cancer-a-case-control-study-4632) — article · [machine version](https://library.globalcastmd.com/watch/urinary-n1-n12-diacetylspermine-as-a-biomarker-for-pediatric-cancer-a-case-control-study-4632.md)
- [Higher rates of regional disease but improved outcomes in pediatric versus adult melanoma](https://library.globalcastmd.com/watch/higher-rates-of-regional-disease-but-improved-outcomes-in-pediatric-versus-adult-melanoma-4647) — article · [machine version](https://library.globalcastmd.com/watch/higher-rates-of-regional-disease-but-improved-outcomes-in-pediatric-versus-adult-melanoma-4647.md)
- [Stage 4S Neuroblastoma: What Are the Outcomes? A Systematic Review of Published Studies](https://library.globalcastmd.com/watch/stage-4s-neuroblastoma-what-are-the-outcomes-a-systematic-review-of-published-studies-4702) — article · [machine version](https://library.globalcastmd.com/watch/stage-4s-neuroblastoma-what-are-the-outcomes-a-systematic-review-of-published-studies-4702.md)
- [KLF5 promotes KIF1A expression through transcriptional repression of microRNA-338 in the development of pediatric neuroblastoma](https://library.globalcastmd.com/watch/klf5-promotes-kif1a-expression-through-transcriptional-repression-of-microrna-338-in-the-development-of-pediatric-neuroblastoma-4772) — article · [machine version](https://library.globalcastmd.com/watch/klf5-promotes-kif1a-expression-through-transcriptional-repression-of-microrna-338-in-the-development-of-pediatric-neuroblastoma-4772.md)
- [Differential expression of miRNA in histological subtype of Wilms tumor](https://library.globalcastmd.com/watch/differential-expression-of-mirna-in-histological-subtype-of-wilms-tumor-4841) — article · [machine version](https://library.globalcastmd.com/watch/differential-expression-of-mirna-in-histological-subtype-of-wilms-tumor-4841.md)
- [Recurrence and Metachronous Disease in Children with Benign Ovarian Tumors: A Systematic Review of the Literature](https://library.globalcastmd.com/watch/recurrence-and-metachronous-disease-in-children-with-benign-ovarian-tumors-a-systematic-review-of-the-literature-4853) — article · [machine version](https://library.globalcastmd.com/watch/recurrence-and-metachronous-disease-in-children-with-benign-ovarian-tumors-a-systematic-review-of-the-literature-4853.md)
- [Invited Commentary on Sadeghi, et al: Sentinel Lymph Node Biopsy in Pediatric Wilms Tumor](https://library.globalcastmd.com/watch/invited-commentary-on-sadeghi-et-al-sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-4986) — article · [machine version](https://library.globalcastmd.com/watch/invited-commentary-on-sadeghi-et-al-sentinel-lymph-node-biopsy-in-pediatric-wilms-tumor-4986.md)
- [Establishment of childhood hepatoblastoma xenografts and evaluation of the anti-tumour effects of anlotinib, oxaliplatin and sorafenib](https://library.globalcastmd.com/watch/establishment-of-childhood-hepatoblastoma-xenografts-and-evaluation-of-the-anti-tumour-effects-of-anlotinib-oxaliplatin-and-sorafenib-5011) — article · [machine version](https://library.globalcastmd.com/watch/establishment-of-childhood-hepatoblastoma-xenografts-and-evaluation-of-the-anti-tumour-effects-of-anlotinib-oxaliplatin-and-sorafenib-5011.md)
- [CO2 pneumoperitoneum effects on proliferation and apoptosis in two different neuroblastoma cell lines](https://library.globalcastmd.com/watch/co2-pneumoperitoneum-effects-on-proliferation-and-apoptosis-in-two-different-neuroblastoma-cell-lines-5017) — article · [machine version](https://library.globalcastmd.com/watch/co2-pneumoperitoneum-effects-on-proliferation-and-apoptosis-in-two-different-neuroblastoma-cell-lines-5017.md)
- [Incidence and prognosis of thyroid cancer in children: based on the SEER database](https://library.globalcastmd.com/watch/incidence-and-prognosis-of-thyroid-cancer-in-children-based-on-the-seer-database-5021) — article · [machine version](https://library.globalcastmd.com/watch/incidence-and-prognosis-of-thyroid-cancer-in-children-based-on-the-seer-database-5021.md)
- [Serine-Threonine Kinase Receptor Associate Protein (STRAP) Confers an Aggressive Phenotype in Neuroblastoma via Regulation of Focal Adhesion Kinase (FAK)](https://library.globalcastmd.com/watch/serine-threonine-kinase-receptor-associate-protein-confers-an-aggressive-phenotype-in-neuroblastoma-via-regulation-of-focal-adhesion-kinase-5081) — article · [machine version](https://library.globalcastmd.com/watch/serine-threonine-kinase-receptor-associate-protein-confers-an-aggressive-phenotype-in-neuroblastoma-via-regulation-of-focal-adhesion-kinase-5081.md)
- [Metastatic Human Hepatoblastoma Cells Exhibit Enhanced Tumorigenicity, Invasiveness and a Stem Cell-Like Phenotype](https://library.globalcastmd.com/watch/metastatic-human-hepatoblastoma-cells-exhibit-enhanced-tumorigenicity-invasiveness-and-a-stem-cell-like-phenotype-5088) — article · [machine version](https://library.globalcastmd.com/watch/metastatic-human-hepatoblastoma-cells-exhibit-enhanced-tumorigenicity-invasiveness-and-a-stem-cell-like-phenotype-5088.md)
- [Analysis of risk factors for angiolymphatic invasion and establishment of a predictive nomogram for hepatoblastomas](https://library.globalcastmd.com/watch/analysis-of-risk-factors-for-angiolymphatic-invasion-and-establishment-of-a-predictive-nomogram-for-hepatoblastomas-5133) — article · [machine version](https://library.globalcastmd.com/watch/analysis-of-risk-factors-for-angiolymphatic-invasion-and-establishment-of-a-predictive-nomogram-for-hepatoblastomas-5133.md)
- [A 17-Year Experience on Bilaterality of Ovarian Germ Cell Tumors in Pediatric Population and its Clinical Implications: A Single-Center Study](https://library.globalcastmd.com/watch/a-17-year-experience-on-bilaterality-of-ovarian-germ-cell-tumors-in-pediatric-population-and-its-clinical-implications-a-single-center-study-5165) — article · [machine version](https://library.globalcastmd.com/watch/a-17-year-experience-on-bilaterality-of-ovarian-germ-cell-tumors-in-pediatric-population-and-its-clinical-implications-a-single-center-study-5165.md)
- [Vaginal tumours in childhood: a descriptive analysis from a large paediatric medical centre](https://library.globalcastmd.com/watch/vaginal-tumours-in-childhood-a-descriptive-analysis-from-a-large-paediatric-medical-centre-5265) — article · [machine version](https://library.globalcastmd.com/watch/vaginal-tumours-in-childhood-a-descriptive-analysis-from-a-large-paediatric-medical-centre-5265.md)
- [Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404) — video · 22:13 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404.md)
- [Outcomes of Children with Well-Differentiated Fetal Hepatoblastoma Treated with Surgery Only: Report from Children's Oncology Group Trial, AHEP0731](https://library.globalcastmd.com/watch/outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5480) — article · [machine version](https://library.globalcastmd.com/watch/outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5480.md)
- [Invited commentary on Moon, et al: An Enhanced Recovery After Surgery Protocol in Children Who Undergo Nephrectomy for Wilms Tumor Safely Shortens Hospital Stay](https://library.globalcastmd.com/watch/invited-commentary-on-moon-et-al-an-enhanced-recovery-after-surgery-protocol-in-children-who-undergo-nephrectomy-for-wilms-tumor-safely-shortens-hospital-stay-5483) — article · [machine version](https://library.globalcastmd.com/watch/invited-commentary-on-moon-et-al-an-enhanced-recovery-after-surgery-protocol-in-children-who-undergo-nephrectomy-for-wilms-tumor-safely-shortens-hospital-stay-5483.md)
- [Antitumor effect of polyphyllin D on liver metastases of neuroblastoma](https://library.globalcastmd.com/watch/antitumor-effect-of-polyphyllin-d-on-liver-metastases-of-neuroblastoma-5495) — article · [machine version](https://library.globalcastmd.com/watch/antitumor-effect-of-polyphyllin-d-on-liver-metastases-of-neuroblastoma-5495.md)
- [Invited Commentary on Vasudevan, et al: Outcomes of children with well differentiated fetal hepatoblastoma treated with surgery only: Report from Children's Oncology Group Trial, AHEP0731](https://library.globalcastmd.com/watch/invited-commentary-on-vasudevan-et-al-outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5500) — article · [machine version](https://library.globalcastmd.com/watch/invited-commentary-on-vasudevan-et-al-outcomes-of-children-with-well-differentiated-fetal-hepatoblastoma-treated-with-surgery-only-report-from-children-s-oncology-group-trial-ahep0731-5500.md)
- [Journal of Pediatric Surgery Article Highlights: April 2022](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md)
- [Optimal value of lymph node ratio and metastatic lymph node size to predict risk of recurrence in pediatric thyroid cancer with lateral neck metastasis](https://library.globalcastmd.com/watch/optimal-value-of-lymph-node-ratio-and-metastatic-lymph-node-size-to-predict-risk-of-recurrence-in-pediatric-thyroid-cancer-with-lateral-neck-metastasis-5560) — article · [machine version](https://library.globalcastmd.com/watch/optimal-value-of-lymph-node-ratio-and-metastatic-lymph-node-size-to-predict-risk-of-recurrence-in-pediatric-thyroid-cancer-with-lateral-neck-metastasis-5560.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878) — video · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881) — podcast · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881.md)
- [An evaluation of the association between radiological parameters and survival outcomes in pediatric patients with hepatoblastoma](https://library.globalcastmd.com/watch/an-evaluation-of-the-association-between-radiological-parameters-and-survival-outcomes-in-pediatric-patients-with-hepatoblastoma-5891) — article · [machine version](https://library.globalcastmd.com/watch/an-evaluation-of-the-association-between-radiological-parameters-and-survival-outcomes-in-pediatric-patients-with-hepatoblastoma-5891.md)
- [Differential expression profiling of onco and tumor-suppressor genes from major-signaling pathways in Wilms’ tumor](https://library.globalcastmd.com/watch/differential-expression-profiling-of-onco-and-tumor-suppressor-genes-from-major-signaling-pathways-in-wilms-tumor-5894) — article · [machine version](https://library.globalcastmd.com/watch/differential-expression-profiling-of-onco-and-tumor-suppressor-genes-from-major-signaling-pathways-in-wilms-tumor-5894.md)
- [Residual tumor doesn't affect survival in neuroblastoma](https://library.globalcastmd.com/watch/residual-tumor-doesn-t-affect-survival-in-neuroblastoma-5920) — article · [machine version](https://library.globalcastmd.com/watch/residual-tumor-doesn-t-affect-survival-in-neuroblastoma-5920.md)
- [Clinical trials in desmoid-type fibromatosis in children and adults: A systematic review](https://library.globalcastmd.com/watch/clinical-trials-in-desmoid-type-fibromatosis-in-children-and-adults-a-systematic-review-5933) — article · [machine version](https://library.globalcastmd.com/watch/clinical-trials-in-desmoid-type-fibromatosis-in-children-and-adults-a-systematic-review-5933.md)
- [Construction of a combined random forest and artificial neural network diagnosis model to screening potential biomarker for hepatoblastoma](https://library.globalcastmd.com/watch/construction-of-a-combined-random-forest-and-artificial-neural-network-diagnosis-model-to-screening-potential-biomarker-for-hepatoblastoma-6091) — article · [machine version](https://library.globalcastmd.com/watch/construction-of-a-combined-random-forest-and-artificial-neural-network-diagnosis-model-to-screening-potential-biomarker-for-hepatoblastoma-6091.md)
- [Effects of changes in skeletal muscle mass on the prognosis of pediatric malignant solid tumors](https://library.globalcastmd.com/watch/effects-of-changes-in-skeletal-muscle-mass-on-the-prognosis-of-pediatric-malignant-solid-tumors-6126) — article · [machine version](https://library.globalcastmd.com/watch/effects-of-changes-in-skeletal-muscle-mass-on-the-prognosis-of-pediatric-malignant-solid-tumors-6126.md)
- [Effects of dedifferentiated fat cells on neurogenic differentiation and cell proliferation in neuroblastoma cells](https://library.globalcastmd.com/watch/effects-of-dedifferentiated-fat-cells-on-neurogenic-differentiation-and-cell-proliferation-in-neuroblastoma-cells-6242) — article · [machine version](https://library.globalcastmd.com/watch/effects-of-dedifferentiated-fat-cells-on-neurogenic-differentiation-and-cell-proliferation-in-neuroblastoma-cells-6242.md)
- [BOB Ped Surg 2023 - Steven Scoville, IPSO  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343) — video · 5:05 · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343.md)
- [BOB Ped Surg 2023 - Lieke Josephine Van Heurn, EUPSA  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354.md)
- [BOB Ped Surg 2023 - Andrew Fleming, AAP  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366.md)
- [Polyphyllin D induces necroptosis in neuroblastoma cells (IMR-32 and LA-N-2) in mice](https://library.globalcastmd.com/watch/polyphyllin-d-induces-necroptosis-in-neuroblastoma-cells-in-mice-6627) — article · [machine version](https://library.globalcastmd.com/watch/polyphyllin-d-induces-necroptosis-in-neuroblastoma-cells-in-mice-6627.md)
- [Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771) — video · [machine version](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771.md)
- [Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival: An Observational Study](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-an-observational-study-6973) — article · [machine version](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-an-observational-study-6973.md)
- [La búsqueda agresiva de un estado libre de enfermedad (NED) en el hepatoblastoma mejora la supervivencia](https://library.globalcastmd.com/watch/la-b-squeda-agresiva-de-un-estado-libre-de-enfermedad-en-el-hepatoblastoma-mejora-la-supervivencia-6977) — article · [machine version](https://library.globalcastmd.com/watch/la-b-squeda-agresiva-de-un-estado-libre-de-enfermedad-en-el-hepatoblastoma-mejora-la-supervivencia-6977.md)
- [Potential involvement of IL-32 in cell-to-cell communication between macrophages and hepatoblastoma](https://library.globalcastmd.com/watch/potential-involvement-of-il-32-in-cell-to-cell-communication-between-macrophages-and-hepatoblastoma-7295) — article · [machine version](https://library.globalcastmd.com/watch/potential-involvement-of-il-32-in-cell-to-cell-communication-between-macrophages-and-hepatoblastoma-7295.md)
- [Treatment-related mortality in children with cancer in low-income and middle-income countries](https://library.globalcastmd.com/watch/treatment-related-mortality-in-children-with-cancer-in-low-income-and-middle-income-countries-7304) — article · [machine version](https://library.globalcastmd.com/watch/treatment-related-mortality-in-children-with-cancer-in-low-income-and-middle-income-countries-7304.md)
- [The expression analysis of SerpinB9 in hepatoblastoma microenvironment](https://library.globalcastmd.com/watch/the-expression-analysis-of-serpinb9-in-hepatoblastoma-microenvironment-7984) — article · [machine version](https://library.globalcastmd.com/watch/the-expression-analysis-of-serpinb9-in-hepatoblastoma-microenvironment-7984.md)
- [Bailey Roberts, MD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011) — video · 8:39 · [machine version](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011.md)
- [Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077.md)
- [Eficacia y efectos renales tardíos de la cirugía conservadora de nefronas en el tratamiento del tumor de Wilms unilateral: una revisión sistemática y un metanálisis](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-una-revisi-n-sistem-tica-y-un-metan-lisis-8079) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-una-revisi-n-sistem-tica-y-un-metan-lisis-8079.md)
- [Current Realities of Wilms Tumor Burden and Therapy in Ghana](https://library.globalcastmd.com/watch/current-realities-of-wilms-tumor-burden-and-therapy-in-ghana-8143) — article · [machine version](https://library.globalcastmd.com/watch/current-realities-of-wilms-tumor-burden-and-therapy-in-ghana-8143.md)
- [Should Pediatric Surgical Oncologists Receive Training in Vascular Surgery ? A Practice Survey Report From the International Society of Paediatric Surgical Oncology (IPSO)](https://library.globalcastmd.com/watch/should-pediatric-surgical-oncologists-receive-training-in-vascular-surgery-a-practice-survey-report-from-the-international-society-of-paediatric-surgical-oncology-8183) — article · [machine version](https://library.globalcastmd.com/watch/should-pediatric-surgical-oncologists-receive-training-in-vascular-surgery-a-practice-survey-report-from-the-international-society-of-paediatric-surgical-oncology-8183.md)
- [Proliferative Effects of Mesenchymal Stromal Cells on Neuroblastoma Cell Lines: Are They Tumor Promoting or Tumor Inhibiting?](https://library.globalcastmd.com/watch/proliferative-effects-of-mesenchymal-stromal-cells-on-neuroblastoma-cell-lines-are-they-tumor-promoting-or-tumor-inhibiting-8185) — article · [machine version](https://library.globalcastmd.com/watch/proliferative-effects-of-mesenchymal-stromal-cells-on-neuroblastoma-cell-lines-are-they-tumor-promoting-or-tumor-inhibiting-8185.md)
- [Factors Associated With Long-term Survival in Children With Bronchial and Lung Carcinoid Tumors](https://library.globalcastmd.com/watch/factors-associated-with-long-term-survival-in-children-with-bronchial-and-lung-carcinoid-tumors-8187) — article · [machine version](https://library.globalcastmd.com/watch/factors-associated-with-long-term-survival-in-children-with-bronchial-and-lung-carcinoid-tumors-8187.md)
- [Characteristics and Clinical Outcomes of Children With Wilms’ Tumour: A 15-year Experience in a Single Centre in Nigeria](https://library.globalcastmd.com/watch/characteristics-and-clinical-outcomes-of-children-with-wilms-tumour-a-15-year-experience-in-a-single-centre-in-nigeria-8265) — article · [machine version](https://library.globalcastmd.com/watch/characteristics-and-clinical-outcomes-of-children-with-wilms-tumour-a-15-year-experience-in-a-single-centre-in-nigeria-8265.md)
- [Ganglioneuromas in Childhood: Hacettepe Experience With 70 Cases](https://library.globalcastmd.com/watch/ganglioneuromas-in-childhood-hacettepe-experience-with-70-cases-8348) — article · [machine version](https://library.globalcastmd.com/watch/ganglioneuromas-in-childhood-hacettepe-experience-with-70-cases-8348.md)
- [Management and Outcomes of Hepatoblastoma in Patients With Trisomy 18: A Systematic Review and Pooled Analysis of 70 Patients](https://library.globalcastmd.com/watch/management-and-outcomes-of-hepatoblastoma-in-patients-with-trisomy-18-a-systematic-review-and-pooled-analysis-of-70-patients-8723) — article · [machine version](https://library.globalcastmd.com/watch/management-and-outcomes-of-hepatoblastoma-in-patients-with-trisomy-18-a-systematic-review-and-pooled-analysis-of-70-patients-8723.md)
- [Treatment abandonment in children with Wilms tumor at a national referral hospital in Uganda](https://library.globalcastmd.com/watch/treatment-abandonment-in-children-with-wilms-tumor-at-a-national-referral-hospital-in-uganda-8778) — article · [machine version](https://library.globalcastmd.com/watch/treatment-abandonment-in-children-with-wilms-tumor-at-a-national-referral-hospital-in-uganda-8778.md)
- [Systemic inflammation enhances metastatic growth in a syngeneic neuroblastoma mouse model](https://library.globalcastmd.com/watch/systemic-inflammation-enhances-metastatic-growth-in-a-syngeneic-neuroblastoma-mouse-model-8876) — article · [machine version](https://library.globalcastmd.com/watch/systemic-inflammation-enhances-metastatic-growth-in-a-syngeneic-neuroblastoma-mouse-model-8876.md)
- [Clinical Characteristics and Outcomes of Neonatal Hepatoblastoma: A Single Center Study](https://library.globalcastmd.com/watch/clinical-characteristics-and-outcomes-of-neonatal-hepatoblastoma-a-single-center-study-8916) — article · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-and-outcomes-of-neonatal-hepatoblastoma-a-single-center-study-8916.md)
- [Hepatic resections for pediatric hepatoblastoma: analysis of 30-day outcomes using the National Surgical Quality Improvement Program—Pediatric database](https://library.globalcastmd.com/watch/hepatic-resections-for-pediatric-hepatoblastoma-analysis-of-30-day-outcomes-using-the-national-surgical-quality-improvement-program-pediatric-database-9030) — article · [machine version](https://library.globalcastmd.com/watch/hepatic-resections-for-pediatric-hepatoblastoma-analysis-of-30-day-outcomes-using-the-national-surgical-quality-improvement-program-pediatric-database-9030.md)
- [CAMK2G Promotes Neuronal Differentiation and Inhibits Migration in Neuroblastoma](https://library.globalcastmd.com/watch/camk2g-promotes-neuronal-differentiation-and-inhibits-migration-in-neuroblastoma-9043) — article · [machine version](https://library.globalcastmd.com/watch/camk2g-promotes-neuronal-differentiation-and-inhibits-migration-in-neuroblastoma-9043.md)
- [Racial and Ethnic Survival Disparities in Pediatric Oncology Over Time: An Analysis of the SEER Registry](https://library.globalcastmd.com/watch/racial-and-ethnic-survival-disparities-in-pediatric-oncology-over-time-an-analysis-of-the-seer-registry-9188) — article · [machine version](https://library.globalcastmd.com/watch/racial-and-ethnic-survival-disparities-in-pediatric-oncology-over-time-an-analysis-of-the-seer-registry-9188.md)
- [A Comparison of in vivo Tumor-Homing Abilities of Placental-Derived and Bone Marrow-Derived Mesenchymal Stromal Cells in High-Risk Neuroblastoma](https://library.globalcastmd.com/watch/a-comparison-of-in-vivo-tumor-homing-abilities-of-placental-derived-and-bone-marrow-derived-mesenchymal-stromal-cells-in-high-risk-neuroblastoma-9190) — article · [machine version](https://library.globalcastmd.com/watch/a-comparison-of-in-vivo-tumor-homing-abilities-of-placental-derived-and-bone-marrow-derived-mesenchymal-stromal-cells-in-high-risk-neuroblastoma-9190.md)
- [Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee](https://library.globalcastmd.com/watch/central-venous-catheter-consideration-in-pediatric-oncology-a-systematic-review-and-meta-analysis-from-the-american-pediatric-surgical-association-cancer-committee-9369) — article · [machine version](https://library.globalcastmd.com/watch/central-venous-catheter-consideration-in-pediatric-oncology-a-systematic-review-and-meta-analysis-from-the-american-pediatric-surgical-association-cancer-committee-9369.md)
- [Dictation Precision: Evaluating Paediatric Oncology Operative Reports as an Impetus for Synoptic Reports](https://library.globalcastmd.com/watch/dictation-precision-evaluating-paediatric-oncology-operative-reports-as-an-impetus-for-synoptic-reports-9680) — article · [machine version](https://library.globalcastmd.com/watch/dictation-precision-evaluating-paediatric-oncology-operative-reports-as-an-impetus-for-synoptic-reports-9680.md)
- [The Role of Sociodemographics in Pediatric, Adolescent and Young Adult Osteosarcoma: A Population Based Study](https://library.globalcastmd.com/watch/the-role-of-sociodemographics-in-pediatric-adolescent-and-young-adult-osteosarcoma-a-population-based-study-9721) — article · [machine version](https://library.globalcastmd.com/watch/the-role-of-sociodemographics-in-pediatric-adolescent-and-young-adult-osteosarcoma-a-population-based-study-9721.md)
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-9736) — article · [machine version](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-9736.md)
- [Commentary - Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/watch/commentary-social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-9768) — article · [machine version](https://library.globalcastmd.com/watch/commentary-social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-9768.md)
- [Clinical characteristics, surgical approaches, and prognosis of follicular and papillary thyroid cancer in children and adolescents: a retrospective cohort study](https://library.globalcastmd.com/watch/clinical-characteristics-surgical-approaches-and-prognosis-of-follicular-and-papillary-thyroid-cancer-in-children-and-adolescents-a-retrospective-cohort-study-9966) — article · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-surgical-approaches-and-prognosis-of-follicular-and-papillary-thyroid-cancer-in-children-and-adolescents-a-retrospective-cohort-study-9966.md)
- [Dr. Yujie Ma - Best of the Best in Pediatric Surgery 2025](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036) — video · 8:08 · [machine version](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036.md)
- [Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044) — video · 6:52 · [machine version](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044.md)
- [Letter to “How Many Lymph Nodes are Enough in Paratesticular Rhabdomyosarcoma?”](https://library.globalcastmd.com/watch/letter-to-how-many-lymph-nodes-are-enough-in-paratesticular-rhabdomyosarcoma-10196) — article · [machine version](https://library.globalcastmd.com/watch/letter-to-how-many-lymph-nodes-are-enough-in-paratesticular-rhabdomyosarcoma-10196.md)
- [Comparison of open and minimally invasive nephrectomy for Wilms tumor: a systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology](https://library.globalcastmd.com/watch/comparison-of-open-and-minimally-invasive-nephrectomy-for-wilms-tumor-a-systematic-review-and-meta-analysis-from-the-international-society-of-pediatric-surgical-oncology-10360) — article · [machine version](https://library.globalcastmd.com/watch/comparison-of-open-and-minimally-invasive-nephrectomy-for-wilms-tumor-a-systematic-review-and-meta-analysis-from-the-international-society-of-pediatric-surgical-oncology-10360.md)
- [Racial Disparities in Pediatric Ovarian Mass Management](https://library.globalcastmd.com/watch/racial-disparities-in-pediatric-ovarian-mass-management-10415) — article · [machine version](https://library.globalcastmd.com/watch/racial-disparities-in-pediatric-ovarian-mass-management-10415.md)
- [gene polymorphisms confer the risk of neuroblastoma in Chinese children from Jiangsu province](https://library.globalcastmd.com/watch/gene-polymorphisms-confer-the-risk-of-neuroblastoma-in-chinese-children-from-jiangsu-province-10449) — article · [machine version](https://library.globalcastmd.com/watch/gene-polymorphisms-confer-the-risk-of-neuroblastoma-in-chinese-children-from-jiangsu-province-10449.md)
- [Quick Literature Updates Ep 19](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465) — video · 4:27 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465.md)
- [When Childhood Meets Cancer: Tracking Two Decades of Mortality in Pediatric Brain and Blood Malignancies](https://library.globalcastmd.com/watch/when-childhood-meets-cancer-tracking-two-decades-of-mortality-in-pediatric-brain-and-blood-malignancies-10485) — article · [machine version](https://library.globalcastmd.com/watch/when-childhood-meets-cancer-tracking-two-decades-of-mortality-in-pediatric-brain-and-blood-malignancies-10485.md)
- [Multidisciplinary tumor boards in pediatric surgical oncology: a systematic review of approaches in low- and middle-income countries](https://library.globalcastmd.com/watch/multidisciplinary-tumor-boards-in-pediatric-surgical-oncology-a-systematic-review-of-approaches-in-low-and-middle-income-countries-10509) — article · [machine version](https://library.globalcastmd.com/watch/multidisciplinary-tumor-boards-in-pediatric-surgical-oncology-a-systematic-review-of-approaches-in-low-and-middle-income-countries-10509.md)
- [Sacrococcygeal teratomas in children and adolescents – a Danish 26-year retrospective cohort study](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-children-and-adolescents-a-danish-26-year-retrospective-cohort-study-10561) — article · [machine version](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-children-and-adolescents-a-danish-26-year-retrospective-cohort-study-10561.md)
- [Novel CTNNB1 gene mutations reveal critical pathogenic mechanisms in pediatric hepatoblastoma](https://library.globalcastmd.com/watch/novel-ctnnb1-gene-mutations-reveal-critical-pathogenic-mechanisms-in-pediatric-hepatoblastoma-10728) — article · [machine version](https://library.globalcastmd.com/watch/novel-ctnnb1-gene-mutations-reveal-critical-pathogenic-mechanisms-in-pediatric-hepatoblastoma-10728.md)
- [2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897) — video · 22:32 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897.md)
- [Quick Literature Updates Ep 21](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050) — video · 4:04 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050.md)
- [Survival Differences in Pulmonary Metastatic Osteosarcoma Between Pediatric and Adult Institutions](https://library.globalcastmd.com/watch/survival-differences-in-pulmonary-metastatic-osteosarcoma-between-pediatric-and-adult-institutions-11109) — article · [machine version](https://library.globalcastmd.com/watch/survival-differences-in-pulmonary-metastatic-osteosarcoma-between-pediatric-and-adult-institutions-11109.md)
- [Is age in children with Wilms tumour an important prognostic factor?](https://library.globalcastmd.com/watch/is-age-in-children-with-wilms-tumour-an-important-prognostic-factor-11171) — article · [machine version](https://library.globalcastmd.com/watch/is-age-in-children-with-wilms-tumour-an-important-prognostic-factor-11171.md)
- [The effect of neighborhood deprivation on access to surgical care for pediatric renal tumors](https://library.globalcastmd.com/watch/the-effect-of-neighborhood-deprivation-on-access-to-surgical-care-for-pediatric-renal-tumors-11258) — article · [machine version](https://library.globalcastmd.com/watch/the-effect-of-neighborhood-deprivation-on-access-to-surgical-care-for-pediatric-renal-tumors-11258.md)
- [Clinical Characteristics, Treatment, and Prognosis of Undifferentiated Embryonal Sarcoma of the Liver in Children: A retrospective study from four hospitals in China](https://library.globalcastmd.com/watch/clinical-characteristics-treatment-and-prognosis-of-undifferentiated-embryonal-sarcoma-of-the-liver-in-children-a-retrospective-study-from-four-hospitals-in-china-11261) — article · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-treatment-and-prognosis-of-undifferentiated-embryonal-sarcoma-of-the-liver-in-children-a-retrospective-study-from-four-hospitals-in-china-11261.md)
- [Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335) — video · 1:14 · [machine version](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335.md)
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371) — video · 1:06 · [machine version](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371.md)
- [CD200 expression predicts poor prognosis in neuroblastoma: a potential biomarker for treatment stratification—a retrospective cohort study](https://library.globalcastmd.com/watch/cd200-expression-predicts-poor-prognosis-in-neuroblastoma-a-potential-biomarker-for-treatment-stratification-a-retrospective-cohort-study-11412) — article · [machine version](https://library.globalcastmd.com/watch/cd200-expression-predicts-poor-prognosis-in-neuroblastoma-a-potential-biomarker-for-treatment-stratification-a-retrospective-cohort-study-11412.md)
- [Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance](https://library.globalcastmd.com/watch/survival-in-children-with-hepatoblastoma-and-pulmonary-metastatic-disease-at-diagnosis-based-on-extent-of-metastases-and-need-for-surgical-clearance-11555) — article · [machine version](https://library.globalcastmd.com/watch/survival-in-children-with-hepatoblastoma-and-pulmonary-metastatic-disease-at-diagnosis-based-on-extent-of-metastases-and-need-for-surgical-clearance-11555.md)
- [Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN0533](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren0533-11558) — article · [machine version](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren0533-11558.md)
- [Malignant peripheral nerve sheath tumors: a report from children's oncology group study ARST0332](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11559) — article · [machine version](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11559.md)
- [Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658) — video · 1:15 · [machine version](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658.md)
- [Proteomic analysis reveals the pro-proliferative role of the LIN28B/HMGA2 axis in hepatoblastoma](https://library.globalcastmd.com/watch/proteomic-analysis-reveals-the-pro-proliferative-role-of-the-lin28b-hmga2-axis-in-hepatoblastoma-11670) — article · [machine version](https://library.globalcastmd.com/watch/proteomic-analysis-reveals-the-pro-proliferative-role-of-the-lin28b-hmga2-axis-in-hepatoblastoma-11670.md)
- [Developing the research roadmap together: a report from the patient-centered outcome research institute (PCORI) and pediatric surgical oncology research collaborative (PSORC)](https://library.globalcastmd.com/watch/developing-the-research-roadmap-together-a-report-from-the-patient-centered-outcome-research-institute-and-pediatric-surgical-oncology-research-collaborative-11722) — article · [machine version](https://library.globalcastmd.com/watch/developing-the-research-roadmap-together-a-report-from-the-patient-centered-outcome-research-institute-and-pediatric-surgical-oncology-research-collaborative-11722.md)
- [Caregivers’ perceptions of fluorescence-guided surgery (FGS) in pediatric oncology: a questionnaire-based study](https://library.globalcastmd.com/watch/caregivers-perceptions-of-fluorescence-guided-surgery-in-pediatric-oncology-a-questionnaire-based-study-12002) — article · [machine version](https://library.globalcastmd.com/watch/caregivers-perceptions-of-fluorescence-guided-surgery-in-pediatric-oncology-a-questionnaire-based-study-12002.md)
- [Infographic: Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance](https://library.globalcastmd.com/watch/infographic-survival-in-children-with-hepatoblastoma-and-pulmonary-metastatic-disease-at-diagnosis-based-on-extent-of-metastases-and-need-for-surgical-clearance-12014) — article · [machine version](https://library.globalcastmd.com/watch/infographic-survival-in-children-with-hepatoblastoma-and-pulmonary-metastatic-disease-at-diagnosis-based-on-extent-of-metastases-and-need-for-surgical-clearance-12014.md)
- [Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC](https://library.globalcastmd.com/watch/pooling-patients-to-study-rare-pediatric-tumors-an-introduction-to-psorc-12082) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/pooling-patients-to-study-rare-pediatric-tumors-an-introduction-to-psorc-12082.md)
- [Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-research-collaborative-studying-rare-pediatric-tumors-12085) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-research-collaborative-studying-rare-pediatric-tumors-12085.md)
- [Journal of Pediatric Surgery Article Review: June 2023, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353) — video · 13:57 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353.md)

### Case-Based Learning
- [Wilms Tumor Protocol Violations: Practice Gap discussion at Update Course 2018](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345) — video · 9:55 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345.md)
- [Neuroblastoma: Update Course 2016](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434) — video · 25:42 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434.md)
- [Lumps & Bumps: Soft Tissue Masses and Lesions](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628) — video · 1:07:50 · [machine version](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628.md)
- [Neuroblastoma: Update Course 2014](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651) — video · 25:59 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651.md)
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648) — video · 24:43 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648.md)
- [Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669.md)
- [Ovarian Teratoma - Ovarian Torsion - Soft Tissue Sarcoma: Update Course 2015](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672) — video · 34:37 · [machine version](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672.md)
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882.md)
- [Soft Tissue Sarcoma Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980) — video · 8:27 · [machine version](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980.md)
- [Compiled Hayes Jordan Rapid Fire Sessions: Update Course 2015](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995) — video · 33:36 · [machine version](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995.md)
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.md)
- [Wilms Tumor Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993) — video · 8:46 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993.md)
- [Ovarian Teratoma Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/ovarian-teratoma-rapid-fire-update-course-2015-994) — video · [machine version](https://library.globalcastmd.com/watch/ovarian-teratoma-rapid-fire-update-course-2015-994.md)
- [Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point](https://library.globalcastmd.com/watch/intussusception-in-children-lessons-learned-from-intestinal-lymphoma-as-a-rare-lead-point-1482) — article · [machine version](https://library.globalcastmd.com/watch/intussusception-in-children-lessons-learned-from-intestinal-lymphoma-as-a-rare-lead-point-1482.md)
- [Sacrococcygeal teratoma with intraspinal extension: A case series and review of literature](https://library.globalcastmd.com/watch/sacrococcygeal-teratoma-with-intraspinal-extension-a-case-series-and-review-of-literature-2277) — article · [machine version](https://library.globalcastmd.com/watch/sacrococcygeal-teratoma-with-intraspinal-extension-a-case-series-and-review-of-literature-2277.md)
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-2534) — video · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-2534.md)
- [BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323) — video · [machine version](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323.md)
- [Journal of Pediatric Article Review: June 2023, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221) — podcast · 13:57 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221.md)
- [Heat 2 Winner: Matthew Urichuk, PhD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013) — video · 1:52 · [machine version](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013.md)
- [Update Course Rewind: Chest Wall Reconstruction 2024](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839) — video · 5:32 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839.md)
- [Update Course Rewind: Updates in Wilms Management 2024](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937) — video · 4:07 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937.md)
- [Clinical & Research Update: Pediatric Liver Tumors -  A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848) — video · 1:09:23 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848.md)
- [Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017) — video · 1:06:24 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017.md)
- [Clinical & Research Update: Neuroblastoma with Drs. Katherine Somers, Cara Morin, Juan Gurria, and Meera Kotagal](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018) — video · 1:07:10 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018.md)
- [Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740) — video · 1:11:52 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740.md)

### In-Depth Reviews
- [Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review](https://library.globalcastmd.com/watch/ovarian-masses-in-the-child-and-adolescent-an-american-pediatric-surgical-association-outcomes-and-evidence-based-practice-committee-systematic-review-83) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-masses-in-the-child-and-adolescent-an-american-pediatric-surgical-association-outcomes-and-evidence-based-practice-committee-systematic-review-83.md)
- [Pediatric Ovarian Tumors Video Podcast](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362) — podcast · 34:06 · [machine version](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362.md)
- [Summary article: Update on Wilms tumor](https://library.globalcastmd.com/watch/summary-article-update-on-wilms-tumor-463) — article · [machine version](https://library.globalcastmd.com/watch/summary-article-update-on-wilms-tumor-463.md)
- [Clinical features, treatment, and outcomes of bilateral Wilms' tumor: A systematic review and meta-analysis](https://library.globalcastmd.com/watch/clinical-features-treatment-and-outcomes-of-bilateral-wilms-tumor-a-systematic-review-and-meta-analysis-462) — article · [machine version](https://library.globalcastmd.com/watch/clinical-features-treatment-and-outcomes-of-bilateral-wilms-tumor-a-systematic-review-and-meta-analysis-462.md)
- [Update on neuroblastoma](https://library.globalcastmd.com/watch/update-on-neuroblastoma-504) — article · [machine version](https://library.globalcastmd.com/watch/update-on-neuroblastoma-504.md)
- [Wilms Tumor: Audio Chapter](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926) — podcast · 1:04:03 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926.md)
- [Pediatric Thyroid Disorders: Update Course 2016](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923) — video · 31:12 · [machine version](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923.md)
- [Pediatric Thyroid Disorders with Dr. Diana Diesen](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954) — podcast · 45:51 · [machine version](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954.md)
- [What’s New in Pediatric Melanoma: An Update from the APSA Cancer Committee](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-melanoma-an-update-from-the-apsa-cancer-committee-1797) — article · [machine version](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-melanoma-an-update-from-the-apsa-cancer-committee-1797.md)
- [Surgery for the complex Wilms tumour](https://library.globalcastmd.com/watch/surgery-for-the-complex-wilms-tumour-1817) — article · [machine version](https://library.globalcastmd.com/watch/surgery-for-the-complex-wilms-tumour-1817.md)
- [Aggressive Pediatric Renal Tumors](https://library.globalcastmd.com/watch/aggressive-pediatric-renal-tumors-1901) — article · [machine version](https://library.globalcastmd.com/watch/aggressive-pediatric-renal-tumors-1901.md)
- [Germ Cell Tumors: APSA Handbook](https://library.globalcastmd.com/watch/germ-cell-tumors-apsa-handbook-1905) — article · [machine version](https://library.globalcastmd.com/watch/germ-cell-tumors-apsa-handbook-1905.md)
- [Recent Progress in Pediatric Soft Tissue Sarcoma Therapy](https://library.globalcastmd.com/watch/recent-progress-in-pediatric-soft-tissue-sarcoma-therapy-1923) — article · [machine version](https://library.globalcastmd.com/watch/recent-progress-in-pediatric-soft-tissue-sarcoma-therapy-1923.md)
- [Neuroblastoma: APSA Handbook](https://library.globalcastmd.com/watch/neuroblastoma-apsa-handbook-2046) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-apsa-handbook-2046.md)
- [Rhabdomyosarcoma: APSA Handbook](https://library.globalcastmd.com/watch/rhabdomyosarcoma-apsa-handbook-2068) — article · [machine version](https://library.globalcastmd.com/watch/rhabdomyosarcoma-apsa-handbook-2068.md)
- [Liver Tumors: APSA Handbook](https://library.globalcastmd.com/watch/liver-tumors-apsa-handbook-2259) — article · [machine version](https://library.globalcastmd.com/watch/liver-tumors-apsa-handbook-2259.md)
- [Renal Tumors: APSA Handbook](https://library.globalcastmd.com/watch/renal-tumors-apsa-handbook-2258) — article · [machine version](https://library.globalcastmd.com/watch/renal-tumors-apsa-handbook-2258.md)
- [Germ Cell Tumors](https://library.globalcastmd.com/watch/germ-cell-tumors-2295) — video · [machine version](https://library.globalcastmd.com/watch/germ-cell-tumors-2295.md)
- [Wilms Tumor](https://library.globalcastmd.com/watch/wilms-tumor-2533) — video · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-2533.md)
- [Medullary Thyroid Carcinoma in Children](https://library.globalcastmd.com/watch/medullary-thyroid-carcinoma-in-children-2576) — article · [machine version](https://library.globalcastmd.com/watch/medullary-thyroid-carcinoma-in-children-2576.md)
- [Papillary and Follicular Thyroid Cancer in Children and Adolescents: Current approach and Future Directions](https://library.globalcastmd.com/watch/papillary-and-follicular-thyroid-cancer-in-children-and-adolescents-current-approach-and-future-directions-2577) — article · [machine version](https://library.globalcastmd.com/watch/papillary-and-follicular-thyroid-cancer-in-children-and-adolescents-current-approach-and-future-directions-2577.md)
- [Pheochromocytoma and Paraganglioma](https://library.globalcastmd.com/watch/pheochromocytoma-and-paraganglioma-2632) — article · [machine version](https://library.globalcastmd.com/watch/pheochromocytoma-and-paraganglioma-2632.md)
- [Gastroenteropancreatic Neuroendocrine Tumors](https://library.globalcastmd.com/watch/gastroenteropancreatic-neuroendocrine-tumors-2633) — article · [machine version](https://library.globalcastmd.com/watch/gastroenteropancreatic-neuroendocrine-tumors-2633.md)
- [Pediatric differentiated thyroid carcinoma: An update from the APSA Cancer Committee](https://library.globalcastmd.com/watch/pediatric-differentiated-thyroid-carcinoma-an-update-from-the-apsa-cancer-committee-2683) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-differentiated-thyroid-carcinoma-an-update-from-the-apsa-cancer-committee-2683.md)
- [Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee](https://library.globalcastmd.com/watch/update-on-pediatric-rhabdomyosarcoma-a-report-from-the-apsa-cancer-committee-2777) — article · [machine version](https://library.globalcastmd.com/watch/update-on-pediatric-rhabdomyosarcoma-a-report-from-the-apsa-cancer-committee-2777.md)
- [7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797) — video · 4:45:42 · [machine version](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797.md)
- [What's New in Pediatric Surgery 2020 - FULL SHOW](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217) — video · 57:41 · [machine version](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217.md)
- [Pancreatic Masses](https://library.globalcastmd.com/watch/pancreatic-masses-3439) — podcast · 37:28 · [machine version](https://library.globalcastmd.com/watch/pancreatic-masses-3439.md)
- [Topics in 10: Neuroblastoma](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md)
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-1620.md)
- [Topics in 10: Wilms Tumor](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583) — podcast · 12:29 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583.md)
- [Ovarian Tumors Video Podcast](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979) — podcast · 34:06 · [machine version](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979.md)
- [Hepatoblastoma](https://library.globalcastmd.com/watch/hepatoblastoma-291) — podcast · 54:16 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-291.md)
- [Thyroid Disorders](https://library.globalcastmd.com/watch/thyroid-disorders-302) — podcast · 45:51 · [machine version](https://library.globalcastmd.com/watch/thyroid-disorders-302.md)
- [Wilms Tumor: Audio Chapter](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 1:04:03 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md)
- [Update on Pediatric Testicular Germ Cell Tumors](https://library.globalcastmd.com/watch/update-on-pediatric-testicular-germ-cell-tumors-3897) — article · [machine version](https://library.globalcastmd.com/watch/update-on-pediatric-testicular-germ-cell-tumors-3897.md)
- [Testicular Tumors in the Pediatric Patient](https://library.globalcastmd.com/watch/testicular-tumors-in-the-pediatric-patient-4327) — article · [machine version](https://library.globalcastmd.com/watch/testicular-tumors-in-the-pediatric-patient-4327.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960) — podcast · 10:12 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md)
- [Update on pediatric testicular germ cell tumors](https://library.globalcastmd.com/watch/update-on-pediatric-testicular-germ-cell-tumors-5469) — article · [machine version](https://library.globalcastmd.com/watch/update-on-pediatric-testicular-germ-cell-tumors-5469.md)
- [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 1:04:30 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.md)
- [Ovarian Tumors with Dr. Roshni Dasgupta](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829) — video · [machine version](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829.md)
- [8th Annual Pediatric Surgery Update Course](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042) — video · 3:35:58 · [machine version](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042.md)
- [8th Annual Pediatric Surgery Update Course](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043) — video · 3:35:58 · [machine version](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043.md)
- [Role of surgery in neuroblastoma](https://library.globalcastmd.com/watch/role-of-surgery-in-neuroblastoma-6554) — article · [machine version](https://library.globalcastmd.com/watch/role-of-surgery-in-neuroblastoma-6554.md)
- [Pancreatic Tumors. Presented by David Skarda, MD 04.10.23 Video](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583) — video · 50:30 · [machine version](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583.md)
- [Liver transplant with Dr. Jonathan Merola](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832) — podcast · 14:37 · [machine version](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832.md)
- [Neuroblastoma with Dr. Meera Kotagal](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212) — video · 14:02 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212.md)
- [Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333) — video · 10:23 · [machine version](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333.md)
- [2025 Pediatric Surgery Update Course - Updates in Enhanced Recovery After Surgery (ERAS) Protocols](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886) — video · 32:14 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886.md)
- [2025 Pediatric Surgery Update Course - Robotics in Pediatric Surgery: Which indications benefit the most?](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896) — video · 18:17 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896.md)
- [2025 Pediatric Surgery Update Course - Updates in Oncology](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901) — video · 21:25 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901.md)
- [An overview of malignant ovarian tumors in children](https://library.globalcastmd.com/watch/an-overview-of-malignant-ovarian-tumors-in-children-11088) — article · [machine version](https://library.globalcastmd.com/watch/an-overview-of-malignant-ovarian-tumors-in-children-11088.md)
- [PDQ Germ Cell TUmor](https://library.globalcastmd.com/watch/pdq-germ-cell-tumor-11620) — article · [machine version](https://library.globalcastmd.com/watch/pdq-germ-cell-tumor-11620.md)
- [NCCN Guidelines - Neuroblastoma](https://library.globalcastmd.com/watch/nccn-guidelines-neuroblastoma-11621) — article · [machine version](https://library.globalcastmd.com/watch/nccn-guidelines-neuroblastoma-11621.md)
- [NCCN Guidelines - Pediatric Soft Tissue Sarcoma](https://library.globalcastmd.com/watch/nccn-guidelines-pediatric-soft-tissue-sarcoma-11622) — article · [machine version](https://library.globalcastmd.com/watch/nccn-guidelines-pediatric-soft-tissue-sarcoma-11622.md)
- [PDQ Hepatoblastoma (Childhood Liver Cancer)](https://library.globalcastmd.com/watch/pdq-hepatoblastoma-11623) — article · [machine version](https://library.globalcastmd.com/watch/pdq-hepatoblastoma-11623.md)
- [NCCN Guidelines - Wilms Tumor](https://library.globalcastmd.com/watch/nccn-guidelines-wilms-tumor-11624) — article · [machine version](https://library.globalcastmd.com/watch/nccn-guidelines-wilms-tumor-11624.md)

### Emerging & Future Directions
- [A curative treatment strategy using tumor debulking surgery combined with immune checkpoint inhibitors for advanced pediatric solid tumors: An in vivo study using a murine model of osteosarcoma](https://library.globalcastmd.com/watch/a-curative-treatment-strategy-using-tumor-debulking-surgery-combined-with-immune-checkpoint-inhibitors-for-advanced-pediatric-solid-tumors-an-in-vivo-study-using-a-murine-model-of-osteosarcoma-468) — article · [machine version](https://library.globalcastmd.com/watch/a-curative-treatment-strategy-using-tumor-debulking-surgery-combined-with-immune-checkpoint-inhibitors-for-advanced-pediatric-solid-tumors-an-in-vivo-study-using-a-murine-model-of-osteosarcoma-468.md)
- [Combined application of Indocyanine green (ICG) and laser lead to targeted tumor cell destruction](https://library.globalcastmd.com/watch/combined-application-of-indocyanine-green-and-laser-lead-to-targeted-tumor-cell-destruction-489) — article · [machine version](https://library.globalcastmd.com/watch/combined-application-of-indocyanine-green-and-laser-lead-to-targeted-tumor-cell-destruction-489.md)
- [Ovarian Tissue Transplantation: Pediatric Oncofertility 2017](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902) — video · 27:46 · [machine version](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902.md)
- [Development of a new reproductive tissue cryopreservation clinical service for children: the Oxford programme](https://library.globalcastmd.com/watch/development-of-a-new-reproductive-tissue-cryopreservation-clinical-service-for-children-the-oxford-programme-1492) — article · [machine version](https://library.globalcastmd.com/watch/development-of-a-new-reproductive-tissue-cryopreservation-clinical-service-for-children-the-oxford-programme-1492.md)
- [Novel Mesenchymal Stem Cell Delivery System as Targeted Therapy Against Neuroblastoma Using the TH-MYCN Mouse Model](https://library.globalcastmd.com/watch/novel-mesenchymal-stem-cell-delivery-system-as-targeted-therapy-against-neuroblastoma-using-the-th-mycn-mouse-model-1737) — article · [machine version](https://library.globalcastmd.com/watch/novel-mesenchymal-stem-cell-delivery-system-as-targeted-therapy-against-neuroblastoma-using-the-th-mycn-mouse-model-1737.md)
- [Precision Oncology: A Primer for Pediatric Surgeons from the APSA Cancer Committee](https://library.globalcastmd.com/watch/precision-oncology-a-primer-for-pediatric-surgeons-from-the-apsa-cancer-committee-1873) — article · [machine version](https://library.globalcastmd.com/watch/precision-oncology-a-primer-for-pediatric-surgeons-from-the-apsa-cancer-committee-1873.md)
- [Metabolomics as a potential method for predicting thyroid malignancy in children and adolescents](https://library.globalcastmd.com/watch/metabolomics-as-a-potential-method-for-predicting-thyroid-malignancy-in-children-and-adolescents-2128) — article · [machine version](https://library.globalcastmd.com/watch/metabolomics-as-a-potential-method-for-predicting-thyroid-malignancy-in-children-and-adolescents-2128.md)
- [Oncofertility Ovarian Salvage](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292) — video · [machine version](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292.md)
- [Evolving applications of fluorescence guided surgery in pediatric surgical oncology: a practical guide for surgeons](https://library.globalcastmd.com/watch/evolving-applications-of-fluorescence-guided-surgery-in-pediatric-surgical-oncology-a-practical-guide-for-surgeons-3201) — article · [machine version](https://library.globalcastmd.com/watch/evolving-applications-of-fluorescence-guided-surgery-in-pediatric-surgical-oncology-a-practical-guide-for-surgeons-3201.md)
- [Commentary regarding evolving applications of fluorescence guided surgery in pediatric surgical oncology: a practical guide for surgeons](https://library.globalcastmd.com/watch/commentary-regarding-evolving-applications-of-fluorescence-guided-surgery-in-pediatric-surgical-oncology-a-practical-guide-for-surgeons-3204) — article · [machine version](https://library.globalcastmd.com/watch/commentary-regarding-evolving-applications-of-fluorescence-guided-surgery-in-pediatric-surgical-oncology-a-practical-guide-for-surgeons-3204.md)
- [Photodynamic therapy with 5-aminolevulinic acid: A new diagnostic, therapeutic, and surgical aid for neuroblastoma](https://library.globalcastmd.com/watch/photodynamic-therapy-with-5-aminolevulinic-acid-a-new-diagnostic-therapeutic-and-surgical-aid-for-neuroblastoma-5176) — article · [machine version](https://library.globalcastmd.com/watch/photodynamic-therapy-with-5-aminolevulinic-acid-a-new-diagnostic-therapeutic-and-surgical-aid-for-neuroblastoma-5176.md)
- [Development of minimally invasive cancer immunotherapy using anti-disialoganglioside GD2 antibody-producing mesenchymal stem cells for a neuroblastoma mouse model](https://library.globalcastmd.com/watch/development-of-minimally-invasive-cancer-immunotherapy-using-anti-disialoganglioside-gd2-antibody-producing-mesenchymal-stem-cells-for-a-neuroblastoma-mouse-model-6214) — article · [machine version](https://library.globalcastmd.com/watch/development-of-minimally-invasive-cancer-immunotherapy-using-anti-disialoganglioside-gd2-antibody-producing-mesenchymal-stem-cells-for-a-neuroblastoma-mouse-model-6214.md)
- [BOB Ped Surg 2023 - Bernadette Jeremiasse, IPSO  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362) — video · 5:35 · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362.md)
- [Technical advances in the surgical management of Wilms tumors in children](https://library.globalcastmd.com/watch/technical-advances-in-the-surgical-management-of-wilms-tumors-in-children-6563) — article · [machine version](https://library.globalcastmd.com/watch/technical-advances-in-the-surgical-management-of-wilms-tumors-in-children-6563.md)
- [Update Course 2023 - Updates in the use of ICG](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267) — video · 19:57 · [machine version](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267.md)
- [Update Course Rewind: Updates in Indocyanine Green (ICG) 2023](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000.md)
- [Dominique Simons, MSc - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009) — video · 7:55 · [machine version](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009.md)
- [CAR T-cell therapy in pediatric oncology: From leukemia to emerging promise in Wilms tumor and solid malignancies](https://library.globalcastmd.com/watch/car-t-cell-therapy-in-pediatric-oncology-from-leukemia-to-emerging-promise-in-wilms-tumor-and-solid-malignancies-10911) — article · [machine version](https://library.globalcastmd.com/watch/car-t-cell-therapy-in-pediatric-oncology-from-leukemia-to-emerging-promise-in-wilms-tumor-and-solid-malignancies-10911.md)
- [Combined MEK and YAP inhibition in a mouse model of neuroblastoma: A promising approach for minimal residual disease](https://library.globalcastmd.com/watch/combined-mek-and-yap-inhibition-in-a-mouse-model-of-neuroblastoma-a-promising-approach-for-minimal-residual-disease-11180) — article · [machine version](https://library.globalcastmd.com/watch/combined-mek-and-yap-inhibition-in-a-mouse-model-of-neuroblastoma-a-promising-approach-for-minimal-residual-disease-11180.md)
- [Clinical characteristics and target exploration via scRNA-seq and high-throughput drug screening of FOXO1 fusion positive rhabdomyosarcoma](https://library.globalcastmd.com/watch/clinical-characteristics-and-target-exploration-via-scrna-seq-and-high-throughput-drug-screening-of-foxo1-fusion-positive-rhabdomyosarcoma-11252) — article · [machine version](https://library.globalcastmd.com/watch/clinical-characteristics-and-target-exploration-via-scrna-seq-and-high-throughput-drug-screening-of-foxo1-fusion-positive-rhabdomyosarcoma-11252.md)
- [Development of a machine learning-based prognostic prediction model and a web-based tool for pediatric hepatoblastoma: a Surveillance, Epidemiology, and End Results (SEER) database study](https://library.globalcastmd.com/watch/development-of-a-machine-learning-based-prognostic-prediction-model-and-a-web-based-tool-for-pediatric-hepatoblastoma-a-surveillance-epidemiology-and-end-results-database-study-12019) — article · [machine version](https://library.globalcastmd.com/watch/development-of-a-machine-learning-based-prognostic-prediction-model-and-a-web-based-tool-for-pediatric-hepatoblastoma-a-surveillance-epidemiology-and-end-results-database-study-12019.md)

### Patient & Family Education
- [Hepatoblastoma: When It Shows Up in Surprising Ways](https://library.globalcastmd.com/watch/hepatoblastoma-when-it-shows-up-in-surprising-ways-15034) — article · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-when-it-shows-up-in-surprising-ways-15034.md)
- [Hepatoblastoma Reaching the Vena Cava: How Do You Get It Out?](https://library.globalcastmd.com/watch/hepatoblastoma-reaching-the-vena-cava-how-do-you-get-it-out-15037) — article · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-reaching-the-vena-cava-how-do-you-get-it-out-15037.md)
- [Hepatoblastoma: A Young Child With a Hard Abdominal Mass](https://library.globalcastmd.com/watch/hepatoblastoma-a-young-child-with-a-hard-abdominal-mass-15041) — article · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-a-young-child-with-a-hard-abdominal-mass-15041.md)
- [Wilms Tumor: A Chest Mass Displacing the Heart](https://library.globalcastmd.com/watch/wilms-tumor-a-chest-mass-displacing-the-heart-15051) — article · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-a-chest-mass-displacing-the-heart-15051.md)
- [SCCOHT and HIPEC: Before or After Chemotherapy?](https://library.globalcastmd.com/watch/sccoht-and-hipec-before-or-after-chemotherapy-15053) — article · [machine version](https://library.globalcastmd.com/watch/sccoht-and-hipec-before-or-after-chemotherapy-15053.md)

### Long-Term Care
- [Existing and Emerging Options for Pediatric Oncofertility Patients: Pediatric...](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421) — video · 49:53 · [machine version](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421.md)
- [Functional outcome and health-related quality of life in patients with sacrococcygeal teratoma – a Swedish multicenter study](https://library.globalcastmd.com/watch/functional-outcome-and-health-related-quality-of-life-in-patients-with-sacrococcygeal-teratoma-a-swedish-multicenter-study-621) — article · [machine version](https://library.globalcastmd.com/watch/functional-outcome-and-health-related-quality-of-life-in-patients-with-sacrococcygeal-teratoma-a-swedish-multicenter-study-621.md)
- [Options for Female Fertility Preservation: Pediatric Oncofertility 2017](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899) — video · 30:48 · [machine version](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899.md)
- [Keys to Building a Successful Interdisciplinary Program](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905) — video · 9:36 · [machine version](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905.md)
- [Options for Male Fertility Preservation: Pediatric Oncofertility 2017](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900) — video · 15:47 · [machine version](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900.md)
- [Keys to Building a Successful Interdisciplinary Program-Funding the...](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904) — video · 19:00 · [machine version](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904.md)
- [Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma](https://library.globalcastmd.com/watch/need-for-urodynamic-evaluation-as-a-regular-follow-up-tool-in-assessment-of-long-term-urological-outcomes-in-patients-with-sacrococcygeal-teratoma-1129) — article · [machine version](https://library.globalcastmd.com/watch/need-for-urodynamic-evaluation-as-a-regular-follow-up-tool-in-assessment-of-long-term-urological-outcomes-in-patients-with-sacrococcygeal-teratoma-1129.md)
- [Testicular wedge biopsy for fertility preservation in children at significant risk for azoospermia after gonadotoxic therapy](https://library.globalcastmd.com/watch/testicular-wedge-biopsy-for-fertility-preservation-in-children-at-significant-risk-for-azoospermia-after-gonadotoxic-therapy-1236) — article · [machine version](https://library.globalcastmd.com/watch/testicular-wedge-biopsy-for-fertility-preservation-in-children-at-significant-risk-for-azoospermia-after-gonadotoxic-therapy-1236.md)
- [A Fertility Preservation Toolkit for Pediatric Surgeons Caring for Children with Cancer](https://library.globalcastmd.com/watch/a-fertility-preservation-toolkit-for-pediatric-surgeons-caring-for-children-with-cancer-1900) — article · [machine version](https://library.globalcastmd.com/watch/a-fertility-preservation-toolkit-for-pediatric-surgeons-caring-for-children-with-cancer-1900.md)
- [Ovarian Tumors in Children: Continued Monitoring is Necessary](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093) — video · [machine version](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093.md)
- [Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions](https://library.globalcastmd.com/watch/surgical-treatment-of-children-and-youth-with-congenital-melanocytic-nevi-self-and-proxy-reported-opinions-2289) — article · [machine version](https://library.globalcastmd.com/watch/surgical-treatment-of-children-and-youth-with-congenital-melanocytic-nevi-self-and-proxy-reported-opinions-2289.md)
- [Late Effects of Treatment for Childhood Cancer PDQ®](https://library.globalcastmd.com/watch/late-effects-of-treatment-for-childhood-cancer-pdq-2369) — article · [machine version](https://library.globalcastmd.com/watch/late-effects-of-treatment-for-childhood-cancer-pdq-2369.md)
- [Long-term functional outcome of sacrococcygeal teratoma after resection in neonates and infants: a single-center experience](https://library.globalcastmd.com/watch/long-term-functional-outcome-of-sacrococcygeal-teratoma-after-resection-in-neonates-and-infants-a-single-center-experience-3067) — article · [machine version](https://library.globalcastmd.com/watch/long-term-functional-outcome-of-sacrococcygeal-teratoma-after-resection-in-neonates-and-infants-a-single-center-experience-3067.md)
- [Radiation-Associated Thyroid Cancer Surveillance and Management in a Cohort of Late Effects Patients](https://library.globalcastmd.com/watch/radiation-associated-thyroid-cancer-surveillance-and-management-in-a-cohort-of-late-effects-patients-3362) — article · [machine version](https://library.globalcastmd.com/watch/radiation-associated-thyroid-cancer-surveillance-and-management-in-a-cohort-of-late-effects-patients-3362.md)
- [Correlation of Continence with Long-term Patient Centered Outcomes in Children with Sacrococcygeal Teratoma](https://library.globalcastmd.com/watch/correlation-of-continence-with-long-term-patient-centered-outcomes-in-children-with-sacrococcygeal-teratoma-4828) — article · [machine version](https://library.globalcastmd.com/watch/correlation-of-continence-with-long-term-patient-centered-outcomes-in-children-with-sacrococcygeal-teratoma-4828.md)
- [Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience](https://library.globalcastmd.com/watch/long-term-surgical-outcomes-in-pediatric-ovarian-neoplasms-20-year-single-center-experience-6127) — article · [machine version](https://library.globalcastmd.com/watch/long-term-surgical-outcomes-in-pediatric-ovarian-neoplasms-20-year-single-center-experience-6127.md)
- [Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor](https://library.globalcastmd.com/watch/clinical-assessment-of-late-health-outcomes-in-survivors-of-wilms-tumor-6287) — article · [machine version](https://library.globalcastmd.com/watch/clinical-assessment-of-late-health-outcomes-in-survivors-of-wilms-tumor-6287.md)
- [Meta-Analysis on Long-Term Outcomes of Pediatric Renal Cancer Survivors Following COG and SIOP Protocols](https://library.globalcastmd.com/watch/meta-analysis-on-long-term-outcomes-of-pediatric-renal-cancer-survivors-following-cog-and-siop-protocols-6376) — article · [machine version](https://library.globalcastmd.com/watch/meta-analysis-on-long-term-outcomes-of-pediatric-renal-cancer-survivors-following-cog-and-siop-protocols-6376.md)
- [Evaluación clínica de los resultados de salud tardíos en sobrevivientes de tumor de Wilms](https://library.globalcastmd.com/watch/evaluaci-n-cl-nica-de-los-resultados-de-salud-tard-os-en-sobrevivientes-de-tumor-de-wilms-6690) — article · [machine version](https://library.globalcastmd.com/watch/evaluaci-n-cl-nica-de-los-resultados-de-salud-tard-os-en-sobrevivientes-de-tumor-de-wilms-6690.md)
- [Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor](https://library.globalcastmd.com/watch/clinical-assessment-of-late-health-outcomes-in-survivors-of-wilms-tumor-6691) — article · [machine version](https://library.globalcastmd.com/watch/clinical-assessment-of-late-health-outcomes-in-survivors-of-wilms-tumor-6691.md)
- [Update Course Rewind: Fertility Preservation 2023](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867.md)
- [Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-8175) — article · [machine version](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-8175.md)
- [Satisfaction of Paediatric Oncology Patients, Survivors, and Nurses with the Position of Their Totally Implantable Venous Access Port (SPACE-Study)](https://library.globalcastmd.com/watch/satisfaction-of-paediatric-oncology-patients-survivors-and-nurses-with-the-position-of-their-totally-implantable-venous-access-port-8257) — article · [machine version](https://library.globalcastmd.com/watch/satisfaction-of-paediatric-oncology-patients-survivors-and-nurses-with-the-position-of-their-totally-implantable-venous-access-port-8257.md)
- [Long-Term Outcomes of Infantile Sacrococcygeal Teratoma: Results from a Multi-Institutional Retrospective Observational Study in Japan](https://library.globalcastmd.com/watch/long-term-outcomes-of-infantile-sacrococcygeal-teratoma-results-from-a-multi-institutional-retrospective-observational-study-in-japan-8292) — article · [machine version](https://library.globalcastmd.com/watch/long-term-outcomes-of-infantile-sacrococcygeal-teratoma-results-from-a-multi-institutional-retrospective-observational-study-in-japan-8292.md)
- [Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-8640) — article · [machine version](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-8640.md)
- [Resultados de la criopreservación de la fertilidad femenina en el cáncer infantil](https://library.globalcastmd.com/watch/resultados-de-la-criopreservaci-n-de-la-fertilidad-femenina-en-el-c-ncer-infantil-8641) — article · [machine version](https://library.globalcastmd.com/watch/resultados-de-la-criopreservaci-n-de-la-fertilidad-femenina-en-el-c-ncer-infantil-8641.md)
- [Resultados de la criopreservación de la fertilidad femenina en el cáncer infantil: una revisión sistemática](https://library.globalcastmd.com/watch/resultados-de-la-criopreservaci-n-de-la-fertilidad-femenina-en-el-c-ncer-infantil-una-revisi-n-sistem-tica-8648) — video · 0:57 · [machine version](https://library.globalcastmd.com/watch/resultados-de-la-criopreservaci-n-de-la-fertilidad-femenina-en-el-c-ncer-infantil-una-revisi-n-sistem-tica-8648.md)
- [Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9185) — article · [machine version](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9185.md)
- [Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9187) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9187.md)
- [Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521.md)
- [Medium-term Ovarian Volume and Anti-Müllerian Hormone After Ovarian-sparing Surgery for Benign Neoplasms in Pediatric Patients](https://library.globalcastmd.com/watch/medium-term-ovarian-volume-and-anti-m-llerian-hormone-after-ovarian-sparing-surgery-for-benign-neoplasms-in-pediatric-patients-9575) — article · [machine version](https://library.globalcastmd.com/watch/medium-term-ovarian-volume-and-anti-m-llerian-hormone-after-ovarian-sparing-surgery-for-benign-neoplasms-in-pediatric-patients-9575.md)
- [Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9774) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9774.md)
- [Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9952) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/ovarian-tissue-collection-for-fertility-preservation-in-children-the-need-for-standardised-surgical-practice-guidance-9952.md)
- [Letter to “Long-term urinary and sexual outcomes in pediatric genitourinary rhabdomyosarcoma survivors: a qualitative study”](https://library.globalcastmd.com/watch/letter-to-long-term-urinary-and-sexual-outcomes-in-pediatric-genitourinary-rhabdomyosarcoma-survivors-a-qualitative-study-10495) — article · [machine version](https://library.globalcastmd.com/watch/letter-to-long-term-urinary-and-sexual-outcomes-in-pediatric-genitourinary-rhabdomyosarcoma-survivors-a-qualitative-study-10495.md)
- [Invited Commentary for: A Report on Testicular Tissue Cryopreservation for Fertility Preservation in Children: Confirmation of Germ Cell Preservation and Few Surgical Complications](https://library.globalcastmd.com/watch/invited-commentary-for-a-report-on-testicular-tissue-cryopreservation-for-fertility-preservation-in-children-confirmation-of-germ-cell-preservation-and-few-surgical-complications-10503) — article · [machine version](https://library.globalcastmd.com/watch/invited-commentary-for-a-report-on-testicular-tissue-cryopreservation-for-fertility-preservation-in-children-confirmation-of-germ-cell-preservation-and-few-surgical-complications-10503.md)
- [Formal fertility preservation program facilitates equitable fertility care among pediatric oncology and stem cell transplant patients](https://library.globalcastmd.com/watch/formal-fertility-preservation-program-facilitates-equitable-fertility-care-among-pediatric-oncology-and-stem-cell-transplant-patients-10540) — article · [machine version](https://library.globalcastmd.com/watch/formal-fertility-preservation-program-facilitates-equitable-fertility-care-among-pediatric-oncology-and-stem-cell-transplant-patients-10540.md)
- [Residual nephrogenic rests affect the long-term prognosis of Wilms tumor with bilateral nephrogenic rests](https://library.globalcastmd.com/watch/residual-nephrogenic-rests-affect-the-long-term-prognosis-of-wilms-tumor-with-bilateral-nephrogenic-rests-10754) — article · [machine version](https://library.globalcastmd.com/watch/residual-nephrogenic-rests-affect-the-long-term-prognosis-of-wilms-tumor-with-bilateral-nephrogenic-rests-10754.md)
- [Perinatal prognostic factors of recurrence or functional sequelae in neonatal sacrococcygeal teratoma, and implications for prenatal counselling: a multicenter retrospective study.](https://library.globalcastmd.com/watch/perinatal-prognostic-factors-of-recurrence-or-functional-sequelae-in-neonatal-sacrococcygeal-teratoma-and-implications-for-prenatal-counselling-a-multicenter-retrospective-study-11003) — article · [machine version](https://library.globalcastmd.com/watch/perinatal-prognostic-factors-of-recurrence-or-functional-sequelae-in-neonatal-sacrococcygeal-teratoma-and-implications-for-prenatal-counselling-a-multicenter-retrospective-study-11003.md)
- [Response to “Perinatal prognostic factors of recurrence or functional sequelae in neonatal sacrococcygeal teratoma, and implications for prenatal counselling: A multicenter retrospective study”](https://library.globalcastmd.com/watch/response-to-perinatal-prognostic-factors-of-recurrence-or-functional-sequelae-in-neonatal-sacrococcygeal-teratoma-and-implications-for-prenatal-counselling-a-multicenter-retrospective-study-11089) — article · [machine version](https://library.globalcastmd.com/watch/response-to-perinatal-prognostic-factors-of-recurrence-or-functional-sequelae-in-neonatal-sacrococcygeal-teratoma-and-implications-for-prenatal-counselling-a-multicenter-retrospective-study-11089.md)
- [Optimizing surveillance strategies for sacrococcygeal teratoma: A Midwest pediatric surgery consortium multi-institutional study](https://library.globalcastmd.com/watch/optimizing-surveillance-strategies-for-sacrococcygeal-teratoma-a-midwest-pediatric-surgery-consortium-multi-institutional-study-11404) — article · [machine version](https://library.globalcastmd.com/watch/optimizing-surveillance-strategies-for-sacrococcygeal-teratoma-a-midwest-pediatric-surgery-consortium-multi-institutional-study-11404.md)
- [Optimizing surveillance strategies for sacrococcygeal teratoma: A Midwest pediatric surgery consortium multi-institutional study](https://library.globalcastmd.com/watch/optimizing-surveillance-strategies-for-sacrococcygeal-teratoma-a-midwest-pediatric-surgery-consortium-multi-institutional-study-11420) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/optimizing-surveillance-strategies-for-sacrococcygeal-teratoma-a-midwest-pediatric-surgery-consortium-multi-institutional-study-11420.md)
- [Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423) — video · 1:05 · [machine version](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423.md)
- [Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581.md)
- [Pediatric Oncofertility: From Cryopreservation to Future Fertility Solutions](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683) — video · 13:01 · [machine version](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683.md)
- [Late complications of treatment for childhood pelvic sarcoma: A report from the Childhood Cancer Survivor Study (CCSS)](https://library.globalcastmd.com/watch/late-complications-of-treatment-for-childhood-pelvic-sarcoma-a-report-from-the-childhood-cancer-survivor-study-11740) — article · [machine version](https://library.globalcastmd.com/watch/late-complications-of-treatment-for-childhood-pelvic-sarcoma-a-report-from-the-childhood-cancer-survivor-study-11740.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=0) Introduction and Initial Presentation (Ep 254)
- [1:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=97) Differential Diagnosis and Initial Workup (Ep 254)
- [6:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=410) PRETEXT Staging and Resectability Assessment (Ep 254)
- [11:45](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=705) PRETEXT System Details and Annotation Factors (Ep 254)
- [19:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1170) Pure Fetal Histology and Treatment Pathways (Ep 254)
- [25:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1535) Unresectable Disease and Referral Timing (Ep 254)
- [28:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1730) Risk Stratification and Pulmonary Metastases (Ep 254)
- [33:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2021) Surgical Technique and Intraoperative Management (Ep 254)
- [42:05](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2525) Extreme Resection versus Transplantation (Ep 254)
- [46:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2779) Recurrence Management and Summary (Ep 254)
- [0:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 255)
- [2:29](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=149) Initial Evaluation of Thyroid Nodules (Ep 255)
- [6:56](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=416) Laboratory and Imaging Workup (Ep 255)
- [9:26](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=566) Ultrasound Characteristics and Biopsy Criteria (Ep 255)
- [11:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=700) FNA Technique and Papillary Cancer Diagnosis (Ep 255)
- [14:17](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=857) Surgical Management of Papillary Thyroid Cancer (Ep 255)
- [17:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 255)
- [21:48](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1308) Follicular Lesions and Indeterminate Cytology (Ep 255)
- [24:39](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1479) Frozen Section and Follicular Cancer Management (Ep 255)
- [27:53](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Inadequate Specimens (Ep 255)
- [30:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1808) Medullary Thyroid Cancer: Initial Workup (Ep 255)
- [35:20](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2120) MEN Syndromes and Prophylactic Thyroidectomy (Ep 255)
- [39:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2367) Medullary Cancer: Postoperative Management (Ep 255)
- [41:59](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2519) Graves' Disease and Diffuse Papillary Cancer (Ep 255)
- [44:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 255)
- [0:00](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=0) Introduction and study question (Ep 20)
- [0:44](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=44) Study design and patient groups (Ep 20)
- [1:53](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=113) Study findings (Ep 20)
- [2:56](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=176) Conclusions and commentary (Ep 20)
- [0:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=1) Case presentation and audience polling on management of metastatic Wilms tumor (Ep 21)
- [1:52](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=112) Lymph node sampling requirement and local versus systemic staging (Ep 21)
- [5:20](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=320) Management of pulmonary nodules and radiation therapy criteria (Ep 21)
- [8:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481) Summary of take-home points and quality improvement outcomes (Ep 21)
- [0:00](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=0) Introduction and rationale for discussing ovarian tumors (Ep 22)
- [3:26](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=206) Case 1: 4-year-old with predominantly cystic mass with solid component (Ep 22)
- [4:56](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=296) Overview of ovarian tumor types and epidemiology (Ep 22)
- [7:30](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=450) Oncologic surgical principles and technique for tumor removal (Ep 22)
- [11:26](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=686) Technical details of ovarian-sparing resection (Ep 22)
- [14:55](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=895) Case 2: 13-year-old with large purely cystic mass (Ep 22)
- [18:47](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1127) Case 3: Teenager with solid mass and elevated AFP (Ep 22)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is no established standard salvage therapy regimen for relapsed hepatoblastoma — Sophia Schermerhorn (guideline) [Ep 621 · 0:12](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=12)
- The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma — Sophia Schermerhorn (epidemiological) [Ep 621 · 0:17](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=17)
- The overall survival for the cohort was about 50% — Sophia Schermerhorn (clinical) [Ep 621 · 0:25](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=25)
- Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin — Sophia Schermerhorn (clinical) [Ep 621 · 0:28](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=28)
- The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality — Sophia Schermerhorn (opinion) [Ep 621 · 0:36](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=36)
- Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy — Sophia Schermerhorn (clinical) [Ep 621 · 0:49](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=49)
- Salvage therapy for relapsed hepatoblastoma is multimodal — Sophia Schermerhorn (clinical) [Ep 621 · 0:57](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=57)
- Cisplatin retreatment should be balanced with the risk of cumulative toxicity — Sophia Schermerhorn (opinion) [Ep 621 · 0:59](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=59)
- This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma — Sophia Schermerhorn (clinical) [Ep 626 · 0:12](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=12)
- ICG was highly sensitive for detecting hepatoblastoma, about 90% — Sophia Schermerhorn (clinical) [Ep 626 · 0:22](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=22)
- In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging — Sophia Schermerhorn (clinical) [Ep 626 · 0:27](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=27)
- Specificity was lower than sensitivity with false positives — Sophia Schermerhorn (clinical) [Ep 626 · 0:39](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=39)
- False positives often represented vascular changes or inflammation — Sophia Schermerhorn (clinical) [Ep 626 · 0:43](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=43)
- There were no adverse outcomes associated with any of the additional resections guided by ICG — Sophia Schermerhorn (clinical) [Ep 626 · 0:46](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=46)
- ICG was effective in both open and minimally invasive surgery — Sophia Schermerhorn (clinical) [Ep 626 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- ICG was effective in both relapse and primary disease — Sophia Schermerhorn (clinical) [Ep 626 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma. — Sophia Schermerhorn (clinical) [Ep 628 · 0:24](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=24)
- Survival for hepatoblastoma continues to improve. — Sophia Schermerhorn (epidemiological) [Ep 628 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves. — Sophia Schermerhorn (opinion) [Ep 628 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma. — Sophia Schermerhorn (clinical) [Ep 628 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups. — Sophia Schermerhorn (clinical) [Ep 628 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- Patients who underwent resection had lower overall procedure anxiety scores than transplant patients. — Sophia Schermerhorn (clinical) [Ep 628 · 0:47](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=47)
- The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys. — Sophia Schermerhorn (clinical) [Ep 628 · 0:53](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=53)
- Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma. — Sophia Schermerhorn (clinical) [Ep 628 · 0:55](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=55)
- Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes. — Sophia Schermerhorn (opinion) [Ep 628 · 1:02](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=62)
- A multi-center prospective study evaluated a structured ERAS pathway for children undergoing abdominal neuroblastoma resection — Sophia Schermerhorn (clinical) [Ep 639 · 0:03](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=3)
- The ERAS protocol included 20 evidence-based elements spanning the entire perioperative process — Sophia Schermerhorn (clinical) [Ep 639 · 0:13](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=13)
- ERAS protocol elements included preoperative counseling, hydrate loading, standardized multimodal analgesia, early feeding, and early mobilization — Sophia Schermerhorn (clinical) [Ep 639 · 0:13](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=13)
- Length of stay decreased from about 7 days to 3.7 days — Sophia Schermerhorn (clinical) [Ep 639 · 0:28](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=28)
- Post-operative opioid use dropped by over half — Sophia Schermerhorn (clinical) [Ep 639 · 0:32](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=32)
- Patients resumed regular diets and ambulated about 3 days earlier — Sophia Schermerhorn (clinical) [Ep 639 · 0:32](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=32)
- The proportion of patients experiencing any postoperative complication decreased by over 50% — Sophia Schermerhorn (clinical) [Ep 639 · 0:39](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=39)
- Patients were cleared to resume adjuvant chemotherapy earlier at around 8 days as opposed to 10 days — Sophia Schermerhorn (clinical) [Ep 639 · 0:46](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=46)
- A structured ERAS pathway meaningfully improves recovery even after complex neuroblastoma resections — Sophia Schermerhorn (opinion) [Ep 639 · 0:51](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=51)
- ERAS represents a tangible opportunity to standardize perioperative care for neuroblastoma resection — Sophia Schermerhorn (opinion) [Ep 639 · 0:51](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=51)
- The study evaluated 169 biopsies in 141 patients over a 10-year period at a single institution. — Sophia Schermerhorn (clinical) [Ep 640 · 0:13](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=13)
- Nearly 90% of the biopsies were core-needle biopsies. — Sophia Schermerhorn (clinical) [Ep 640 · 0:19](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=19)
- All biopsies were performed with image guidance, most commonly CT, sometimes combined with fluoroscopy and ultrasound. — Sophia Schermerhorn (clinical) [Ep 640 · 0:22](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=22)
- All biopsies were performed by interventional radiologists. — Sophia Schermerhorn (clinical) [Ep 640 · 0:28](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=28)
- 97.9% of biopsies were diagnostic. — Sophia Schermerhorn (clinical) [Ep 640 · 0:33](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33)
- Only 3 patients required repeat biopsy. — Sophia Schermerhorn (clinical) [Ep 640 · 0:33](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33)
- There was one patient with transient sciatic nerve paresis, which resolved. — Sophia Schermerhorn (clinical) [Ep 640 · 0:40](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=40)
- The complication rate was 0.7%. — Sophia Schermerhorn (clinical) [Ep 640 · 0:43](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=43)
- The approach provided sufficient tissue for histology, immunostains, and molecular studies. — Sophia Schermerhorn (clinical) [Ep 640 · 0:46](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46)
- Immunostains and molecular studies are increasingly essential for modern risk stratification and targeted therapy. — Sophia Schermerhorn (clinical) [Ep 640 · 0:46](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46)
- Image-guided percutaneous biopsy should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. — Sophia Schermerhorn (opinion) [Ep 640 · 0:56](https://library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=56)
- This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma — Sophia Schermerhorn (epidemiological) [Ep 644 · 0:11](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=11)
- 14% of patients required a repeat laparotomy — Sophia Schermerhorn (epidemiological) [Ep 644 · 0:20](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=20)
- The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence — Sophia Schermerhorn (clinical) [Ep 644 · 0:21](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=21)
- In Wilms tumor, obstruction typically occurred within the first year — Sophia Schermerhorn (clinical) [Ep 644 · 0:26](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=26)
- In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up — Sophia Schermerhorn (clinical) [Ep 644 · 0:29](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=29)
- Radiation dose was not associated with re-operation risk — Sophia Schermerhorn (clinical) [Ep 644 · 0:34](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=34)
- Secondary malignancy was uncommon in this cohort — Sophia Schermerhorn (epidemiological) [Ep 644 · 0:37](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37)
- Hypertension after nephrectomy was not increased compared to population norms — Sophia Schermerhorn (clinical) [Ep 644 · 0:37](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37)
- Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population — Sophia Schermerhorn (epidemiological) [Ep 644 · 0:45](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45)
- Scoliosis has multi-factorial contributors including surgery and possibly radiation — Sophia Schermerhorn (clinical) [Ep 644 · 0:45](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45)
- Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up — Sophia Schermerhorn (guideline) [Ep 644 · 0:58](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=58)
- IDRFs are necessary knowledge for clinicians treating neuroblastoma to determine safety of surgical intervention — Sophia Schermerhorn (clinical) [Ep 659 · 0:00](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=0)
- IDRFs are imaging findings on CT or MRI that predict when neuroblastoma may be difficult or dangerous to remove surgically — Sophia Schermerhorn (clinical) [Ep 659 · 0:14](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=14)
- The IDRF concept was first introduced in 2009 by the International Neuroblastoma Risk Group — Sophia Schermerhorn (guideline) [Ep 659 · 0:21](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=21)
- The International Neuroblastoma Risk Group defined 20 specific imaging risk factors — Sophia Schermerhorn (guideline) [Ep 659 · 0:21](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=21)
- Most IDRFs relate to how the tumor interacts with critical anatomy — Sophia Schermerhorn (clinical) [Ep 659 · 0:29](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=29)
- In the abdomen, a tumor that infiltrates the portahepati or hepatoduodenal ligament is considered to contain an IDRF — Sophia Schermerhorn (clinical) [Ep 659 · 0:34](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=34)
- The presence of an IDRF does not mean a tumor cannot be resected — Sophia Schermerhorn (clinical) [Ep 659 · 0:41](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41)
- IDRF presence signals that surgery may be technically more complex — Sophia Schermerhorn (clinical) [Ep 659 · 0:41](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41)
- Patients with IDRFs often receive neoadjuvant therapy first to try to shrink the tumor — Sophia Schermerhorn (clinical) [Ep 659 · 0:41](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41)
- Surgeons use IDRFs to predict surgical risk and guide the safest treatment approach using imaging — Sophia Schermerhorn (clinical) [Ep 659 · 0:52](https://library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=52)
- Radiation improves survival in high-risk neuroblastoma — Sophia Schermerhorn (clinical) [Ep 670 · 0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0)
- This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy — Sophia Schermerhorn (clinical) [Ep 670 · 0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13)
- The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment — Sophia Schermerhorn (clinical) [Ep 670 · 0:19](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=19)
- There was a significant decrease in pancreatic volume after radiation — Sophia Schermerhorn (clinical) [Ep 670 · 0:27](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=27)
- Very few patients developed clinically apparent pancreatic insufficiency — Sophia Schermerhorn (clinical) [Ep 670 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- Pancreatic insufficiency wasn't systematically screened for in this study — Sophia Schermerhorn (clinical) [Ep 670 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients — Sophia Schermerhorn (opinion) [Ep 670 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- Pancreatic dysfunction could be an under-recognized late effect — Sophia Schermerhorn (opinion) [Ep 670 · 0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43)
- Patients had a significant drop in weight percentile with smaller decreases in fat and muscle — Sophia Schermerhorn (clinical) [Ep 670 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone — Sophia Schermerhorn (opinion) [Ep 670 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- These findings highlight the importance of nutritional screening during cancer treatments — Sophia Schermerhorn (opinion) [Ep 670 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself — Sophia Schermerhorn (opinion) [Ep 670 · 1:03](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=63)
- Gillippelli et al. performed a systematic retrospective review of female fertility cryopreservation outcomes in children with cancer — Alex Halpern (clinical) [Ep 538 · 0:13](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=13)
- The review initially examined 104 abstracts and 34 full text articles — Alex Halpern (clinical) [Ep 538 · 0:19](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=19)
- 12 studies were included in the final systematic review — Alex Halpern (clinical) [Ep 538 · 0:19](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=19)
- Ovarian tissue cryopreservation was performed in 501 patients across the included studies — Alex Halpern (epidemiological) [Ep 538 · 0:27](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=27)
- 5.9% of patients who underwent ovarian tissue cryopreservation later received ovarian tissue transplantation — Alex Halpern (epidemiological) [Ep 538 · 0:27](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=27)
- 33% of patients who underwent ovarian tissue transplantation were able to become pregnant — Alex Halpern (clinical) [Ep 538 · 0:38](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=38)
- Ovarian tissue cryopreservation has great advantages for pediatric cancer patients but needs to be studied further — Alex Halpern (opinion) [Ep 538 · 0:44](https://library.globalcastmd.com/watch/female-fertility-cryopreservation-outcomes-in-childhood-cancer-a-systematic-review-9521?t=44)
- Survival rate for high-risk neuroblastoma patients is in the 38 to 40% range — Daniel von Allmen (epidemiological) [Ep 50 · 0:42](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=42)
- Surgeon-reported degree of resection showed only 66% concordance with radiologist assessment of postoperative imaging in tandem transplant pilot study — Daniel von Allmen (clinical) [Ep 50 · 6:52](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=412)
- Repeat study in recent COG high-risk trial showed same 66% concordance rate between surgeon op notes and postoperative imaging, with surgeons underestimating and radiologists overcalling resection completeness — Daniel von Allmen (clinical) [Ep 50 · 7:33](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=453)
- More chemotherapy or other agents like MIBG may make tumor more fibrotic and make subadventitial dissection more difficult — Daniel von Allmen (opinion) [Ep 50 · 10:17](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=617)
- Complication rate for aggressive neuroblastoma resection is approximately 30% morbidity with mortality less than 1% — Daniel von Allmen (epidemiological) [Ep 50 · 13:07](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=787)
- Riley Hospital study showed only survivors with stage 4 neuroblastoma were those who had primary tumor resection (clinical) [Ep 50 · 14:07](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=847)
- High-risk neuroblastoma patients receive 9 different drugs, bone marrow transplantation, and some receive total body radiation (clinical) [Ep 50 · 14:55](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=895)
- High-risk neuroblastoma treatment includes tandem peripheral blood stem cell transplants, with second transplant given as soon as patient recovers from first, followed by immunotherapy and Retin-A — Daniel von Allmen (clinical) [Ep 50 · 15:10](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=910)
- High-risk neuroblastoma survival increased from 10% to 30-40% with treatment intensification (epidemiological) [Ep 50 · 16:01](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=961)
- COG 3973 study's inability to demonstrate overall survival benefit may be type 2 error due to smaller sample size (230 vs 1,300 patients in European study) — Daniel von Allmen (opinion) [Ep 50 · 21:56](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1316)
- Aggressive neuroblastoma resections using subadventitial dissection should not be performed by occasional pediatric oncological surgeons doing one case per year or every other year (opinion) [Ep 50 · 22:21](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1341)
- Immunotherapy is effective in neuroblastoma in the setting of minimal residual disease — Daniel von Allmen (clinical) [Ep 50 · 25:38](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1538)
- Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024 — Sophia Schermerhorn (clinical) [Ep 617 · 0:05](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=5)
- PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology — Sophia Schermerhorn (clinical) [Ep 617 · 0:07](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=7)
- The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers — Sophia Schermerhorn (clinical) [Ep 617 · 0:20](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=20)
- Among 33 patients studied, about 2/3 had relapse limited to the lungs — Sophia Schermerhorn (epidemiological) [Ep 617 · 0:32](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule — Sophia Schermerhorn (epidemiological) [Ep 617 · 0:32](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation — Sophia Schermerhorn (clinical) [Ep 617 · 0:39](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- Patients with solitary pulmonary nodule had the highest overall three-year survival at 73% — Sophia Schermerhorn (epidemiological) [Ep 617 · 0:39](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- Three-year survival for patients with multiple nodules was 40% — Sophia Schermerhorn (epidemiological) [Ep 617 · 0:50](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- Three-year survival for patients with extrapulmonary disease was 23% — Sophia Schermerhorn (epidemiological) [Ep 617 · 0:50](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- Solitary pulmonary relapse may represent a biologically more favorable type of recurrence — Sophia Schermerhorn (opinion) [Ep 617 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- Solitary pulmonary relapse is more amenable to achieving meaningful local control — Sophia Schermerhorn (opinion) [Ep 617 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma — Sophia Schermerhorn (opinion) [Ep 617 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- 42% of 220 oncology patients had a fever in the 48 hours following tumor resection — Sophia Schermerhorn (epidemiological) [Ep 619 · 0:12](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=12)
- Only 2 of the febrile patients (2.8%) had an actual infection — Sophia Schermerhorn (epidemiological) [Ep 619 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- The two patients with actual infection were hemodynamically unstable with positive blood cultures — Sophia Schermerhorn (clinical) [Ep 619 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- Most fevers triggered a workup that costs on average about $500 per patient — Sophia Schermerhorn (epidemiological) [Ep 619 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- About a third of patients received empiric antibiotics that they did not need — Sophia Schermerhorn (epidemiological) [Ep 619 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- In the 48 hours following tumor resection, fever alone may not be a reason to panic — Sophia Schermerhorn (opinion) [Ep 619 · 0:40](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=40)
- Extensive workup should be reserved for patients who are hemodynamically unstable or have more overt signs of infection — Sophia Schermerhorn (guideline) [Ep 619 · 0:45](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=45)
- Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:12](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=12)
- Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:20](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=20)
- The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:31](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=31)
- After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:37](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=37)
- Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma — Sophia Schermerhorn (epidemiological) [Ep 620 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health — Sophia Schermerhorn (opinion) [Ep 620 · 0:51](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=51)
- Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors — Sophia Schermerhorn (opinion) [Ep 620 · 1:00](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=60)
- Predominantly cystic ovarian masses have approximately 3-4% malignancy risk — Fred Rescorla (epidemiological) [Ep 253 · 4:03](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=243)
- Heterogeneous ovarian masses have 15-20% malignancy rate — Fred Rescorla (epidemiological) [Ep 253 · 4:25](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=265)
- Solid ovarian masses have over 25% malignancy risk — Fred Rescorla (epidemiological) [Ep 253 · 4:32](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=272)
- Approximately 10% or less of all pediatric ovarian tumors are malignant — Fred Rescorla (epidemiological) [Ep 253 · 5:03](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=303)
- Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series — Fred Rescorla (epidemiological) [Ep 253 · 5:18](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=318)
- Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases — Fred Rescorla (epidemiological) [Ep 253 · 5:43](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=343)
- Immature teratoma accounts for approximately 10-15% of benign ovarian tumors — Fred Rescorla (epidemiological) [Ep 253 · 5:51](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=351)
- For ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged) — Fred Rescorla (guideline) [Ep 253 · 10:40](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=640)
- Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely — Fred Rescorla (guideline) [Ep 253 · 10:54](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=654)
- For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1% — Fred Rescorla (epidemiological) [Ep 253 · 15:57](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=957)
- Stage I malignant germ cell ovarian tumors have 96% overall survival — Fred Rescorla (epidemiological) [Ep 253 · 30:20](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1820)
- Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate — Fred Rescorla (epidemiological) [Ep 253 · 30:33](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1833)
- Salvage rate for relapsed stage I germ cell tumors is nearly 100% — Fred Rescorla (epidemiological) [Ep 253 · 30:43](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1843)
- Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy — Fred Rescorla (epidemiological) [Ep 253 · 30:55](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1855)
- Stage IV germ cell ovarian tumors have approximately 80% overall survival — Fred Rescorla (epidemiological) [Ep 253 · 31:15](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1875)
- Stage IV germ cell tumors in patients under 11 years have 92% survival — Fred Rescorla (epidemiological) [Ep 253 · 31:23](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1883)
- Stage IV germ cell tumors in patients over 11 years have 60% survival — Fred Rescorla (epidemiological) [Ep 253 · 31:33](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1893)
- Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin — Fred Rescorla (guideline) [Ep 253 · 32:00](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1920)
- Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging — Fred Rescorla (clinical) [Ep 253 · 32:13](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1933)
- Black, torsed ovaries should not be removed; detorsion alone is appropriate — Fred Rescorla (clinical) [Ep 253 · 32:32](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1952)
- Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors — Fred Rescorla (clinical) [Ep 253 · 32:44](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1964)
- Alpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely — Fred Rescorla (clinical) [Ep 253 · 3:25](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=205)
- Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively — Fred Rescorla (guideline) [Ep 253 · 20:53](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1253)
- For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present — Fred Rescorla (clinical) [Ep 253 · 21:31](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1291)
- Fallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate — Fred Rescorla (clinical) [Ep 253 · 21:42](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1302)
- Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage — Fred Rescorla (clinical) [Ep 253 · 22:48](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1368)
- Pediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection — Fred Rescorla (clinical) [Ep 253 · 23:20](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1400)
- Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation — Fred Rescorla (guideline) [Ep 253 · 24:07](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1447)
- Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors — Fred Rescorla (clinical) [Ep 253 · 24:16](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1456)
- Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy — Fred Rescorla (opinion) [Ep 253 · 24:32](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1472)
- For acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging — Fred Rescorla (clinical) [Ep 253 · 26:57](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1617)
- A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery — Fred Rescorla (clinical) [Ep 253 · 28:50](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1730)
- Pyogenic granuloma surgical resection has approximately 3% recurrence rate with gross negative margins — Danielle Walsh (clinical) [Ep 49 · 4:47](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=287)
- Shave excision with curettage of pyogenic granuloma has 9.5% recurrence rate — Danielle Walsh (clinical) [Ep 49 · 5:04](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=304)
- Silver nitrate treatment for pyogenic granuloma has 15% recurrence rate, the highest among treatment options — Danielle Walsh (clinical) [Ep 49 · 5:20](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=320)
- Retinoid medications for acne are significantly associated with development of pyogenic granulomas; removal of medication often resolves the lesion — Danielle Walsh (clinical) [Ep 49 · 4:14](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=254)
- In a large study, 80% of characteristic Spitz nevi involuted spontaneously — Danielle Walsh (epidemiological) [Ep 49 · 8:28](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=508)
- Half of pediatric dermatologists would observe classic Spitz nevi without excision, waiting for spontaneous resolution — Danielle Walsh (clinical) [Ep 49 · 8:44](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=524)
- In a series of 30 patients with incompletely removed Spitz nevi, 24 were observed and none recurred; 6 were re-excised and only 1 had residual disease — Danielle Walsh (clinical) [Ep 49 · 9:43](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=583)
- In a retrospective study with 1-3mm margins for Spitz nevi, 20% had positive margins on re-excision — Danielle Walsh (clinical) [Ep 49 · 10:23](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=623)
- Barnhill recommends 3-5mm margins for classic Spitz nevi, 1cm for atypical, and melanoma-protocol margins for severely atypical based on depth — Danielle Walsh (guideline) [Ep 49 · 10:45](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=645)
- About one-third of Spitz nevi cases had nodal micrometastases on sentinel lymph node biopsy in combined adult and pediatric series — Danielle Walsh (epidemiological) [Ep 49 · 11:56](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=716)
- In 8 series, 39% of Spitz nevi with sentinel lymph node biopsy were positive, but all patients remained disease-free at 3-year follow-up without further intervention — Danielle Walsh (clinical) [Ep 49 · 12:18](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=738)
- Pediatric melanoma ABCDE criteria capture only 40% of cases in children under 10 and 60% in children over 11 — Danielle Walsh (epidemiological) [Ep 49 · 18:28](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1108)
- Melanoma margin recommendations: 5mm for in situ, 1cm for ≤1mm thick, 1-2cm for 1-2mm thick, 2cm for >2mm thick — Danielle Walsh (guideline) [Ep 49 · 19:35](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1175)
- Cochrane review suggests 2cm margins are adequate for thick melanomas; no benefit demonstrated for 4cm margins — Danielle Walsh (clinical) [Ep 49 · 19:50](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1190)
- Giant congenital nevi (>20cm) have 8% melanoma risk, higher if hairy; 60% of melanomas occur in first decade, reported as young as 3 years — Danielle Walsh (epidemiological) [Ep 49 · 20:12](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1212)
- Pediatric melanoma has higher metastatic rate to lymph nodes (about 25%) than adults, especially in children younger than 10 and with thicker lesions — Danielle Walsh (epidemiological) [Ep 49 · 20:35](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1235)
- If sentinel node is negative in melanoma, probability of subsequent recurrence is only about 5% — Danielle Walsh (clinical) [Ep 49 · 21:02](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1262)
- If sentinel node is negative in melanoma, probability of non-sentinel node being positive is low but not zero — Danielle Walsh (clinical) [Ep 49 · 21:08](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1268)
- Acute unilateral cervical lymphadenopathy is mostly bacterial (strep and staph); acute bilateral is usually viral — Danielle Walsh (clinical) [Ep 49 · 30:57](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1857)
- Chronic/subacute unilateral lymphadenopathy suggests atypical mycobacteria, Bartonella, tuberculosis, or toxoplasmosis — Danielle Walsh (clinical) [Ep 49 · 31:30](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1890)
- Chronic/subacute bilateral lymphadenopathy suggests EBV, CMV, or HIV — Danielle Walsh (clinical) [Ep 49 · 31:45](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1905)
- Lymphadenopathy may persist 6-8 weeks after antibiotic treatment — Danielle Walsh (clinical) [Ep 49 · 32:43](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1963)
- Biopsy indications for cervical lymphadenopathy include: >3cm, hard/fixed, supraclavicular or epitrochlear location, multiple nodal groups, systemic symptoms, hepatosplenomegaly, significantly abnormal labs, or abnormal imaging — Danielle Walsh (clinical) [Ep 49 · 34:22](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2062)
- FNA for lymph nodes has 90% sensitivity and specificity but 10% false rate, with higher false-negative rate in Hodgkin lymphoma — Danielle Walsh (clinical) [Ep 49 · 34:58](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2098)
- Malignancy rate in cervical lymph node biopsies varies 10-25% overall but ranges 12-80% depending on referral patterns and specialty — Danielle Walsh (epidemiological) [Ep 49 · 35:39](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2139)
- Atypical mycobacterial lymphadenitis is a local problem in immunocompetent children, usually age 1-5 years, enters through oropharynx, and is not considered contagious — Danielle Walsh (clinical) [Ep 49 · 38:00](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2280)
- In a randomized multicenter trial for atypical mycobacterial lymphadenitis, surgery had 96% cure rate versus 66% cure rate with antibiotics alone — Danielle Walsh (clinical) [Ep 49 · 38:31](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2311)
- In a series of 55 patients with confirmed atypical mycobacteria, 45 started on antibiotics and 30 (67%) resolved without surgery — Danielle Walsh (clinical) [Ep 49 · 38:56](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2336)
- Neonatal breast mastitis occurs mostly in term or near-term infants due to estrogen exposure; very uncommon in preemies because estrogen levels don't rise — Danielle Walsh (clinical) [Ep 49 · 50:31](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3031)
- Peak age for neonatal mastitis is 2-4 weeks; majority are staph but gram negatives reported — Danielle Walsh (epidemiological) [Ep 49 · 50:44](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3044)
- Parenteral antibiotics for 7-14 days may be needed for neonatal mastitis because infants have delayed absorption and delayed antibiotic efficacy — Danielle Walsh (clinical) [Ep 49 · 51:26](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3086)
- In two small series of neonatal mastitis with I&D, breast deformity occurred in 2 of 5 patients (40%) in one study and 2 of 7 patients (29%) in another — Danielle Walsh (clinical) [Ep 49 · 52:39](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3159)
- Fibroadenomas are the most common breast lesion in the under-20 age group, representing an exaggerated response to estrogen — Danielle Walsh (clinical) [Ep 49 · 63:11](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3791)
- About 10-15% of fibroadenomas are multiple and 10% are bilateral — Danielle Walsh (epidemiological) [Ep 49 · 63:20](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3800)
- Fibroadenomas typically increase in size over 6-12 months, then stabilize and can regress completely — Danielle Walsh (clinical) [Ep 49 · 63:27](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3807)
- Excisional biopsy for fibroadenoma is recommended if continuing to grow, changing, over 5cm, symptomatic, complex on ultrasound, unreliable follow-up, or severe family anxiety — Danielle Walsh (clinical) [Ep 49 · 64:17](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3857)
- Juvenile fibroadenomas are larger lesions with rapid growth, greater than 5cm, but only 10% reach that size — Danielle Walsh (clinical) [Ep 49 · 65:00](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3900)
- Juvenile fibroadenomas larger than 5cm are difficult to distinguish from cystosarcoma phyllodes, even on percutaneous biopsy — Danielle Walsh (clinical) [Ep 49 · 65:14](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3914)
- Simple fibroadenomas (isolated, well-demarcated, solid) have no increased cancer risk if no family history and no adjacent breast tissue abnormality — Danielle Walsh (clinical) [Ep 49 · 65:57](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3957)
- Complex fibroadenomas (with cysts, calcifications, or abnormal surrounding tissue) carry a slight increased risk of future breast cancer up to 20 years after diagnosis — Danielle Walsh (clinical) [Ep 49 · 66:14](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3974)
- Malignant breast disease in pediatric patients is rare and more commonly metastatic from other sites than primary breast tumors — Danielle Walsh (epidemiological) [Ep 49 · 66:42](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4002)
- Lymphoma patients treated with chest radiation at young ages have up to 25% higher incidence of malignant breast disease — Danielle Walsh (epidemiological) [Ep 49 · 66:53](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4013)
- American Society of Clinical Oncology discourages BRCA genetic testing before age 20 due to lack of timely medical benefit and psychosocial risks — Danielle Walsh (guideline) [Ep 49 · 67:05](https://library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4025)
- The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies — Sophia Schermerhorn (clinical) [Ep 680 · 0:05](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=5)
- Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node — Sophia Schermerhorn (clinical) [Ep 680 · 0:21](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=21)
- All sentinel nodes that contained malignancy were ICG avid — Sophia Schermerhorn (clinical) [Ep 680 · 0:28](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=28)
- ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy — Sophia Schermerhorn (clinical) [Ep 680 · 0:33](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33)
- ICG may outperform blue dye localization based on previously reported literature — Sophia Schermerhorn (opinion) [Ep 680 · 0:33](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33)
- The study did not directly compare the effectiveness of ICG to blue dye localization — Sophia Schermerhorn (clinical) [Ep 680 · 0:45](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=45)
- ICG in most cases was used in conjunction with standard localization techniques such as technetium — Sophia Schermerhorn (clinical) [Ep 680 · 0:49](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=49)
- No adverse reactions to ICG were identified within 30 days of surgery — Sophia Schermerhorn (clinical) [Ep 680 · 0:58](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=58)
- Blue dye can cause permanent tattooing — Sophia Schermerhorn (clinical) [Ep 680 · 1:02](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62)
- ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy — Sophia Schermerhorn (opinion) [Ep 680 · 1:02](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62)
- PRETEXT staging stands for pretreatment extent of disease and is based on segmental liver anatomy prior to chemotherapy (clinical) [Ep 58 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect (clinical) [Ep 58 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- POSTTEXT refers to extensive disease after neoadjuvant chemotherapy has been given (clinical) [Ep 58 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- Key staging annotations include involvement of the retrohepatic cava or hepatic veins and the portal vein bifurcation (clinical) [Ep 58 · 3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232)
- COG recommendations state that PRETEXT stage 2 tumors with no vascular involvement and achievable 1 cm margin can be resected upfront without neoadjuvant chemotherapy (guideline) [Ep 58 · 7:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=450)
- COG feels that PRETEXT stage 1 and 2 tumors do not necessarily need referral to centers with liver resection expertise if the local surgeon feels competent (guideline) [Ep 58 · 7:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=475)
- Most tumor shrinkage from chemotherapy occurs within the first two cycles (clinical) [Ep 58 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- Current recommendations are that after two cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant (guideline) [Ep 58 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply, so chemotherapy does not improve vascular margins (clinical) [Ep 58 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- The goal surgical margin for hepatoblastoma resection is 1 cm (clinical) [Ep 58 · 12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728)
- Survival in patients undergoing extended or heroic resections (tumor liver explants with back table resection and reimplant, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival (clinical) [Ep 58 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- There has been a move away from heroic resections for hepatoblastoma (opinion) [Ep 58 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- Patients who undergo failed resection followed by rescue transplant have worse survival than patients who undergo planned transplant upfront (clinical) [Ep 58 · 14:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=892)
- Patients should be referred to a transplant center early even if they may not ultimately need transplant, to have pre-transplant evaluation completed and be plugged into the system (guideline) [Ep 58 · 15:48](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=948)
- Primary transplant patients with hepatoblastoma do surprisingly well despite immunosuppression against rejection in the setting of cancer (clinical) [Ep 58 · 16:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=998)
- For non-transplant center surgeons, criteria for proceeding with resection include feeling 95% confident of success and ability to perform an anatomic resection with good margin (opinion) [Ep 58 · 18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136)
- Disease close to hepatic veins, disease extending across the liver, or involvement of the portal vein should prompt referral to a transplant center (opinion) [Ep 58 · 19:54](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1194)
- The truth about resectability is determined at the time of operation despite all available imaging (opinion) [Ep 58 · 21:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1312)
- In Europe, all liver tumors receive chemotherapy upfront before surgery because it results in smaller, easier-to-resect tumors (clinical) [Ep 58 · 22:13](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1333)
- Core needle biopsy for hepatoblastoma typically requires about 10 passes through an area that includes normal parenchyma and tumor (clinical) [Ep 58 · 23:53](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1433)
- There are two camps regarding pulmonary metastasis treatment: one advocates resecting metastases upfront before hepatectomy, the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites (clinical) [Ep 58 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- There is no good data on either side of the pulmonary metastasis timing debate, with both approaches limited to a handful of patients (opinion) [Ep 58 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- Papers on stage IV hepatoblastoma with lung metastases are limited to cohorts of less than 20 patients, making it hard to draw good conclusions (epidemiological) [Ep 58 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- There may be reporting bias in transplant outcomes because successes are reported but not all failures (opinion) [Ep 58 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- Lymph nodes must be taken out during nephrectomy for Wilms tumor (guideline) [Ep 93 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Failure to take out lymph nodes automatically upstages Wilms tumor patients (guideline) [Ep 93 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- There is both a local and systemic staging system for Wilms tumor (clinical) [Ep 93 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Pulmonary metastases do not preclude primary nephrectomy in Wilms tumor (guideline) [Ep 93 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Primary nephrectomy in metastatic Wilms tumor affects whether the patient receives radiation therapy (clinical) [Ep 93 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- There is a local stage for Wilms tumor and a patient staging for Wilms tumor — Erlick (clinical) [Ep 93 · 0:50](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- Omission of lymph node biopsies is a major protocol violation in Wilms tumor surgery — Erlick (opinion) [Ep 93 · 0:50](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall — Andrew Davidoff (epidemiological) [Ep 184 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=0)
- Approximately 75% of Wilms tumor cases occur in children younger than five years of age with a peak incidence at two to three years of age — Andrew Davidoff (epidemiological) [Ep 184 · 0:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=30)
- Survival for patients with Wilms tumor when considered as a whole is currently greater than 90% — Andrew Davidoff (epidemiological) [Ep 184 · 1:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=60)
- Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality — Andrew Davidoff (epidemiological) [Ep 184 · 1:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=80)
- Children with Wilms tumor typically present with an asymptomatic abdominal mass — Andrew Davidoff (clinical) [Ep 184 · 3:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=180)
- Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension — Andrew Davidoff (clinical) [Ep 184 · 3:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=200)
- CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound — Andrew Davidoff (guideline) [Ep 184 · 4:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=250)
- Intravascular tumor extension occurs in about 6% of Wilms tumor cases — Andrew Davidoff (epidemiological) [Ep 184 · 5:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=320)
- The most common site of metastatic spread of Wilms tumor is the lungs — Andrew Davidoff (clinical) [Ep 184 · 6:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=380)
- Stage one Wilms tumors are localized tumors confined within the renal capsule — Andrew Davidoff (guideline) [Ep 184 · 7:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=440)
- Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins — Andrew Davidoff (guideline) [Ep 184 · 7:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=460)
- Stage three criteria include biopsy or rupture (pre-operative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or administration of preoperative chemotherapy — Andrew Davidoff (guideline) [Ep 184 · 8:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=480)
- Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four — Andrew Davidoff (epidemiological) [Ep 184 · 8:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=530)
- Patients with synchronous bilateral Wilms tumor are stage five — Andrew Davidoff (guideline) [Ep 184 · 9:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=560)
- For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group — Andrew Davidoff (guideline) [Ep 184 · 10:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=620)
- Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures — Andrew Davidoff (clinical) [Ep 184 · 11:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=680)
- Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin — Andrew Davidoff (guideline) [Ep 184 · 11:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=710)
- Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D — Andrew Davidoff (guideline) [Ep 184 · 12:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=760)
- For stage one tumors weighing less than 550 grams (tumor plus kidney) in patients less than 2 years of age, no adjuvant chemotherapy is given — Andrew Davidoff (guideline) [Ep 184 · 13:05](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=785)
- Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis — Andrew Davidoff (clinical) [Ep 184 · 14:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=850)
- Lymph node sampling should be performed even in the absence of abnormal nodes on pre-operative imaging or gross inspection because these circumstances don't reliably predict lymph node negativity — Andrew Davidoff (guideline) [Ep 184 · 14:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=875)
- Partial nephrectomy for patients with unilateral non-syndromic disease or laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial — Andrew Davidoff (guideline) [Ep 184 · 15:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=920)
- About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease — Andrew Davidoff (epidemiological) [Ep 184 · 16:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=980)
- Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma — Andrew Davidoff (guideline) [Ep 184 · 16:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1000)
- A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis — Andrew Davidoff (guideline) [Ep 184 · 17:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1060)
- Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass — Andrew Davidoff (clinical) [Ep 184 · 18:15](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1095)
- A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor — Andrew Davidoff (guideline) [Ep 184 · 18:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1115)
- Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy — Andrew Davidoff (guideline) [Ep 184 · 19:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1140)
- Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor — Andrew Davidoff (guideline) [Ep 184 · 19:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1170)
- Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor — Andrew Davidoff (clinical) [Ep 184 · 20:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1230)
- Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity — Andrew Davidoff (clinical) [Ep 184 · 21:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1280)
- Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium — Andrew Davidoff (guideline) [Ep 184 · 21:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1310)
- Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove — Andrew Davidoff (guideline) [Ep 184 · 22:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1330)
- About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis — Andrew Davidoff (epidemiological) [Ep 184 · 23:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1380)
- Stage four patients with radiographic disappearance of lung metastasis or tissue confirmation of no viable tumor at week six are considered rapid responders and continue three drug chemotherapy — Andrew Davidoff (guideline) [Ep 184 · 23:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1420)
- Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation — Andrew Davidoff (guideline) [Ep 184 · 24:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1470)
- Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress — Daniel von Allmen (clinical) [Ep 185 · 2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131)
- Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly — Daniel von Allmen (clinical) [Ep 185 · 2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131)
- Familial neuroblastoma occurs in about 1% of patients — Tony Sandler (epidemiological) [Ep 185 · 4:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=279)
- For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen — Todd Ponsky (guideline) [Ep 185 · 5:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=307)
- CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated — Tony Sandler (guideline) [Ep 185 · 5:34](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=334)
- MIBG scan is the next step if catecholamines are elevated — Daniel von Allmen (guideline) [Ep 185 · 6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362)
- Radiologists are quite good at identifying adrenal hemorrhage on ultrasound — Daniel von Allmen (opinion) [Ep 185 · 6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362)
- In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes — Daniel von Allmen (clinical) [Ep 185 · 8:14](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=494)
- Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance — Daniel von Allmen (guideline) [Ep 185 · 8:44](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=524)
- Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference — Tony Sandler (epidemiological) [Ep 185 · 10:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=639)
- Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma — Erika Newman (epidemiological) [Ep 185 · 11:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=667)
- First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year — Erika Newman (guideline) [Ep 185 · 11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697)
- After one year, surveillance becomes every six months, then yearly — Erika Newman (guideline) [Ep 185 · 11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697)
- Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma — Daniel von Allmen (clinical) [Ep 185 · 12:27](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=747)
- 5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses — Tony Sandler (guideline) [Ep 185 · 14:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=876)
- Volume increase of more than 50% is criterion for considering surgery — Todd Ponsky (guideline) [Ep 185 · 15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908)
- 50% increase in VMA or HVA prompts consideration of surgery — Todd Ponsky (guideline) [Ep 185 · 15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908)
- Laparoscopic approach is reasonable for masses less than 6 centimeters — Erika Newman (guideline) [Ep 185 · 16:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=967)
- Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor — Daniel von Allmen (clinical) [Ep 185 · 16:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=996)
- Biology of neuroblastoma is more important than lymph node status for treatment decisions — Erika Newman (clinical) [Ep 185 · 17:00](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1020)
- Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology — Erika Newman (clinical) [Ep 185 · 17:30](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1050)
- Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise — Daniel von Allmen (clinical) [Ep 185 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Stage MS without distress can be treated with aggressive observation — Erika Newman (guideline) [Ep 185 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy — Erika Newman (guideline) [Ep 185 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy — Daniel von Allmen (opinion) [Ep 185 · 19:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1146)
- Liver biopsy in newborns is difficult because bleeding is hard to control — Erika Newman (clinical) [Ep 185 · 19:52](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1192)
- If NMYC is amplified in stage MS, staging changes from MS to M — Todd Ponsky (clinical) [Ep 185 · 20:40](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1240)
- VIP secretion can cause severe diarrhea in neuroblastoma — Erika Newman (clinical) [Ep 185 · 21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265)
- Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid — Erika Newman (guideline) [Ep 185 · 21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265)
- Ultrasound is important for Wilms tumor to assess venous extension — Tony Sandler (clinical) [Ep 185 · 22:56](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1376)
- Large mass encasing aorta and celiac axis with microcalcifications represents L2 INRG classification — Tony Sandler (clinical) [Ep 185 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430)
- Complete staging workup includes bone marrow biopsy, MIBG scan, chest CT to rule out metastasis, and head CT if clinical symptoms present — Tony Sandler (guideline) [Ep 185 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430)
- 10% of neuroblastomas are not MIBG avid — Daniel von Allmen (epidemiological) [Ep 185 · 25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506)
- PET scan may detect metastases in MIBG-negative neuroblastomas — Daniel von Allmen (clinical) [Ep 185 · 25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506)
- PET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar — Erika Newman (guideline) [Ep 185 · 26:03](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1563)
- Open retroperitoneal biopsy provides adequate tissue size for pathology and biology studies — Tony Sandler (opinion) [Ep 185 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Transperitoneal laparoscopic biopsy may not allow adequate bleeding control for large tumors — Tony Sandler (opinion) [Ep 185 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Multiple percutaneous biopsies may not provide adequate tissue for biology studies — Tony Sandler (opinion) [Ep 185 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- NMYC amplification can be obtained from bone marrow, but additional biology studies require tumor tissue — Tony Sandler (clinical) [Ep 185 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Biology studies beyond NMYC include ALK mutation and ploidy status — Tony Sandler (clinical) [Ep 185 · 28:28](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1708)
- Hepatoblastoma is the most common malignant liver tumor in the pediatric population (epidemiological) [Ep 351 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0)
- There are around 250 new cases of hepatoblastoma per year (epidemiological) [Ep 351 · 0:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20)
- Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years (clinical) [Ep 351 · 0:10](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10)
- Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children — Greg Tiao (epidemiological) [Ep 351 · 0:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46)
- Neuroblastoma is the most common solid malignancy in the pediatric population (epidemiological) [Ep 351 · 1:14](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74)
- Hemangioma is the most common liver lesion in children (epidemiological) [Ep 351 · 1:40](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100)
- Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size — Greg Tiao (clinical) [Ep 351 · 2:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140)
- Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty (clinical) [Ep 351 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response (clinical) [Ep 351 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma — Greg Tiao (clinical) [Ep 351 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging — Greg Tiao (clinical) [Ep 351 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy (clinical) [Ep 351 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- The most important intervention for survival is to achieve complete resection (clinical) [Ep 351 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation — Greg Tiao (clinical) [Ep 351 · 4:25](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265)
- Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled (clinical) [Ep 351 · 4:50](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290)
- The right hepatic vein differentiates anterior and posterior sections of the right liver — Greg Tiao (clinical) [Ep 351 · 5:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341)
- The right portal vein separates superior and inferior segments of the right liver — Greg Tiao (clinical) [Ep 351 · 6:02](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362)
- The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) — Greg Tiao (clinical) [Ep 351 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor — Greg Tiao (clinical) [Ep 351 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis (clinical) [Ep 351 · 8:01](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481)
- Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today — Greg Tiao (clinical) [Ep 351 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections — Greg Tiao (clinical) [Ep 351 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant (clinical) [Ep 351 · 9:12](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552)
- It is important to consult a transplant center early for pre-text 3 and 4 tumors — Greg Tiao (clinical) [Ep 351 · 9:35](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575)
- The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage — Greg Tiao (clinical) [Ep 351 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- The PHITT study has been ongoing for three years — Greg Tiao (clinical) [Ep 351 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers — Chiro Esposito (epidemiological) [Ep 358 · 3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice — Chiro Esposito (clinical) [Ep 358 · 0:23](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=23)
- For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization — Chiro Esposito (clinical) [Ep 358 · 7:15](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=435)
- If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult — Chiro Esposito (clinical) [Ep 358 · 7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively — Chiro Esposito (clinical) [Ep 358 · 7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy — Chiro Esposito (clinical) [Ep 358 · 4:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=280)
- For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line — Chiro Esposito (clinical) [Ep 358 · 9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG — Chiro Esposito (clinical) [Ep 358 · 9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels — Chiro Esposito (clinical) [Ep 358 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases — Chiro Esposito (clinical) [Ep 358 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles — Chiro Esposito (clinical) [Ep 358 · 19:10](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1150)
- The spermatic bundle contains three to four lymphatic vessels — Chiro Esposito (clinical) [Ep 358 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- There is no maximum dose limit for ICG based on adult surgery studies — Chiro Esposito (clinical) [Ep 358 · 21:53](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1313)
- ICG vial remains usable for six hours after preparation — Chiro Esposito (clinical) [Ep 358 · 21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- No adverse effects of ICG were observed in the presenter's experience — Chiro Esposito (clinical) [Ep 358 · 21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system — Chiro Esposito (clinical) [Ep 358 · 1:20](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=80)
- The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images — Chiro Esposito (clinical) [Ep 358 · 5:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=340)
- For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning — Chiro Esposito (clinical) [Ep 358 · 8:42](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=522)
- ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes — Chiro Esposito (opinion) [Ep 358 · 3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old — Stephen Scoville (epidemiological) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults — Stephen Scoville (clinical) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Management of pediatric melanoma is based on adult studies despite differences in disease mechanisms — Stephen Scoville (clinical) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Tumors less than 8 millimeters thick are largely managed with wide local excision — Stephen Scoville (guideline) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Tumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies — Stephen Scoville (guideline) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Two adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections — Stephen Scoville (clinical) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- There is no pediatric data to support ultrasound observation versus completion lymph node dissection — Stephen Scoville (clinical) [Ep 417 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- Study included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions — Stephen Scoville (clinical) [Ep 417 · 4:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- Breslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters — Stephen Scoville (clinical) [Ep 417 · 4:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%) — Stephen Scoville (clinical) [Ep 417 · 5:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=320)
- Patients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy — Stephen Scoville (clinical) [Ep 417 · 6:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups — Stephen Scoville (clinical) [Ep 417 · 6:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group — Stephen Scoville (clinical) [Ep 417 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- Only 21% of those who underwent completion lymph node dissection had additional positive nodal disease — Stephen Scoville (clinical) [Ep 417 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden — Stephen Scoville (clinical) [Ep 417 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- Recurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death — Stephen Scoville (clinical) [Ep 417 · 8:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=480)
- Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate — Stephen Scoville (clinical) [Ep 417 · 8:31](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- Management of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease — Stephen Scoville (clinical) [Ep 417 · 8:31](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- Before the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults — Stephen Scoville (clinical) [Ep 417 · 9:15](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- For most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection — Stephen Scoville (opinion) [Ep 417 · 9:15](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- Not all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size — Stephen Scoville (clinical) [Ep 417 · 10:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=645)
- If a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection — Stephen Scoville (opinion) [Ep 417 · 11:46](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=706)
- Hepatoblastoma is the most common pediatric liver cancer — Andrew Fleming (epidemiological) [Ep 422 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0)
- The number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group — Andrew Fleming (clinical) [Ep 422 · 0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=30)
- PRETEXT group in combination with presence/absence of metastatic disease, alpha fetoprotein at diagnosis, PRETEXT modifiers, patient age and resectability at diagnosis can be used to risk stratify patients according to the AHEAD 1531 clinical trial — Andrew Fleming (guideline) [Ep 422 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=60)
- Complete surgical resection has been determined to be necessary for patient survival — Andrew Fleming (clinical) [Ep 422 · 1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=90)
- Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients — Andrew Fleming (clinical) [Ep 422 · 1:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=105)
- The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature — Andrew Fleming (epidemiological) [Ep 422 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120)
- No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging — Andrew Fleming (clinical) [Ep 422 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=180)
- Among 50 patients included for analysis, 24 were determined to be high risk — Andrew Fleming (epidemiological) [Ep 422 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240)
- All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status — Andrew Fleming (clinical) [Ep 422 · 4:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=255)
- 14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient — Andrew Fleming (clinical) [Ep 422 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=270)
- Median of three nodules per patient contained pathologically confirmed viable hepatoblastoma, confirming a high degree of concordance between radiographic evidence of disease and pathological confirmation of disease — Andrew Fleming (clinical) [Ep 422 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=300)
- On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality — Andrew Fleming (clinical) [Ep 422 · 5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=330)
- The overall survival of the entire cohort is quite high — Andrew Fleming (clinical) [Ep 422 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360)
- The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease — Andrew Fleming (clinical) [Ep 422 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=375)
- The overall survival and event-free survival of the group in whom we were unable to render them no evidence of disease is significantly lower, with no patients in these cohorts surviving past two years — Andrew Fleming (clinical) [Ep 422 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=390)
- The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status — Andrew Fleming (clinical) [Ep 422 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=420)
- The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed — Andrew Fleming (clinical) [Ep 422 · 7:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=435)
- Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections — Andrew Fleming (clinical) [Ep 422 · 7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=450)
- No evidence of disease status is necessary for survival in patients with hepatoblastoma — Andrew Fleming (clinical) [Ep 422 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients — Andrew Fleming (clinical) [Ep 422 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- The presented case is a 16-month-old with a right adrenal mass measuring 8 centimeters (clinical) [Ep 442 · 0:00](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=0)
- Biopsy showed favorable cell neuroblastoma biology with no MYCN amplification but with segmental chromosomal abnormalities (clinical) [Ep 442 · 0:00](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=0)
- The Children's Oncology Group neuroblastoma classification tree is constantly changing as new information is added — Paul Yasurjak (guideline) [Ep 442 · 0:24](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24)
- Based on the 2021 COG classification, the presented tumor would be classified as higher risk — Paul Yasurjak (guideline) [Ep 442 · 0:24](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24)
- COG reviewed patients enrolled in trials between 2007 and 2017 — Paul Yasurjak (epidemiological) [Ep 442 · 0:24](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24)
- The presence of segmental chromosomal aberrations such as loss or gain of a portion of the chromosomal arm can have a negative impact on patient outcomes — Paul Yasurjak (clinical) [Ep 442 · 0:24](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24)
- The updated schema classifies tumors as high risk when there is no MYCN amplification but segmental chromosomal abnormalities are present — Paul Yasurjak (guideline) [Ep 442 · 0:24](https://library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24)
- 97% of bilateral kidney tumors in children are Wilms tumor, so biopsy is not needed upfront—chemotherapy should be started empirically. — Tony Sandler (epidemiological) [Ep 52 · 9:12](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=552)
- Current standard for bilateral Wilms tumor is to start chemotherapy, give 2 cycles, and stop when tumor shrinkage plateaus (defined as less than 50% volume reduction). — Tony Sandler (guideline) [Ep 52 · 1:32](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=92)
- Bilateral nephron-sparing surgery for Wilms tumor can be performed by placing kidneys on ice, clamping vessels, and performing sharp tumor dissection—surprisingly feasible even for large tumors. — Tony Sandler (clinical) [Ep 52 · 4:44](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=284)
- When chemotherapy fails to shrink bilateral Wilms tumors and they have not been biopsied, changing to a more aggressive chemotherapy regimen should be considered to rule out anaplastic elements that might respond. — Dan (clinical) [Ep 52 · 3:02](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=182)
- Biopsy of Wilms tumor is problematic because these are heterogeneous tumors and focal anaplasia may be missed on needle biopsy. — Dan (clinical) [Ep 52 · 3:22](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=202)
- When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation. — Tony Sandler (clinical) [Ep 52 · 4:19](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=259)
- Anaplastic recurrence of Wilms tumor portends a very bad outcome; salvage is difficult even with chemotherapy. — Dan (clinical) [Ep 52 · 6:48](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=408)
- It is debated whether anaplasia in Wilms tumor is present initially or develops secondary to chemotherapy-induced differentiation; most pathologists believe it is present primarily, making these heterogeneous tumors. — Tony Sandler (opinion) [Ep 52 · 7:56](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=476)
- Multifocal Wilms tumors raise concern about underlying embryologic kidney abnormalities and increased risk of developing additional tumors. — Dan (clinical) [Ep 52 · 8:15](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=495)
- For gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated. — Todd Ponsky (clinical) [Ep 52 · 9:58](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=598)
- Gastroschisis babies are being delivered earlier by high-risk obstetric teams, resulting in less thick matted bowel at birth and higher rates of successful bedside reduction. (clinical) [Ep 52 · 11:11](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=671)
- For gastroschisis closure using Tegaderm technique, if the fascia is not cut to widen the defect, most umbilical hernias will close spontaneously and do not require repair. — Tony Sandler (clinical) [Ep 52 · 12:54](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=774)
- Spring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level. — Todd Ponsky (opinion) [Ep 52 · 14:20](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=860)
- Tegaderm can be applied directly over reduced gastroschisis without Betadine or other topical agents, left in place for approximately 3 days, then converted to dry dressing once tissues are adherent. — Tony Sandler (clinical) [Ep 52 · 14:52](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=892)
- Even when a gastroschisis silo fails and the defect dilates significantly, Tegaderm-only closure can achieve successful cicatrization over 8 weeks. — Tony Sandler (clinical) [Ep 52 · 15:32](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=932)
- For gastroschisis with intestinal atresia and pristine bowel, an ostomy can be created at the umbilical fascial ring, with the downstream limb tacked adjacent, allowing for delayed anastomosis and ostomy closure after 2-4 weeks. (clinical) [Ep 52 · 16:42](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1002)
- For gastroschisis with atresia and thick inflamed bowel, the bowel should be reduced into the abdomen without repair, allowing inflammation to resolve, then re-explored at 4-6 weeks. (clinical) [Ep 52 · 17:23](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1043)
- Primary anastomosis of intestinal atresia in gastroschisis is feasible if the bowel is pristine, but the size discrepancy (massively dilated proximal, decompressed distal) creates a tenuous anastomosis in bowel that has been outside the abdomen. (clinical) [Ep 52 · 18:32](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1112)
- When gastroschisis is reduced without closing the fascia, ambient intra-abdominal pressure is lower than with fascial closure, which may benefit bowel function. — Tony Sandler (clinical) [Ep 52 · 19:26](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1166)
- In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the presence of atresia from external appearance—exploration is necessary but resection should be avoided. — Dan (clinical) [Ep 52 · 21:01](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1261)
- Re-exploration at 2 weeks after initial gastroschisis reduction (rather than the traditional 4-6 weeks) can reveal that inflamed 'gastroschisis bowel' has transformed into viable intestine suitable for anastomosis. — Tony Sandler (clinical) [Ep 52 · 22:07](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1327)
- For apple-peel ileal atresia with ischemic distal bowel, if the bowel does not pink up on the operating table and is not twisted, resection with primary anastomosis is appropriate. — Tony Sandler (clinical) [Ep 52 · 24:21](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1461)
- If apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection. — Todd Ponsky (opinion) [Ep 52 · 25:19](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1519)
- Plication of massively dilated proximal bowel in intestinal atresia is helpful and the plication typically unravels over time, preserving bowel length for later lengthening procedures if needed. — Tony Sandler (clinical) [Ep 52 · 25:37](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1537)
- Bianchi procedure is preferred over STEP for neonatal bowel lengthening because it creates two equal chambers without blind-ending outpouchings, and a patient can undergo Bianchi followed by STEP later, whereas STEP limits future lengthening options. — Greg (opinion) [Ep 52 · 26:46](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1606)
- In newborns with questionable short-gut syndrome, tapering should be avoided to preserve bowel for potential lengthening procedures later; plication is preferred. — Tony Sandler (clinical) [Ep 52 · 28:10](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1690)
- If a child has extensive bowel length and only a segment is dilated, tapering is reasonable. — Tony Sandler (clinical) [Ep 52 · 28:23](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1703)
- NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 386 · 4:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=247)
- During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 386 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=337)
- Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 386 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=433)
- PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 386 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=586)
- PSORC was founded because there was a need to amalgamate data from multiple institutions to better study surgical questions in pediatric cancer — Marcus Malek (clinical) [Ep 386 · 10:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=605)
- Image-guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 386 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=726)
- Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time, with diagnosis before 8 years of age — Todd Ponsky and Biran Modi (clinical) [Ep 386 · 12:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=777)
- The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of puberty in terms of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 386 · 13:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=824)
- There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 386 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- The finding that short stature is not because kids are missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty with working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 386 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 4:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=247)
- During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 388 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=337)
- Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 388 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=433)
- We never had a hepatoblastoma cell line mouse model before — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 8:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=509)
- PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 388 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=586)
- There has not been consistency in localization techniques for small pulmonary nodules across North America, with surgeons doing their own thing — Marcus Malek (clinical) [Ep 388 · 10:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=619)
- Time under anesthesia can be long and quite variable depending on whether institutions use hybrid ORs or have IR on different floors — Marcus Malek (clinical) [Ep 388 · 11:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=670)
- ICG will become much more popular and more effective for nodule localization in 5 years — Todd Ponsky and Biran Modi (opinion) [Ep 388 · 11:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=714)
- Image guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 388 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=726)
- The study focused on patients with pediatric intestinal failure, defined as requirement of parenteral nutrition for 60 days or more at any time, who had the diagnosis before age 8 and were older than 8 at time of study — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 12:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=772)
- Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers of puberty — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 13:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=818)
- The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=825)
- Children with intestinal failure might be slightly short statured but are not severely undersized compared to the general population — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 14:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=860)
- There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 388 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- The finding that kids with intestinal failure are not missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty by working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 388 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- Upper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals. — Todd Ponsky (clinical) [Ep 357 · 5:30](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=330)
- Ultrasound for malrotation diagnosis is very dependent on the person who performs the ultrasound, making it less reliable than upper GI contrast study. (opinion) [Ep 357 · 8:08](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=488)
- Reversal of vessels at the root of the mesentery on ultrasound is not a very reliable way to make the diagnosis of malrotation. (clinical) [Ep 357 · 8:35](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=515)
- The presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment. — Todd Ponsky (clinical) [Ep 357 · 10:22](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=622)
- Current ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma. — Todd Ponsky (guideline) [Ep 357 · 19:40](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180)
- Nationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation. — Todd Ponsky (clinical) [Ep 357 · 19:40](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180)
- The challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults. — Todd Ponsky (clinical) [Ep 357 · 20:28](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1228)
- Some centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships. — Todd Ponsky (clinical) [Ep 357 · 21:13](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1273)
- Since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma. — Todd Ponsky (opinion) [Ep 20 · 3:26](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=206)
- Re-excision can have high morbidity because it may require taking significantly more tissue. — Todd Ponsky (clinical) [Ep 20 · 3:39](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=219)
- The management approach discussed is based on US protocols, which differ from European SIOP protocols. (guideline) [Ep 21 · 2:30](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=150)
- In Hong Kong, for Wilms tumor they tend to follow American protocols, though for various tumors they use either European or American protocols. — Ken Wong (clinical) [Ep 21 · 3:15](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=195)
- When there are multiple lung masses, a correct assumption can be made that they represent metastases without biopsy. (clinical) [Ep 21 · 5:33](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=333)
- If you treat the patient and lung nodules go away, you presume that represents metastatic disease; if there is a residual nodule after treatment, that is an indication to resect it. (clinical) [Ep 21 · 6:03](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=363)
- Previously, if a nodule was not present on plain film it was not considered significant even if seen on CT, but now CT is the diagnostic test of choice and impacts therapy. (clinical) [Ep 21 · 6:24](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=384)
- For a single lung nodule, patients are treated and if it resolves, it is presumed to be metastatic Wilms tumor. (clinical) [Ep 21 · 6:41](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=401)
- What is avoided by proving a nodule is not metastatic is radiation therapy to the lungs, not chemotherapy. (clinical) [Ep 21 · 7:12](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=432)
- If lung nodules resolve after 6 weeks of treatment, regardless of how many there are, no radiation to the lungs is given. (guideline) [Ep 21 · 7:18](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=438)
- For lung nodules to avoid radiation therapy, they must completely disappear; if there is a residual nodule, you cannot distinguish scar from active tumor and must biopsy or continue therapy with radiation. (clinical) [Ep 21 · 7:43](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=463)
- APSA has addressed the lymph node sampling practice gap through expert questions, the NAT exam, and annual meeting educational efforts. (clinical) [Ep 21 · 9:29](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- High-risk neuroblastoma patients continue to have survival rates in the 38-40% range despite aggressive therapy — Dan (epidemiological) [Ep 28 · 0:25](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=25)
- Surgeons overestimated their degree of resection compared to postoperative imaging in 2/3 of cases (66% concordance rate) in the tandem transplant pilot study — Dan (clinical) [Ep 28 · 6:35](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=395)
- In a repeat study with COG high-risk patients, surgeons underestimated resection extent while radiologists overcalled it, again showing only 66% concordance, suggesting no correlation between surgeon assessment and imaging — Dan (clinical) [Ep 28 · 7:22](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=442)
- The biggest volume response of neuroblastoma tumor occurs with the first two cycles of chemotherapy, with very little response after that (Memorial Sloan Kettering data) — Dan (clinical) [Ep 28 · 9:43](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=583)
- More chemotherapy or other treatments like MIBG make the tumor more fibrotic and make subadventitial dissection more difficult — Dan (opinion) [Ep 28 · 10:00](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=600)
- There is good evidence that aggressive resection improves survival in stage 3 neuroblastoma patients, supported by pre-COG merger studies (clinical) [Ep 28 · 11:53](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=713)
- Surgical complication rate for aggressive neuroblastoma resection is approximately 30% morbidity with mortality less than 1% — Dan (epidemiological) [Ep 28 · 12:50](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=770)
- The Riley study showed the only survivors with stage 4 neuroblastoma were those who had primary tumor resection (clinical) [Ep 28 · 13:50](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=830)
- The Sloan Kettering study suggests stage 4 patients do better with primary tumor resection (clinical) [Ep 28 · 14:10](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=850)
- Kiely's study showed no difference in survival based on extent of resection (clinical) [Ep 28 · 14:16](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=856)
- European studies show no difference in survival based on extent of resection in stage 4 disease (clinical) [Ep 28 · 14:19](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=859)
- High-risk neuroblastoma patients receive 9 different drugs, bone marrow transplantation, and some receive total body radiation, with outrageous morbidity from medical treatment (clinical) [Ep 28 · 14:31](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=871)
- High-risk neuroblastoma treatment includes tandem peripheral blood stem cell transplants (two sequential transplants), followed by immunotherapy and Retin-A — Dan (clinical) [Ep 28 · 14:53](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=893)
- High-risk neuroblastoma survival improved from 10% to 30-40% with treatment intensification (epidemiological) [Ep 28 · 15:44](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=944)
- The Georgia study showed 46% survival with transplantation plus immunotherapy plus differentiating agents, but many deaths were due to intensified treatment rather than cancer (epidemiological) [Ep 28 · 16:05](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=965)
- German study of 278 stage 4 high-risk neuroblastoma patients achieved complete resection in almost half and >90% resection in another quarter (75% total achieving >90% resection) — Dan (epidemiological) [Ep 28 · 16:30](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=990)
- German study outcomes: overall survival 45%, event-free survival 33%, local progression-free survival 58% — Dan (epidemiological) [Ep 28 · 16:57](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1017)
- German study showed no difference in overall survival, event-free survival, or local progression-free survival based on completeness of resection — Dan (clinical) [Ep 28 · 17:15](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1035)
- European SIOPEN study included 1,324 high-risk neuroblastoma patients (stages 3 and 4) and achieved >95% resection in 76% of patients — Dan (epidemiological) [Ep 28 · 17:57](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1077)
- SIOPEN study surgical mortality was 0.5% with 10% morbidity (30% if including lesser complications) — Dan (epidemiological) [Ep 28 · 18:45](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1125)
- SIOPEN study showed significant improvement in event-free survival and overall survival with >95% resection - the first study to show overall survival benefit — Dan (clinical) [Ep 28 · 19:01](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1141)
- SIOPEN study concluded >95% resection results in improvement in event-free survival in high-risk neuroblastoma — Dan (clinical) [Ep 28 · 19:55](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1195)
- COG 3973 study (230 patients) showed statistically significant improvement in local relapse-free survival and event-free survival with aggressive resection — Dan (clinical) [Ep 28 · 21:07](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1267)
- COG 3973 study was not able to demonstrate improvement in overall survival, possibly due to type 2 error from smaller sample size (230 vs 1,300 in European study) — Dan (clinical) [Ep 28 · 21:35](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1295)
- Aggressive neuroblastoma resections using the Kiely subadventitial approach should not be performed by occasional pediatric oncological surgeons doing one case per year or every other year (opinion) [Ep 28 · 22:05](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1325)
- European neuroblastoma procedures are performed in more than 200 hospitals, yet still demonstrated survival improvements despite this distribution — Dan (epidemiological) [Ep 28 · 23:16](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1396)
- Older data shows that if the kidney is removed during neuroblastoma resection, survival is worse; renal preservation leads to better outcomes — Dan (clinical) [Ep 28 · 23:53](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1433)
- Renal preservation is important because patients with only one kidney cannot receive as much chemotherapy, which impacts overall survival — Dan (clinical) [Ep 28 · 24:12](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1452)
- Aggressive surgical approach to local neuroblastoma recurrence is justified as long as it is not progressive metastatic disease, though prognosis is worse — Dan (opinion) [Ep 28 · 24:36](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1476)
- New therapies like targeted MIBG therapy may justify surgical removal of bulk disease in recurrent neuroblastoma — Dan (opinion) [Ep 28 · 25:05](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1505)
- Immunotherapy is effective in the setting of minimal residual disease, so achieving 95% resection may improve the impact of medical therapy on metastatic disease — Dan (opinion) [Ep 28 · 25:21](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1521)
- Thyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant. — Diana Deason (epidemiological) [Ep 255 · 6:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=383)
- When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults. — Diana Deason (clinical) [Ep 255 · 6:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=391)
- Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors. — Diana Deason (clinical) [Ep 255 · 4:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes. — Diana Deason (clinical) [Ep 255 · 4:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- If TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected. — Diana Deason (guideline) [Ep 255 · 7:24](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=444)
- Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes. — Diana Deason (clinical) [Ep 255 · 9:57](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- In pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted. — Diana Deason (guideline) [Ep 255 · 11:21](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=681)
- Total or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker. — Diana Deason (guideline) [Ep 255 · 15:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- Nerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease. — Diana Deason (opinion) [Ep 255 · 17:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- There is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive. — Diana Deason (guideline) [Ep 255 · 18:33](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol. — Diana Deason (clinical) [Ep 255 · 19:37](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years. — Diana Deason (guideline) [Ep 255 · 21:12](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1272)
- Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively. — Diana Deason (guideline) [Ep 255 · 21:48](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens. — Diana Deason (epidemiological) [Ep 255 · 23:05](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%. — Diana Deason (epidemiological) [Ep 255 · 24:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children. — Diana Deason (epidemiological) [Ep 255 · 24:18](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus. — Diana Deason (guideline) [Ep 255 · 23:50](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components. — Diana Deason (clinical) [Ep 255 · 25:04](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- For follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored. — Diana Deason (guideline) [Ep 255 · 26:10](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy. — Diana Deason (epidemiological) [Ep 255 · 27:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- TSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1. — Diana Deason (guideline) [Ep 255 · 27:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- For benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features. — Diana Deason (clinical) [Ep 255 · 28:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA. — Diana Deason (clinical) [Ep 255 · 29:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1789)
- Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule. — Diana Deason (guideline) [Ep 255 · 31:34](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- For medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan. — Diana Deason (guideline) [Ep 255 · 33:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1981)
- MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism. — Diana Deason (clinical) [Ep 255 · 33:36](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity. — Diana Deason (clinical) [Ep 255 · 33:47](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- MEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age. — Diana Deason (guideline) [Ep 255 · 34:11](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- MEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time. — Diana Deason (guideline) [Ep 255 · 36:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy. — Diana Deason (guideline) [Ep 255 · 36:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2187)
- Children under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands. — Diana Deason (clinical) [Ep 255 · 36:52](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2212)
- For MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance. — Diana Deason (guideline) [Ep 255 · 36:59](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- MEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11. — Diana Deason (guideline) [Ep 255 · 37:47](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2267)
- For prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary. — Diana Deason (guideline) [Ep 255 · 39:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- After thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually. — Diana Deason (guideline) [Ep 255 · 40:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2408)
- If postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton. — Diana Deason (guideline) [Ep 255 · 40:22](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin. — Diana Deason (guideline) [Ep 255 · 41:38](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- For Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine. — Diana Deason (opinion) [Ep 255 · 42:29](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- Some pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children. — Diana Deason (clinical) [Ep 255 · 43:52](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- Liver tumors are rare in children, and sorting out the diagnosis is crucial for good outcomes. — Max Langham (clinical) [Ep 254 · 1:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=97)
- A one-year-old with a liver mass is likely to be hepatoblastoma, although rhabdoid tumor can occur at that age and is a bad actor. — Max Langham (clinical) [Ep 254 · 1:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=113)
- If alpha-fetoprotein is quite high and very elevated, the presumptive diagnosis in a 1-year-old would be hepatoblastoma. — Max Langham (clinical) [Ep 254 · 2:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=126)
- Hepatoblastoma presents from the first year of life through perhaps 10 years of age, although there are a few that have been diagnosed older than that. — Max Langham (epidemiological) [Ep 254 · 2:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=139)
- If this is a rhabdoid tumor, chemotherapy is not important and the lesion needs to be resected. — Max Langham (clinical) [Ep 254 · 2:43](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=163)
- If it's a very low risk hepatoblastoma, it probably doesn't need a biopsy and needs an upfront resection. — Max Langham (clinical) [Ep 254 · 2:55](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=175)
- Most people favor needle biopsy of the liver rather than an open biopsy or a laparoscopic biopsy. — Max Langham (clinical) [Ep 254 · 3:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=220)
- The biopsy should go through the normal part of the liver that will be resected with the specimen, approaching from the side of the tumor to avoid seeding the contralateral lobe. — Max Langham (clinical) [Ep 254 · 3:51](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=231)
- Hepatoblastoma will seed and can create big issues for future resection and cure if the biopsy crosses the uninvolved lobe. — Max Langham (clinical) [Ep 254 · 4:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=246)
- There have been prenatal diagnoses of hepatoblastoma, not super rare but not very common. — Max Langham (epidemiological) [Ep 254 · 4:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=286)
- Rhabdoid tumor is more common in very young children compared to hepatoblastoma. — Max Langham (epidemiological) [Ep 254 · 4:57](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=297)
- Hepatocellular carcinoma can occur in young children, usually in association with an inborn error of metabolism, with tyrosinemia as the prototype. — Max Langham (clinical) [Ep 254 · 5:29](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=329)
- A baby with tyrosinemia will develop hepatocellular carcinoma if they are not transplanted, usually in the first couple of years of life. — Max Langham (clinical) [Ep 254 · 5:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=340)
- There is a mixed tumor with features of hepatoblastoma and hepatocellular carcinoma that tends to occur in children over 6 years of age. — Max Langham (clinical) [Ep 254 · 5:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=350)
- There is a predisposition of premature infants to getting hepatoblastomas, usually not in the nursery but in the first year or two of life. — Max Langham (epidemiological) [Ep 254 · 7:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=460)
- For the biology arm of the Children's Oncology Group, they want 10 core biopsies. — Max Langham (guideline) [Ep 254 · 8:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=532)
- The complication rate and some mortality seems higher with open biopsies than with the needle technique. — Max Langham (clinical) [Ep 254 · 9:16](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=556)
- There is no role for frozen section in hepatoblastoma, either for initial biopsy or for later margin assessment. — Max Langham (clinical) [Ep 254 · 9:57](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=597)
- The overarching goal of treatment for hepatoblastoma is to get the kids to a safe resection. — Max Langham (clinical) [Ep 254 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=627)
- The PRETEXT system is a pre-treatment extent of disease radiographic imaging-based system developed in Europe during SIOPEL 1. — Max Langham (clinical) [Ep 254 · 10:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=646)
- Couinaud based the numerology of liver segments on the street map of Paris, with the caudate lobe (segment 1) representing the Île de Paris where Notre Dame is located. — Max Langham (clinical) [Ep 254 · 12:13](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=733)
- A PRETEXT 1 lesion has three contiguous sectors of the liver that are free of tumor. — Max Langham (clinical) [Ep 254 · 12:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=770)
- A PRETEXT 2 lesion has two adjoining sectors free of tumor. — Max Langham (clinical) [Ep 254 · 13:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=797)
- With PRETEXT 3, there is only one sector free of disease. — Max Langham (clinical) [Ep 254 · 13:42](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=822)
- In PRETEXT 4, all of the sectors are involved with no sectors of the liver free of disease. — Max Langham (clinical) [Ep 254 · 14:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=840)
- It is more common for people to over-read PRETEXT than under-read it. — Max Langham (clinical) [Ep 254 · 14:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=857)
- In AHEP 0731 and the FIT trial, upfront resection is acceptable if it is a conventional hemihepatectomy or less, with clearly 1 centimeter of normal liver between the middle hepatic vein and tumor, and no annotation factors. — Max Langham (guideline) [Ep 254 · 14:43](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=883)
- If a lesion is resected upfront and histology shows well-differentiated pure fetal histology, the baby is done with no need for any chemotherapy at all, and survival is 100%. — Max Langham (clinical) [Ep 254 · 15:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=937)
- Along with imaging for suspected hepatoblastoma, a chest CT is needed because pulmonary metastases make up the vast majority of metastases, and even small liver tumors can metastasize. — Max Langham (clinical) [Ep 254 · 16:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1012)
- If there is a PRETEXT 1 lesion with metastatic disease in the lungs, that is a high-risk patient. — Max Langham (clinical) [Ep 254 · 17:21](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1041)
- For a PRETEXT 1 lesion with clear lungs, no vena cava, hepatic vein confluence, or portal vein involvement, and judged resectable by the surgeon, it should be resected with an anatomic resection and the child will be in a very low risk group. — Max Langham (clinical) [Ep 254 · 17:31](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1051)
- A PRETEXT 1 lesion with vascular involvement (within 1 cm of cava or hepatic veins) would be considered an intermediate risk patient. — Max Langham (clinical) [Ep 254 · 18:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1124)
- If a patient with hepatoblastoma is over 8 years of age, that moves the patient into a higher risk environment. — Max Langham (clinical) [Ep 254 · 18:59](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1139)
- Not all PRETEXT 1 lesions are resectable upfront, and there are some PRETEXT 2 lesions that are resectable upfront. — Max Langham (clinical) [Ep 254 · 19:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1193)
- Annotation factors include V for vena cava and hepatic veins; if they are more than 1 centimeter away from the vena cava, there is no annotation factor. — Max Langham (clinical) [Ep 254 · 20:14](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1214)
- V0 means the lesion is within 1 centimeter of the cava or confluence of hepatic veins, making the patient no longer eligible for upfront resection. — Max Langham (clinical) [Ep 254 · 20:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1235)
- V1 means the tumor is abutting either the vena cava or the three hepatic veins. — Max Langham (clinical) [Ep 254 · 20:48](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1248)
- V2 means the tumor is large enough that it is distorting or pushing the vessels away. — Max Langham (clinical) [Ep 254 · 20:56](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1256)
- V3 means there is evidence of tumor thrombus extending out of the vein, which is particularly problematic. — Max Langham (clinical) [Ep 254 · 21:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1260)
- Hepatoblastoma is like Wilms tumor in that you can get direct extension of large tumor thrombus out of the hepatic veins into the vena cava and even up into the heart. — Max Langham (clinical) [Ep 254 · 21:09](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1269)
- Most hepatoblastomas are a mixture of fetal and embryonal histologies. — Max Langham (clinical) [Ep 254 · 22:34](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1354)
- The most common adverse finding is small cell undifferentiated (SCU) histology, which is a primitive tumor with small blue cell morphology and high nuclear-cytoplasmic ratio, making it a much higher risk lesion. — Max Langham (clinical) [Ep 254 · 22:54](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1374)
- In AHEP 0731, patients with mixed fetal and embryonal histology after upfront resection with negative margins were treated with two courses of cisplatin-based chemotherapy with excellent results. — Max Langham (clinical) [Ep 254 · 24:25](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1465)
- If the diagnosis is hepatoblastoma, the child needs long-term central access and will have two rounds of cisplatin-based chemotherapy in the United States, then be reimaged. — Max Langham (clinical) [Ep 254 · 25:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1540)
- Most of the tumor shrinkage that will occur with chemotherapy happens in the first two rounds. — Max Langham (clinical) [Ep 254 · 26:31](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1591)
- After two rounds of chemotherapy and reimaging, the surgeon should make a commitment about resectability; if resectable, do 2 more rounds of chemotherapy, resect after 4, then give 2 consolidation rounds for a total of 6. — Max Langham (clinical) [Ep 254 · 26:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1601)
- Multifocal tumors should be referred to transplantation because they have high recurrence risk after resection. — Max Langham (clinical) [Ep 254 · 27:14](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1634)
- Most surgeons will be able to make the call about resectability at the end of two rounds of chemotherapy. — Max Langham (opinion) [Ep 254 · 27:59](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1679)
- A child that is 6 years of age or older with hepatoblastoma is going to be a significantly higher risk patient. — Max Langham (clinical) [Ep 254 · 29:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1746)
- Children who are 8 years of age or older with hepatoblastoma are going to be high risk. — Max Langham (clinical) [Ep 254 · 29:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1793)
- Children with hepatoblastoma who have normal or near-normal alpha-fetoproteins (less than 100) are going to be high-risk patients. — Max Langham (clinical) [Ep 254 · 30:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1808)
- Pulmonary metastases in hepatoblastoma can have superb results, and current AHEP results look similar to Wilms tumor outcomes with pulmonary mets. — Max Langham (clinical) [Ep 254 · 31:01](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1861)
- Rapid responders whose pulmonary mets disappear with chemotherapy probably do not need any specific pulmonary therapy. — Max Langham (clinical) [Ep 254 · 31:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1895)
- A child where the pulmonary mets get smaller but persist will need a pulmonary metastectomy, which can be done thoracoscopically or open. — Max Langham (clinical) [Ep 254 · 31:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1913)
- The Japanese have published using indocyanine green as a marker for thoracoscopic metastectomy because it is concentrated in the liver and lights up. — Max Langham (clinical) [Ep 254 · 32:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1937)
- If pulmonary mets don't disappear, they should be biopsied to confirm metastatic disease and rule out other lesions like histoplasmosis in the Mississippi Valley. — Max Langham (clinical) [Ep 254 · 32:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1955)
- Before doing anything of consequence with the liver, ensure you can vascularly isolate it by dissecting the suprahepatic and infrahepatic vena cava and placing umbilical tapes for potential clamping. — Max Langham (clinical) [Ep 254 · 36:56](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2216)
- Disasters during liver resection happen because of major bleeding or air embolism from holes in the low-pressure vena cava system. — Max Langham (clinical) [Ep 254 · 37:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2272)
- Use hypovolemic anesthesia with low CVP during liver resection, preserving transfusions until later in the case, because high CVP causes the liver to swell, become turgid, bleed more, and makes veins harder to dissect. — Max Langham (clinical) [Ep 254 · 38:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2332)
- Take inflow before outflow during liver resection to prevent the liver from swelling. — Max Langham (clinical) [Ep 254 · 39:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2377)
- Anatomic resections are preferred; non-anatomic resections are generally not favored except for lesions hanging off the edge of segments 3 or 5. — Max Langham (opinion) [Ep 254 · 39:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2386)
- The handheld harmonic device used for thyroidectomies is fast with excellent hemostasis for parenchymal transection. — Max Langham (opinion) [Ep 254 · 40:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2408)
- The CUSA is good for dissecting around veins and clearing anatomy but provides no hemostasis. — Max Langham (clinical) [Ep 254 · 40:16](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2416)
- Staplers work well in older kids and adults but in babies the stapler width can be wider than the margin, potentially causing false positive margins or getting into vessels. — Max Langham (clinical) [Ep 254 · 41:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2466)
- Liver transplant has great 3- and 5-year disease-free survival but requires lifelong immunosuppression with risks of rejection, secondary malignancies, and post-transplant lymphoproliferative disorders. — Max Langham (clinical) [Ep 254 · 42:20](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2540)
- Extreme resections with vena cava reconstruction or hepatic vein reimplantation can provide equivalent oncologic results to transplant without immunosuppression. — Max Langham (opinion) [Ep 254 · 42:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2564)
- Several patients have developed portal hypertension or other problems late after extreme resections that required transplant or other therapy. — Max Langham (clinical) [Ep 254 · 43:18](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2598)
- The complication rate of extreme resections is higher than transplantation. — Max Langham (clinical) [Ep 254 · 43:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2610)
- Having a grossly positive margin or leaving gross residual disease behind is not acceptable and should not happen if surgical guidelines are followed. — Max Langham (clinical) [Ep 254 · 44:47](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2687)
- Gross residual disease most often happens in older kids with trauma who rupture a liver tumor, such as during peewee football. — Max Langham (clinical) [Ep 254 · 45:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2700)
- Kids relapse either locally in the liver or in the lungs. — Max Langham (clinical) [Ep 254 · 45:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2730)
- If a patient has a negative margin resection and relapses locally in the liver, refer them for transplantation; salvage transplantation is not optimal but probably better than re-resection. — Max Langham (opinion) [Ep 254 · 45:36](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2736)
- For pulmonary recurrence, treating with chemotherapy is important but you will probably need to re-excise the pulmonary mets. — Max Langham (clinical) [Ep 254 · 46:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2768)
- Hepatoblastoma is not thought to be radiation sensitive, and there is almost no anecdotal data of radiation being used in the lungs. — Max Langham (clinical) [Ep 254 · 46:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2779)
- After resection following 4 rounds of chemotherapy with clear margins and no residual tumor, patients usually receive 2 courses of consolidation chemotherapy. — Max Langham (clinical) [Ep 254 · 46:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2813)
- Most recurrences will happen within the first 3 years of therapy. — Max Langham (clinical) [Ep 254 · 47:02](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2822)
- After a child gets two cycles of chemotherapy and is restaged, whether it is PRETEXT 2, 3, or has annotation factors, the surgeon's job is to resect that patient after 4 courses of chemotherapy. — Max Langham (clinical) [Ep 254 · 48:02](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2882)
- In a recent SIOPEL study, nearly half of PRETEXT 4 lesions were resected with conventional resections and did not need liver transplants. — Max Langham (clinical) [Ep 254 · 48:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2910)
- In the US for PRETEXT 4 in AHEP 0731, about 90% of those patients were transplanted. — Max Langham (epidemiological) [Ep 254 · 48:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2924)
- A patient being PRETEXT 3 or 4 does not mean they cannot be resected ultimately; it just means they need chemotherapy first. — Max Langham (clinical) [Ep 254 · 48:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2933)
- PRETEXT staging stands for pre-treatment extent of disease and is based on segmental liver anatomy, performed prior to chemotherapy. (guideline) [Ep 51 · 2:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=122)
- PRETEXT staging has a tendency to overstage because it is based purely on imaging, and bulky tumors make it difficult to assess true vascular invasion versus mass effect. (clinical) [Ep 51 · 2:28](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=148)
- POSTTEXT staging refers to extent of disease after neoadjuvant chemotherapy has been given. (guideline) [Ep 51 · 2:51](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=171)
- Key staging annotations include involvement of the retrohepatic cava or hepatic veins, and the portal vein bifurcation. (guideline) [Ep 51 · 4:10](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=250)
- COG recommendations state that PRETEXT I-II tumors with clear 1 cm margins and no vascular involvement can be resected locally without referral to specialized centers. (guideline) [Ep 51 · 7:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=461)
- Most tumor volume shrinkage from chemotherapy occurs within the first two cycles. (clinical) [Ep 51 · 10:14](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=614)
- After 2 cycles of chemotherapy, if the tumor has not shrunk to a resectable size, the patient should be evaluated for transplant. (guideline) [Ep 51 · 10:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=633)
- As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from vascular supply significantly; size decreases but vascular margins do not substantially improve. (clinical) [Ep 51 · 11:06](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=666)
- Survival after extensive or 'heroic' resections (tumor liver explants with back table resections and reimplants, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival. (clinical) [Ep 51 · 12:10](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=730)
- There has been a move away from heroic resections in hepatoblastoma due to inferior survival compared to transplantation. (opinion) [Ep 51 · 12:40](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=760)
- Patients who undergo rescue transplant after failed resection do far worse than patients who have a planned transplant upfront. (clinical) [Ep 51 · 14:09](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=849)
- Current thinking is to refer patients to a transplant center early, even if two cycles of chemotherapy will be given first, to have pre-transplant evaluation completed and the patient integrated into the system. (guideline) [Ep 51 · 14:36](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=876)
- Primary transplant patients do surprisingly well despite immunosuppression for cancer, particularly in liver tumors. (clinical) [Ep 51 · 15:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=911)
- In the UK, all biliary atresia patients are referred upfront to a transplant center. (clinical) [Ep 51 · 16:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=962)
- For non-transplant center surgeons performing hepatoblastoma resection, there must be 95% confidence of successful resection with adequate margins before proceeding; otherwise referral to a transplant center is indicated. (opinion) [Ep 51 · 17:36](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1056)
- Anatomic resection with a good margin is appropriate for local management; disease near hepatic veins, crossing the liver, or involving the portal vein should be referred. (opinion) [Ep 51 · 18:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1091)
- Liver transplant surgeons have extensive experience operating on the liver, which may benefit pediatric surgeons managing borderline-resectable hepatoblastoma cases. (opinion) [Ep 51 · 18:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1135)
- Despite advanced imaging, the truth about resectability is determined at the time of operation. (clinical) [Ep 51 · 19:43](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1183)
- In Europe, all liver tumors receive chemotherapy upfront before surgery to make the tumor smaller and potentially avoid transplantation. (clinical) [Ep 51 · 19:58](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1198)
- Trisegmentectomy for cure is a reasonable approach to avoid lifelong immunosuppression from transplantation. (opinion) [Ep 51 · 20:19](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1219)
- Central hepatectomies have been performed successfully for hepatoblastoma cure without requiring transplant, though it is a difficult operation. (clinical) [Ep 51 · 20:34](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1234)
- For core needle biopsy of hepatoblastoma, approximately 10 passes are recommended, going through an area that includes normal parenchyma and tumor. (guideline) [Ep 51 · 21:25](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1285)
- There are two camps regarding pulmonary metastases in hepatoblastoma: one advocates resecting metastases upfront before hepatectomy; the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites. (clinical) [Ep 51 · 22:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1331)
- There is no good data on either side of the pulmonary metastases timing debate; all evidence is limited to a handful of patients. (clinical) [Ep 51 · 22:45](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1365)
- Papers examining stage 4 hepatoblastoma with pulmonary metastases are limited to cohorts of less than 20 patients, making it difficult to draw good conclusions. (epidemiological) [Ep 51 · 23:22](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1402)
- There may be reporting bias in hepatoblastoma transplant literature: successful cases (good chemo response, transplant, long-term survival) are reported, but failures may not be. (opinion) [Ep 51 · 23:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1418)
- PLUTO (Pediatric Liver Unresectable Tumor Observatory) is an international group seeking to answer questions about unresectable hepatoblastoma that cannot be answered at individual or multi-center level within North America or Europe. (clinical) [Ep 51 · 24:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1442)
- It will likely take several years before PLUTO can answer key questions about unresectable hepatoblastoma management. (opinion) [Ep 51 · 24:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1470)
- 80% of ovarian masses are teratomas — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 1:25](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=85)
- In the year 2000, girls with ovarian germ cell tumors have almost 100% survival — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 1:50](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=110)
- Stage one ovarian tumors limited to the ovary now receive only oophorectomy without chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 53 · 2:14](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=134)
- Microscopic residual and lymph node involvement in ovarian tumors require chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 53 · 2:26](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=146)
- 25% of girls with ovarian germ cell tumors will be missed if peritoneal cytology and washings are not performed — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 3:16](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=196)
- If staging procedures are omitted from the operative report, oncologists will treat ovarian tumors as stage 2 — Andrea Hayes-Jordan (clinical) [Ep 53 · 3:54](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=234)
- Gliomatosis peritonei is a benign disease appearance associated with ovarian teratomas with nearly 100% survival — Andrea Hayes-Jordan (clinical) [Ep 53 · 4:41](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=281)
- In bilateral ovarian disease, tumors larger than 10 cm should definitely be biopsied — Andrea Hayes-Jordan (guideline) [Ep 53 · 5:37](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=337)
- If an ovarian tumor is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum — Dan (clinical) [Ep 53 · 7:11](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=431)
- 15% of ovarian tumors in adolescents are epithelial tumors with different staging criteria than germ cell tumors — Dan (epidemiological) [Ep 53 · 7:19](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=439)
- If alpha-fetoprotein and beta-HCG levels are normal preoperatively, there is some comfort about draining a cyst without contamination — Andrea Hayes-Jordan (clinical) [Ep 53 · 8:07](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=487)
- The salvage rate for recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective — Dan (clinical) [Ep 53 · 12:15](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=735)
- Ovarian torsion is an urgent but not emergent situation if the goal is to preserve the ovary — Andrea Hayes-Jordan (guideline) [Ep 53 · 13:40](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820)
- Many black-colored ovaries from torsion have viable follicles and ovarian preservation should be the goal — Andrea Hayes-Jordan (clinical) [Ep 53 · 13:40](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820)
- 76% of ovaries removed for torsion had normal ovarian tissue, only 13% had no ovarian tissue, and only 11% were completely necrotic — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 15:44](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=944)
- Pain after oophoropexy is usually short-lived and resolves in about a week — Andrea Hayes-Jordan (clinical) [Ep 53 · 16:34](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=994)
- The ability to preserve ovarian function after torsion is related to age, with pediatric patients having more active follicles than older adults — Andrea Hayes-Jordan (clinical) [Ep 53 · 16:58](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1018)
- Ultrasound Doppler for ovarian torsion has sensitivity and specificity in the 50-60% range — Andrea Hayes-Jordan (clinical) [Ep 53 · 21:03](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1263)
- Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdo sarcomas — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 25:58](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1558)
- Abdominal, pelvic, and retroperitoneal rhabdomyosarcomas have the worst survival while orbital rhabdomyosarcomas have the best survival — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 26:22](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1582)
- Even small tumors in the extremity or abdomen can only achieve stage 2 at best (not stage 1) in rhabdomyosarcoma staging — Andrea Hayes-Jordan (clinical) [Ep 53 · 27:04](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1624)
- Surgical extent determines clinical group in rhabdomyosarcoma: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only — Andrea Hayes-Jordan (guideline) [Ep 53 · 27:15](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1635)
- Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis while group 3 patients do more poorly — Andrea Hayes-Jordan (clinical) [Ep 53 · 27:27](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1647)
- Inability to resect a large rhabdomyosarcoma is a biologic determination, not a reflection of surgical skill, and aggressive resection with high morbidity will not improve outcome — Andrea Hayes-Jordan (opinion) [Ep 53 · 27:44](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1664)
- Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas — Andrea Hayes-Jordan (guideline) [Ep 53 · 29:15](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1755)
- For rhabdomyosarcoma, completion node dissection is not performed for positive sentinel nodes; radiation therapy is given instead — Andrea Hayes-Jordan (guideline) [Ep 53 · 29:31](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1771)
- Sentinel lymph node mapping for rhabdomyosarcoma should be performed at the time of re-excision if initial excisional biopsy had positive margins — Andrea Hayes-Jordan (guideline) [Ep 53 · 30:10](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1810)
- 40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive — Andrea Hayes-Jordan (epidemiological) [Ep 53 · 30:36](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1836)
- Histologic grade is now critical in non-rhabdo soft tissue sarcomas, not just the diagnosis — Andrea Hayes-Jordan (guideline) [Ep 53 · 31:00](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1860)
- Low-grade soft tissue sarcomas require only resection with observation, no chemotherapy or radiation — Andrea Hayes-Jordan (guideline) [Ep 53 · 31:27](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1887)
- Low-grade soft tissue sarcomas with positive margins receive adjuvant radiation therapy — Andrea Hayes-Jordan (guideline) [Ep 53 · 31:34](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1894)
- Unresectable soft tissue sarcomas should receive both preoperative radiation and chemotherapy (previously only chemotherapy was recommended) — Andrea Hayes-Jordan (guideline) [Ep 53 · 31:49](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1909)
- Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma — Andrea Hayes-Jordan (clinical) [Ep 53 · 32:07](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1927)
- Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, which are primarily treated with surgery and radiation — Andrea Hayes-Jordan (clinical) [Ep 53 · 32:25](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1945)
- A 5 cm tumor in a child less than 3 years old is equivalent to a 3 cm tumor in a larger patient, so 3 cm should be the cutoff for excision versus biopsy in toddlers — Andrea Hayes-Jordan (clinical) [Ep 53 · 32:51](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1971)
- Low-grade non-rhabdo sarcomas with negative margins can be cured with surgery alone without chemotherapy — Andrea Hayes-Jordan (clinical) [Ep 53 · 33:22](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2002)
- Core needle biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained — Andrea Hayes-Jordan (guideline) [Ep 53 · 34:07](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2047)
- Half of soft tissue sarcomas are rhabdomyosarcomas, and the other half are non-rhabdomyosarcomas. — Andrea (epidemiological) [Ep 68 · 0:00](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0)
- Prognosis in rhabdomyosarcoma varies depending on site, with abdominal, pelvic, and retroperitoneal tumors having the worst survival and orbital rhabdomyosarcomas having the best survival. — Andrea (clinical) [Ep 68 · 0:25](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=25)
- Stage 1 rhabdomyosarcoma includes favorable sites (vaginal and paratesticular), while stages 2, 3, and 4 are unfavorable sites with various amounts of disease. — Andrea (clinical) [Ep 68 · 0:50](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=50)
- Even a small tumor in the extremity or abdomen can only achieve stage 2 at best. — Andrea (clinical) [Ep 68 · 1:02](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=62)
- Clinical grouping in rhabdomyosarcoma depends on surgical extent: group 1 is complete removal, group 2 is microscopic residual, and group 3 is biopsy only. — Andrea (clinical) [Ep 68 · 1:14](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=74)
- Group 1 and 2 rhabdomyosarcoma patients have an excellent prognosis, while group 3 patients do more poorly. — Andrea (clinical) [Ep 68 · 1:30](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=90)
- A large tumor that a surgeon cannot resect is a biologic determination, and attempting resection with high morbidity will not improve the patient's outcome. — Andrea (opinion) [Ep 68 · 1:45](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=105)
- Five centimeters is the cutoff for low-risk versus high-risk patients in soft tissue sarcoma. — Andrea (clinical) [Ep 68 · 2:09](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=129)
- Sentinel lymph node biopsies are now required for all rhabdomyosarcoma patients with trunk or extremity tumors. — Andrea (guideline) [Ep 68 · 3:18](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=198)
- In rhabdomyosarcoma, completion node dissection is not performed after sentinel lymph node biopsy; patients receive radiation therapy instead. — Andrea (guideline) [Ep 68 · 3:34](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=214)
- Alveolar rhabdomyosarcoma patients should receive chemotherapy after biopsy, which typically reduces the tumor to approximately 1 centimeter, making resection with negative margins easier. — Andrea (clinical) [Ep 68 · 3:53](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=233)
- Sentinel lymph node mapping should be performed at the time of re-excision in rhabdomyosarcoma. — Andrea (guideline) [Ep 68 · 4:07](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=247)
- Forty to fifty percent of biopsied lymph nodes are positive in rhabdomyosarcoma. — Andrea (epidemiological) [Ep 68 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- Clinically negative lymph nodes may be positive in rhabdomyosarcoma, which is why sentinel node biopsy is performed. — Andrea (clinical) [Ep 68 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- Positive lymph nodes in rhabdomyosarcoma have a worse prognosis and require radiation therapy. — Andrea (clinical) [Ep 68 · 4:39](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- In non-rhabdomyosarcoma soft tissue sarcoma, histological grade is now critical for treatment planning. — Andrea (guideline) [Ep 68 · 4:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- Large soft tissue sarcoma tumors should be biopsied first and treated with chemotherapy before resection. — Andrea (guideline) [Ep 68 · 4:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- Soft tissue sarcomas have been identified as chemotherapy-sensitive or chemotherapy-insensitive, which changes treatment approach. — Andrea (clinical) [Ep 68 · 5:13](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=313)
- Low-grade soft tissue sarcoma tumors require only resection and observation, with no need for radiation or chemotherapy. — Andrea (guideline) [Ep 68 · 5:21](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=321)
- If a low-grade soft tissue sarcoma is resected with positive margins, the patient will receive adjuvant radiation therapy. — Andrea (guideline) [Ep 68 · 5:38](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=338)
- Unresectable large soft tissue sarcomas should be treated with preoperative radiation therapy and preoperative chemotherapy (previously only chemotherapy was recommended). — Andrea (guideline) [Ep 68 · 5:52](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=352)
- Small soft tissue sarcoma tumors less than 5 centimeters should be resected with attempts to achieve negative margins. — Andrea (guideline) [Ep 68 · 6:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma. — Andrea (clinical) [Ep 68 · 6:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, all of which are high-grade tumors. — Andrea (clinical) [Ep 68 · 6:28](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- For chemotherapy-insensitive soft tissue sarcomas, the surgeon and radiation therapist are the primary treaters. — Andrea (clinical) [Ep 68 · 6:28](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- High-risk soft tissue sarcoma patients receive preoperative radiation and chemotherapy. — Andrea (guideline) [Ep 68 · 6:48](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=408)
- Sentinel lymph node biopsy should always be performed if lymph nodes are clinically negative by imaging. — Andrea (guideline) [Ep 68 · 7:15](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- Positive lymph nodes receive radiation to the lymph node basin, and completion node dissection is not required. — Andrea (guideline) [Ep 68 · 7:15](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- Non-rhabdomyosarcoma tumors with negative margins after resection do not need chemotherapy if they are low-grade. — Andrea (guideline) [Ep 68 · 7:25](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=445)
- Chemotherapy-insensitive soft tissue sarcomas require aggressive surgical extirpation as much as possible. — Andrea (guideline) [Ep 68 · 7:37](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=457)
- Core biopsies are acceptable for soft tissue sarcoma diagnosis if 3 or 4 good cores that are not necrotic are obtained, with the pathologist checking the core before the interventional radiologist finishes. — Andrea (clinical) [Ep 68 · 8:10](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=490)
- The current status for bilateral Wilms tumor with positive lymph nodes and lung metastasis is to start chemotherapy without biopsy. (guideline) [Ep 71 · 0:54](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=54)
- Tumor shrinkage is defined as a decrease of 50% in tumor size. (clinical) [Ep 71 · 1:00](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=60)
- When bilateral Wilms tumors stop shrinking after chemotherapy, it is usually because of mesenchymal differentiation and not anaplastic tumor. (clinical) [Ep 71 · 3:52](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=232)
- Wilms tumors are heterogeneous and biopsy might miss foci of anaplasia. — Dan (clinical) [Ep 71 · 2:49](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=169)
- The concept with bilateral Wilms tumor is to preserve as much kidney tissue as possible. — Dan (clinical) [Ep 71 · 2:11](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=131)
- If a tumor has not been biopsied and is not responding to chemotherapy, there may be anaplastic elements that would respond to a more aggressive chemotherapy regimen. — Dan (clinical) [Ep 71 · 2:25](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=145)
- Bilateral nephron-sparing surgery can be performed surprisingly often in large bilateral Wilms tumors. (clinical) [Ep 71 · 4:07](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=247)
- The surgical technique for bilateral nephron-sparing involves putting the kidneys on ice, clamping the vessels, then sharp dissection to remove the tumor. (clinical) [Ep 71 · 4:15](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=255)
- Stage 3 local Wilms tumor requires radiation on both sides. (guideline) [Ep 71 · 5:03](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=303)
- Recurrence of anaplastic Wilms tumor portends a very bad outcome. — Dan (clinical) [Ep 71 · 6:10](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=370)
- Salvage is difficult for anaplastic Wilms tumor recurrence, despite chemotherapy. — Dan (clinical) [Ep 71 · 6:18](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=378)
- Bilateral Wilms tumors are no longer biopsied upfront; they are treated with chemotherapy first. — Dan (guideline) [Ep 71 · 6:44](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=404)
- Once anaplastic Wilms tumor recurs, it is very hard to salvage. — Dan (clinical) [Ep 71 · 7:11](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=431)
- Multifocal Wilms tumors raise concern about the underlying embryology of the kidney and risk for developing additional tumors. — Dan (clinical) [Ep 71 · 7:42](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=462)
- Mutations in WT1 or WT2 increase risk for additional Wilms tumors. (clinical) [Ep 71 · 7:53](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=473)
- 97% of large bilateral kidney tumors in children are Wilms tumor. (epidemiological) [Ep 71 · 8:35](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=515)
- Upfront chemotherapy without biopsy is appropriate for bilateral kidney tumors because only a very small percentage are not Wilms tumor. (guideline) [Ep 71 · 8:35](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=515)
- 97% of bilateral kidney tumors in children are Wilms tumor, with only a small percentage being other diagnoses — Tony Sandler (epidemiological) [Ep 70 · 9:12](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction) — Tony Sandler (guideline) [Ep 70 · 1:32](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation — Tony Sandler (clinical) [Ep 70 · 4:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- Bilateral nephron-sparing surgery is feasible even in large bilateral Wilms tumors by placing kidneys on ice, clamping vessels, and performing sharp dissection — Tony Sandler (clinical) [Ep 70 · 4:44](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia — Dan (clinical) [Ep 70 · 3:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- Recurrence of anaplastic Wilms tumor portends a very bad outcome and salvage is difficult despite chemotherapy — Dan (clinical) [Ep 70 · 6:48](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- Multifocal Wilms tumors raise concern about underlying embryologic abnormalities of the kidney and risk of developing additional tumors — Dan (clinical) [Ep 70 · 8:15](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy — Tony Sandler (opinion) [Ep 70 · 7:56](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- For gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl — Todd Ponsky (clinical) [Ep 70 · 9:58](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=598)
- Tegaderm closure of gastroschisis without fascial closure allows cicatrization over 3 days to 8 weeks, with feeding started when bowel function returns rather than waiting for complete closure — Tony Sandler (clinical) [Ep 70 · 14:52](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=892)
- When gastroschisis defect dilates during silo reduction attempts, Tegaderm closure alone can still achieve successful cicatrization without fascial closure — Tony Sandler (clinical) [Ep 70 · 15:32](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=932)
- Umbilical hernias after gastroschisis closure will close spontaneously if no fascia was cut; if fascia is cut, a permanent defect results — Tony Sandler (clinical) [Ep 70 · 12:54](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally — Todd Ponsky (opinion) [Ep 70 · 14:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=867)
- In gastroschisis with intestinal atresia and pristine bowel, creating an ostomy through the umbilical fascial ring is technically favorable because the bowel size matches the ring and provides good tissue for suturing (clinical) [Ep 70 · 17:49](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- Primary anastomosis in gastroschisis with atresia is risky because the proximal bowel is massively dilated and distal bowel is decompressed, creating a tenuous anastomosis in bowel that has been outside the abdomen (clinical) [Ep 70 · 18:36](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the extent of remaining intra-abdominal bowel from external examination — Tony Sandler (clinical) [Ep 70 · 21:01](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1261)
- Re-exploration at 2 weeks after gastroschisis closure (rather than the traditional 4-6 weeks) can reveal that inflamed gastroschisis bowel has transformed into functional intestine suitable for anastomosis — Tony Sandler (clinical) [Ep 70 · 22:07](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- Bianchi procedure is preferred over STEP for bowel lengthening because a patient can undergo Bianchi followed by STEP if needed, but once STEP is performed, lengthening options are limited — Greg (opinion) [Ep 70 · 26:46](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- In neonatal ileal atresia with dilated proximal bowel, plication is preferred over tapering to preserve bowel length for potential future lengthening procedures — Tony Sandler (clinical) [Ep 70 · 28:10](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- Plication of dilated bowel in ileal atresia usually unravels with time, allowing the bowel to be used later for lengthening procedures — Tony Sandler (clinical) [Ep 70 · 26:13](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1573)
- In many centers, high-risk obstetric teams deliver gastroschisis cases early by C-section, resulting in less thick and matted bowel at birth (clinical) [Ep 70 · 11:11](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- For gastroschisis reduction at bedside, babies are intubated and paralyzed, a stitch is placed in the fascia with cord left as a biological patch, and Opsite dressing is applied; patients are kept paralyzed for 1-2 days (clinical) [Ep 70 · 11:53](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=713)
- 80% of ovarian masses in children are teratomas — Andrea Hayes-Jordan (epidemiological) [Ep 69 · 0:37](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=37)
- By the year 2000, girls with ovarian germ cell tumors have almost 100% survival — Andrea Hayes-Jordan (epidemiological) [Ep 69 · 1:03](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=63)
- Stage 1 ovarian germ cell tumors (limited to ovary) now receive only oophorectomy without chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 69 · 1:22](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=82)
- Peritoneal cytology/washings will miss approximately 25% of girls with disease if not performed — Andrea Hayes-Jordan (clinical) [Ep 69 · 2:28](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=148)
- If staging procedures are omitted from the operative report, oncologists will treat the patient as stage 2 — Andrea Hayes-Jordan (clinical) [Ep 69 · 3:06](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=186)
- Gliomatosis peritonei is a benign disease with 100% survival, typically associated with ovarian teratomas — Andrea Hayes-Jordan (clinical) [Ep 69 · 3:53](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=233)
- For bilateral ovarian disease, tumors larger than 10 centimeters should be biopsied, with lower threshold for bilateral oophorectomy on first operation — Andrea Hayes-Jordan (clinical) [Ep 69 · 4:38](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=278)
- 15% of ovarian tumors in the teenage age range are actually epithelial tumors with different staging criteria than germ cell tumors — Dan (epidemiological) [Ep 69 · 6:31](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=391)
- If a presumed teratoma is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum — Dan (clinical) [Ep 69 · 6:12](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=372)
- If preoperative AFP and beta-HCG levels are normal, there is increased comfort (though not 100%) about draining a cystic ovarian mass — Andrea Hayes-Jordan (clinical) [Ep 69 · 7:18](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=438)
- The salvage rate for patients with recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective — Dan (clinical) [Ep 69 · 11:28](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=688)
- Ovarian torsion should be considered an urgent rather than emergent situation if the goal is ovarian preservation — Andrea Hayes-Jordan (clinical) [Ep 69 · 12:52](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=772)
- Many black-colored ovaries from torsion actually contain viable follicles and ovarian preservation should be the goal — Andrea Hayes-Jordan (clinical) [Ep 69 · 13:25](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=805)
- 76% of ovaries removed for torsion (that surgeons judged to be dead) contained normal ovarian tissue on pathology; only 11% were completely necrotic — Andrea Hayes-Jordan (clinical) [Ep 69 · 14:56](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=896)
- The ability to preserve ovarian function after torsion is related to patient age, with pediatric patients having more active follicles than older adults — Andrea Hayes-Jordan (clinical) [Ep 69 · 16:10](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=970)
- The current recommendation is detorsion without complete oophorectomy for ovarian torsion — Andrea Hayes-Jordan (guideline) [Ep 69 · 17:17](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1037)
- Ultrasound Doppler has only 50-60% sensitivity and specificity for diagnosing ovarian torsion — Andrea Hayes-Jordan (clinical) [Ep 69 · 20:10](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1210)
- Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdomyosarcomas — Andrea Hayes-Jordan (epidemiological) [Ep 69 · 25:10](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1510)
- In rhabdomyosarcoma, prognosis varies by site, with abdominal/pelvic/retroperitoneal tumors having the worst survival and orbital tumors having the best — Andrea Hayes-Jordan (clinical) [Ep 69 · 25:27](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1527)
- The surgeon determines the clinical group in rhabdomyosarcoma based on surgical extent: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only — Andrea Hayes-Jordan (clinical) [Ep 69 · 26:27](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1587)
- Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis; group 3 patients do more poorly — Andrea Hayes-Jordan (clinical) [Ep 69 · 26:39](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1599)
- Attempting to resect a large unresectable rhabdomyosarcoma with high morbidity will not improve the patient's outcome; this is a biologic determination, not a reflection of surgical skill — Andrea Hayes-Jordan (opinion) [Ep 69 · 27:01](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1621)
- A 4-centimeter mass in the forearm of a 5-year-old is relatively huge and should probably be biopsied rather than resected initially — Andrea Hayes-Jordan (clinical) [Ep 69 · 28:08](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1688)
- Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas — Andrea Hayes-Jordan (guideline) [Ep 69 · 28:27](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1707)
- For rhabdomyosarcoma, completion lymph node dissection is not performed for positive sentinel nodes; patients receive radiation therapy instead — Andrea Hayes-Jordan (guideline) [Ep 69 · 28:43](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1723)
- 40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive — Andrea Hayes-Jordan (epidemiological) [Ep 69 · 29:48](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1788)
- For non-rhabdomyosarcoma soft tissue sarcomas, histologic grade is now critical and determines treatment — Andrea Hayes-Jordan (guideline) [Ep 69 · 30:03](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1803)
- Low-grade soft tissue sarcomas require only resection and observation; no chemotherapy or radiation unless margins are positive — Andrea Hayes-Jordan (guideline) [Ep 69 · 30:39](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1839)
- For unresectable soft tissue sarcomas, preoperative radiation therapy and chemotherapy are now recommended (previously only chemotherapy) — Andrea Hayes-Jordan (guideline) [Ep 69 · 31:01](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1861)
- Chemosensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma — Andrea Hayes-Jordan (clinical) [Ep 69 · 31:19](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1879)
- Chemoinsensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid, and clear cell sarcoma; surgery and radiation are the primary treatments — Andrea Hayes-Jordan (clinical) [Ep 69 · 31:37](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1897)
- A 5-centimeter tumor in a child less than 3 years old is equivalent to a 3-centimeter tumor in a larger patient, so 3 centimeters should be the cutoff for excision in toddlers — Andrea Hayes-Jordan (clinical) [Ep 69 · 32:03](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1923)
- Low-grade non-rhabdomyosarcoma soft tissue sarcomas with negative margins can be cured with surgery alone and do not need chemotherapy — Andrea Hayes-Jordan (clinical) [Ep 69 · 32:34](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1954)
- Core biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained, confirmed by pathologist during the procedure — Andrea Hayes-Jordan (clinical) [Ep 69 · 33:19](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1999)
- Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. — Andrew Davidoff (epidemiological) [Ep 252 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. — Andrew Davidoff (epidemiological) [Ep 252 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. — Andrew Davidoff (clinical) [Ep 252 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. — Andrew Davidoff (epidemiological) [Ep 252 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Children with Wilms tumor typically present with an asymptomatic abdominal mass. — Andrew Davidoff (clinical) [Ep 252 · 1:20](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension. — Andrew Davidoff (clinical) [Ep 252 · 1:20](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. — Andrew Davidoff (guideline) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound. — Andrew Davidoff (guideline) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- CT will confirm the presence of a solid renal mass and afford the opportunity to visualize the contralateral kidney to confirm its presence and function and to exclude synchronous bilateral disease. — Andrew Davidoff (clinical) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- Intravascular tumor extension occurs in about 6% of Wilms tumor cases. — Andrew Davidoff (epidemiological) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. — Andrew Davidoff (guideline) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. — Andrew Davidoff (guideline) [Ep 252 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- The most common site of metastatic spread of Wilms tumor is the lungs. — Andrew Davidoff (clinical) [Ep 252 · 2:44](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. — Andrew Davidoff (guideline) [Ep 252 · 2:44](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Circumstances that make Wilms tumor stage 3 include biopsy or rupture (preoperative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or the administration of preoperative chemotherapy. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. — Andrew Davidoff (guideline) [Ep 252 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. — Andrew Davidoff (clinical) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Failure to perform upfront resection but instead administering neoadjuvant chemotherapy in the COG results in classification of a tumor as stage 3, thus mandating the use of flank irradiation and doxorubicin, each associated with significant long-term toxicities. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Careful lymph node sampling is a critical part of any operation for Wilms tumor because the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis. — Andrew Davidoff (clinical) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Lymph node sampling should be performed even in the absence of abnormal nodes on preoperative imaging or on gross inspection during operative exploration, since these circumstances don't reliably predict lymph node negativity. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Partial nephrectomy for patients with unilateral, non-syndromic disease and laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. — Andrew Davidoff (clinical) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. — Andrew Davidoff (guideline) [Ep 252 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. — Andrew Davidoff (epidemiological) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Children with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs (as used for stage 3 or 4 favorable histology) to shrink tumors prior to surgery and facilitate preservation of normal renal parenchyma, due to increased risk of renal failure. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Patients with Wilms tumor arising in a solitary kidney or those with unilateral Wilms tumor at increased risk for developing metachronous tumor are also treated with neoadjuvant chemotherapy, though these patients usually don't receive doxorubicin. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. — Andrew Davidoff (clinical) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. — Andrew Davidoff (guideline) [Ep 252 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. — Andrew Davidoff (guideline) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. — Andrew Davidoff (clinical) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. — Andrew Davidoff (clinical) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. — Andrew Davidoff (clinical) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Primary resection of tumors with extension above the level of the hepatic veins or especially into the atrium is associated with higher operative morbidity, so neoadjuvant chemotherapy is generally used in these circumstances. — Andrew Davidoff (guideline) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Thrombus that extends above the hepatic veins and persists to this extent after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove the full extent of disease. — Andrew Davidoff (clinical) [Ep 252 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. — Andrew Davidoff (epidemiological) [Ep 252 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. — Andrew Davidoff (guideline) [Ep 252 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- Stage 4 patients treated with three-drug chemotherapy who have radiographic disappearance of their lung metastases or tissue confirmation that residual nodules don't contain viable tumor at week 6 imaging re-evaluation will be considered rapid responders, will continue on three-drug chemotherapy, but won't receive pulmonary irradiation. — Andrew Davidoff (guideline) [Ep 252 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- Patients who don't have complete resolution of pulmonary nodules at 6 weeks will be considered slow or incomplete responders, will be switched to more intensive chemotherapy regimen, and will receive whole lung irradiation. — Andrew Davidoff (guideline) [Ep 252 · 10:47](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=647)
- In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass. — Daniel von Allmen (clinical) [Ep 250 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression. — Daniel von Allmen (clinical) [Ep 250 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor. — Daniel von Allmen (clinical) [Ep 250 · 1:07](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI. — Daniel von Allmen (clinical) [Ep 250 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study. — Daniel von Allmen (clinical) [Ep 250 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease. — Daniel von Allmen (clinical) [Ep 250 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- About 10% of neuroblastomas are MIBG negative. — Daniel von Allmen (clinical) [Ep 250 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease. — Daniel von Allmen (clinical) [Ep 250 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed. — Daniel von Allmen (guideline) [Ep 250 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M. — Daniel von Allmen (guideline) [Ep 250 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin. — Daniel von Allmen (guideline) [Ep 250 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. — Daniel von Allmen (guideline) [Ep 250 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- The prior neuroblastoma staging system required tissue diagnosis before assigning a stage. — Daniel von Allmen (guideline) [Ep 250 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy. — Daniel von Allmen (clinical) [Ep 250 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor. — Daniel von Allmen (opinion) [Ep 250 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist. — Daniel von Allmen (clinical) [Ep 250 · 4:44](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status. — Daniel von Allmen (clinical) [Ep 250 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue. — Daniel von Allmen (clinical) [Ep 250 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk. — Daniel von Allmen (clinical) [Ep 250 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk. — Daniel von Allmen (epidemiological) [Ep 250 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma. — Daniel von Allmen (clinical) [Ep 250 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy. — Daniel von Allmen (clinical) [Ep 250 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have. — Daniel von Allmen (clinical) [Ep 250 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection. — Daniel von Allmen (clinical) [Ep 250 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation. — Daniel von Allmen (clinical) [Ep 250 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure. — Daniel von Allmen (clinical) [Ep 250 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- In patients with MS disease, simple observation can be the treatment path. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated. — Daniel von Allmen (clinical) [Ep 250 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- You can biopsy the skin lesions in MS disease and that will give you the diagnosis. — Daniel von Allmen (clinical) [Ep 250 · 8:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)
- Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress — Daniel von Allmen (clinical) [Ep 251 · 2:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- Familial neuroblastoma occurs in approximately 1% of patients — Tony Sandler (epidemiological) [Ep 251 · 3:27](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery — Daniel von Allmen (clinical) [Ep 251 · 7:24](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival — Tony Sandler (clinical) [Ep 251 · 9:09](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly — Erika Newman (guideline) [Ep 251 · 9:58](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA — Erika Newman (guideline) [Ep 251 · 13:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma — Tony Sandler (opinion) [Ep 251 · 12:43](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=763)
- Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor — Daniel von Allmen (clinical) [Ep 251 · 14:21](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly — Erika Newman (clinical) [Ep 251 · 14:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=890)
- Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy — Erika Newman (clinical) [Ep 251 · 15:42](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful — Daniel von Allmen (clinical) [Ep 251 · 22:12](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status — Tony Sandler (clinical) [Ep 251 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma — Erika Newman (epidemiological) [Ep 251 · 26:56](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment — Erika Newman (clinical) [Ep 251 · 28:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1684)
- Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor — Erika Newman (clinical) [Ep 251 · 28:55](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1735)
- Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy — Erika Newman (clinical) [Ep 251 · 29:45](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1785)
- NMEC amplification automatically means high-risk neuroblastoma regardless of other factors — Tony Sandler (clinical) [Ep 251 · 31:38](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category — Erika Newman (clinical) [Ep 251 · 33:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months) — Tony Sandler (guideline) [Ep 251 · 35:25](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant — Erika Newman (clinical) [Ep 251 · 37:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy — Tony Sandler (clinical) [Ep 251 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies — Daniel von Allmen (clinical) [Ep 251 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect — Erika Newman (clinical) [Ep 251 · 42:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2560)
- COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients) — Daniel von Allmen (clinical) [Ep 251 · 44:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival — Daniel von Allmen (clinical) [Ep 251 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection — Daniel von Allmen (epidemiological) [Ep 251 · 46:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2770)
- Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes — Tony Sandler (clinical) [Ep 251 · 46:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2810)
- High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence — Tony Sandler (clinical) [Ep 251 · 47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed — Daniel von Allmen (clinical) [Ep 251 · 50:54](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3054)
- There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings — Daniel von Allmen (clinical) [Ep 251 · 51:30](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3090)
- Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction — Tony Sandler (clinical) [Ep 251 · 53:13](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60% — Tony Sandler (clinical) [Ep 251 · 53:44](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor — Tony Sandler (clinical) [Ep 251 · 54:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)
- Exception to restrictive transfusion is sickle cell disease where hematocrit needs to be around 30 or HbSS below 50% (clinical) [Ep 210 · 1:45](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=105)
- At our institution, VTE prophylaxis policy is for patients 12 years and over (clinical) [Ep 210 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- High risk for VTE includes femur fractures, cervical spine fracture, and intubated patients (clinical) [Ep 210 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- Kids with IBD are probably the most at-risk group for deep venous thromboses (clinical) [Ep 210 · 5:50](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=350)
- It is important to take lymph nodes in Wilms tumor regardless of whether the patient has lung metastases because you treat the local disease and it has an impact on treatment for abdominal disease — Dan (clinical) [Ep 210 · 15:37](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=937)
- For Wilms tumor lymph node sampling, there are data to show that nine nodes or seven nodes are probably adequate, but plucking nodes from the mesentery or pelvis is not helpful just to get a number — Dan (clinical) [Ep 210 · 22:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1321)
- For Wilms tumor, you should take nodes from both sides of the cava and the aorta, but you don't have to dive into the renal hilum on the other side or open Gerota's fascia (clinical) [Ep 210 · 23:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1381)
- Babies don't need antibiotics just because they showed up in the NICU; they only need standard prophylactic antibiotics when going to the OR (clinical) [Ep 210 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- Children with ruptured omphalocele or gastroschisis have an open abdomen and probably should receive antibiotics (clinical) [Ep 210 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- Children with duodenal atresia probably don't need antibiotics if they're going to the operating room within the next 24 to 48 hours (clinical) [Ep 210 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- For intact omphalocele managed with paint and wait, no antibiotics are needed as long as mom didn't have chorioamnionitis and baby doesn't have fever (clinical) [Ep 210 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- Broad-spectrum antimicrobial therapy for sepsis means extended-spectrum penicillin like piperacillin-tazobactam or ampicillin-sulbactam to cover everything empirically — Stephen Lee (clinical) [Ep 210 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- ECMO survival for patients with severe sepsis and recalcitrant hypotension is about 46% overall, which is better than zero — Salim Islam (epidemiological) [Ep 210 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- Elevated lipase and elevated bilirubin suggest obstruction in the pancreatic head, which can be caused by neoplasms or more commonly in pediatrics by non-neoplastic findings such as autoimmune pancreatitis or complications of pancreatitis. — Jaimie Nathan (clinical) [Ep 249 · 1:21](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=81)
- Pancreatoblastoma is the most common malignant pancreatic tumor in children, typically presenting in patients less than 10 years of age. — Jaimie Nathan (epidemiological) [Ep 249 · 5:14](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=314)
- In pancreatoblastoma, alpha-fetoprotein is elevated in up to 80% of cases. — Jaimie Nathan (clinical) [Ep 249 · 5:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=340)
- Up to 45-50% of pancreatoblastoma cases present with metastases. — Jaimie Nathan (epidemiological) [Ep 249 · 5:50](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=350)
- Pancreatoblastomas respond well to chemotherapy with a cisplatin and doxorubicin-based regimen. — Jaimie Nathan (clinical) [Ep 249 · 6:00](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=360)
- The number one prognostic factor for pancreatoblastoma is complete surgical excision, whether at initial presentation or following neoadjuvant chemotherapy. — Jaimie Nathan (clinical) [Ep 249 · 6:10](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=370)
- Solid pseudopapillary neoplasms are more common in young female patients, typically in their second or third decade of life. — Jaimie Nathan (epidemiological) [Ep 249 · 6:25](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=385)
- Solid pseudopapillary tumors are indolent and slow-growing, often presenting with very large masses in the body and tail of the pancreas. — Jaimie Nathan (clinical) [Ep 249 · 6:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=400)
- Enucleation or simple biopsy of solid pseudopapillary neoplasms should be avoided due to high recurrence rates; complete surgical resection is required. — Jaimie Nathan (clinical) [Ep 249 · 6:55](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=415)
- Solid pseudopapillary neoplasms have a recurrence rate of up to 10% but excellent long-term survival with 95% 10-year survival. — Jaimie Nathan (epidemiological) [Ep 249 · 7:04](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=424)
- Neuroendocrine tumors make up about 1-2% of all pancreatic tumors and can be either benign adenomas or malignant carcinomas. — Jaimie Nathan (epidemiological) [Ep 249 · 9:30](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=570)
- Neuroendocrine tumors tend to present in children over 10 years of age, though they are more common in middle-aged patients. — Jaimie Nathan (epidemiological) [Ep 249 · 9:45](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=585)
- In 10% of patients, neuroendocrine tumors may present in the setting of multiple endocrine neoplasia type 1, von Hippel-Lindau, or tuberous sclerosis. — Jaimie Nathan (clinical) [Ep 249 · 9:55](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=595)
- Insulinoma is the most common neuroendocrine tumor, accounting for almost 50% of pancreatic neuroendocrine tumors, followed by gastrinomas at 30%. — Jaimie Nathan (epidemiological) [Ep 249 · 10:10](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=610)
- Insulinomas are typically benign; 6% can be malignant. 90% are solitary, 10% are associated with MEN1. — Jaimie Nathan (epidemiological) [Ep 249 · 10:25](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=625)
- Insulinomas present with Whipple's triad: symptoms of hypoglycemia, low fasting blood glucose, and symptom resolution with glucose administration. — Jaimie Nathan (clinical) [Ep 249 · 10:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=640)
- On imaging, a solid lesion in the pancreas is more worrisome than a cystic lesion when found incidentally. — Jaimie Nathan (clinical) [Ep 249 · 12:00](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=720)
- Ultrasound is low cost and easily accessible but the pancreas is often suboptimally visualized and characterization of pancreatic masses is poor. — Jaimie Nathan (clinical) [Ep 249 · 13:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=820)
- CT scan is rapidly acquired with good resolution but has downsides of radiation and need for contrast; it is often used for solid tumor staging. — Jaimie Nathan (clinical) [Ep 249 · 14:00](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=840)
- MRI provides better differentiation between solid and cystic or fluid components and can better characterize components of a pancreatic mass. — Jaimie Nathan (clinical) [Ep 249 · 14:20](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=860)
- Cross-sectional imaging (CT or MRI) cannot confidently differentiate a benign versus malignant pancreatic lesion. — Jaimie Nathan (clinical) [Ep 249 · 15:03](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=903)
- A completely cystic pancreatic lesion is less concerning for malignancy, but if the mass has solid components, it becomes more concerning for neoplasm. — Jaimie Nathan (clinical) [Ep 249 · 15:25](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=925)
- Pediatric EUS is not practical in many institutions because there are not many practitioners in the pediatric GI community comfortable with pediatric EUS. — Jaimie Nathan (clinical) [Ep 249 · 17:20](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1040)
- In the pediatric realm, autoimmune pancreatitis is more common than pancreatic neoplasm. — Jaimie Nathan (epidemiological) [Ep 249 · 18:24](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1104)
- With negative biliary cytology and after biliary and pancreatic duct stenting, a four-week steroid trial with taper can be initiated for presumed autoimmune pancreatitis, even if IgG4 findings are normal. — Jaimie Nathan (clinical) [Ep 249 · 18:35](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1115)
- Type 1 autoimmune pancreatitis is IgG4-mediated; type 2 autoimmune pancreatitis is IgG4-negative. — Jaimie Nathan (clinical) [Ep 249 · 19:05](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1145)
- Autoimmune pancreatitis with a pancreatic head mass is typically very steroid responsive, with rapid resolution of the mass in most cases. — Jaimie Nathan (clinical) [Ep 249 · 20:03](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1203)
- Studies report up to about a 10% risk of diabetes (endocrine impairment) after just a distal pancreatectomy in the setting of otherwise normal pancreas. — Jaimie Nathan (epidemiological) [Ep 249 · 23:20](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1400)
- For malignant pancreatic head lesions, a radical resection (Whipple pancreaticoduodenectomy) is required; for benign or borderline benign lesions, duodenum-preserving pancreatic head resections (Beger or Berne procedures) may be considered. — Jaimie Nathan (clinical) [Ep 249 · 22:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1360)
- Enucleation may be appropriate for pancreatic neuroendocrine tumors but should be used sparingly; it is not recommended for solid pseudopapillary neoplasms due to higher recurrence risk. — Jaimie Nathan (clinical) [Ep 249 · 24:50](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1490)
- Type 1 autoimmune pancreatitis is IgG4-related systemic disease involving multiple organs (sialoadenitis, sclerosing cholangitis, retroperitoneal fibrosis) and responds quickly to steroids; IgG4 levels are elevated in 90% of patients. — Jaimie Nathan (clinical) [Ep 249 · 28:53](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1733)
- Type 2 autoimmune pancreatitis is pancreas-specific with normal IgG4 levels; 30% of patients also have IBD. Histology shows idiopathic duct-centric pancreatitis. — Jaimie Nathan (clinical) [Ep 249 · 29:40](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1780)
- Over 90% of children with autoimmune pancreatitis present with abdominal pain; about 40% present with obstructive jaundice. — Jaimie Nathan (epidemiological) [Ep 249 · 30:10](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1810)
- Positive serologies for IgG4 are described in only 22% of children with autoimmune pancreatitis in one study. — Jaimie Nathan (epidemiological) [Ep 249 · 30:30](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1830)
- In pediatric autoimmune pancreatitis, focal enlargement in the pancreatic head occurs in about 50% of patients; global pancreatic enlargement in 30%; main pancreatic duct irregularity in two-thirds; common bile duct strictures in 55%; and the capsule-like rim sign in only 16%. — Jaimie Nathan (epidemiological) [Ep 249 · 30:45](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1845)
- 93% of pediatric patients with autoimmune pancreatitis respond to steroids, indicating very steroid-responsive disease. — Jaimie Nathan (epidemiological) [Ep 249 · 31:30](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1890)
- Autoimmune pancreatitis in children more commonly follows a type 2 presentation rather than type 1 or IgG4-related presentation, based on data from the INSPIRE consortium and European pancreatic consortium. — Jaimie Nathan (epidemiological) [Ep 249 · 32:30](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=1950)
- Ideally, a tissue diagnosis should be obtained before initiating therapy for autoimmune pancreatitis, but barriers in pediatrics (limited EUS-skilled endoscopists and pathologists, inadequate biopsies) often cannot be overcome. — Jaimie Nathan (clinical) [Ep 249 · 33:20](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=2000)
- The diagnosis of autoimmune pancreatitis in children can be made with a combination of clinical and imaging findings because the risk of pediatric neoplasm is lower than autoimmune pancreatitis. — Jaimie Nathan (guideline) [Ep 249 · 33:50](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=2030)
- Clinical response to corticosteroid therapy for autoimmune pancreatitis should be seen within a few weeks; imaging response should be anticipated after about three months. — Jaimie Nathan (clinical) [Ep 249 · 34:30](https://library.globalcastmd.com/watch/pancreatic-masses-3439?t=2070)
- In North America, the preferred approach for resectable Wilms tumor is primary nephrectomy (total nephrectomy and ureterectomy with lymph node sampling). — Peter Ehrlich (guideline) [Ep 258 · 6:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383)
- Preoperative chemotherapy is recommended if tumor extends into the IVC beyond the infrahepatic vena cava, if tumor is so large it compromises respiratory status, if major liver or bowel resection would be required, if only one functioning kidney exists, or if bilateral tumors are present. — Peter Ehrlich (guideline) [Ep 258 · 7:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=421)
- The 'claw sign' on CT—normal kidney displaced into a horseshoe pattern around a mass—is a classic feature of Wilms tumor. — Peter Ehrlich (clinical) [Ep 258 · 3:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229)
- Wilms tumor tends to push structures out of the way rather than growing into them, whereas neuroblastoma grows around structures like blood vessels. — Peter Ehrlich (clinical) [Ep 258 · 4:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256)
- If a tumor requires major liver or bowel resection, biopsy and preoperative chemotherapy are preferred because complication rates are higher when these organs are resected at the same time as the kidney, and most tumors will respond to chemotherapy. — Peter Ehrlich (clinical) [Ep 258 · 10:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=624)
- Biopsy with residual gross tumor has always been treated as stage 3 abdominal disease, requiring three-drug chemotherapy plus flank radiation. — Peter Ehrlich (guideline) [Ep 258 · 11:18](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=678)
- Evidence suggests higher risk of tumor rupture when tumors reach 13-15 centimeters or larger, which may warrant consideration of preoperative chemotherapy. — Peter Ehrlich (clinical) [Ep 258 · 14:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873)
- For biopsy, open biopsy provides large tissue sections; large-core needle biopsy (10-20 cores) has proven accurate in several series. Fine needle aspiration or single-pass true-cut biopsy cannot diagnose anaplasia and should not be used. — Peter Ehrlich (guideline) [Ep 258 · 17:19](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1039)
- COG stage 1 is tumor limited to kidney, completely resected, no capsular invasion, no rupture or biopsy, vessels of renal sinus not involved, negative margins, and negative regional lymph nodes. — Peter Ehrlich (guideline) [Ep 258 · 20:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1200)
- COG stage 2 is complete resection with negative margins but tumor extends beyond kidney through capsular penetration, renal sinus invasion, or blood vessel involvement within the nephrectomy specimen outside the primary kidney. — Peter Ehrlich (guideline) [Ep 258 · 20:28](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228)
- COG stage 3 includes: biopsy with gross residual tumor, positive lymph nodes, peritoneal surface penetration with implants, positive margins, microscopic residual from intraoperative spill, incomplete resection, piecemeal removal, or renal vein division with tumor present. — Peter Ehrlich (guideline) [Ep 258 · 21:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1260)
- COG stage 4 is hematogenous metastasis to lung, liver (most common), bone, or brain. Stage 5 is bilateral renal tumor involvement. — Peter Ehrlich (guideline) [Ep 258 · 21:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1318)
- Stage 1-2 abdominal disease without lung metastases receives two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation, significantly reducing late effects including renal failure, second malignancies, and cardiovascular disease. — Peter Ehrlich (guideline) [Ep 258 · 23:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1388)
- If a patient has a lung lesion but stage 1-2 abdominal disease after primary nephrectomy with negative lymph nodes, the child avoids abdominal radiation (though still receives chemotherapy for the lung lesion). — Peter Ehrlich (clinical) [Ep 258 · 24:15](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455)
- Recent COG data shows approximately 40% of patients with pulmonary metastases who have complete response at 6 weeks can avoid pulmonary radiation without affecting event-free or overall survival, with 80-85% not relapsing. — Peter Ehrlich (clinical) [Ep 258 · 26:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1584)
- Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer, a significant late effect. — Peter Ehrlich (epidemiological) [Ep 258 · 26:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568)
- For a single lung lesion remaining at 6 weeks that did not respond to chemotherapy, thoracoscopic biopsy is reasonable because 50-60% of such lesions may not be cancer (could be scar), and if benign, the patient would not need pulmonary radiation. — Peter Ehrlich (clinical) [Ep 258 · 28:09](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1689)
- SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with evaluation at 4 and 8 weeks, then resection followed by post-chemotherapy pathology-based risk stratification (low, intermediate, high risk). — Peter Ehrlich (guideline) [Ep 258 · 30:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1816)
- In SIOP protocols, predominantly blastema component after preoperative chemotherapy is a negative prognostic factor, but blastema percentage does not correlate with outcome in COG primary nephrectomy patients. — Peter Ehrlich (clinical) [Ep 258 · 31:19](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1879)
- Outcomes for stage 1 and stage 2 patients are basically identical between COG and SIOP treatment approaches. — Peter Ehrlich (clinical) [Ep 258 · 33:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2038)
- Some Wilms tumor patients present with low hemoglobin because the tumor ruptures internally and bleeds. — Peter Ehrlich (clinical) [Ep 258 · 34:46](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2086)
- Acquired von Willebrand disease occurs in Wilms tumor patients; in most cases it is meaningless, but a few case series report significant intraoperative bleeding until tumor removal. — Peter Ehrlich (clinical) [Ep 258 · 35:11](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111)
- Right-sided tumors can cause complications including adrenal vein injury, duodenal injury (due to proximity), superior mesenteric artery injury, and IVC injury due to anatomic distortion. — Peter Ehrlich (clinical) [Ep 258 · 36:25](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2185)
- Wilms tumors can cause intense inflammatory reaction making them adherent to diaphragm or liver; taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided. — Peter Ehrlich (clinical) [Ep 258 · 42:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551)
- The main factor predicting outcome in stage 3 disease is whether lymph nodes are positive, along with genetic changes including loss of heterozygosity and 1Q gain. — Peter Ehrlich (clinical) [Ep 258 · 32:50](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1970)
- Patients with loss of heterozygosity of both 1p and 16q (5-7% of patients) have significantly worse outcomes regardless of stage. Stage 1-2 patients with LOH have about 10% lower overall survival; stage 3-4 patients have 18% lower survival. — Peter Ehrlich (clinical) [Ep 258 · 54:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281)
- Patients with both 1p and 16q loss of heterozygosity receive augmented therapy: doxorubicin is added for stage 1-2 disease, and five-drug regimen M is used for stage 3-4 disease. — Peter Ehrlich (guideline) [Ep 258 · 55:07](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3307)
- IVC tumor extension is not a negative prognostic factor if the tumor is completely resected. — Peter Ehrlich (clinical) [Ep 258 · 46:27](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2787)
- Major complication rate for primary surgery with tumor extending beyond infrahepatic IVC is 26-30%, including mortality, increased transfusions, and ICU stay, supporting preoperative chemotherapy for these cases. — Peter Ehrlich (clinical) [Ep 258 · 48:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929)
- Favorable histology Wilms tumor has three components: blastema, stroma, and epithelial (triphasic tumor). Tumors with only two components are also considered favorable histology. — Peter Ehrlich (clinical) [Ep 258 · 52:39](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3159)
- Unfavorable histology is classified as focal anaplasia or diffuse anaplasia based on number of high-power fields showing anaplasia, with different treatments for each. — Peter Ehrlich (clinical) [Ep 258 · 55:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3358)
- Clear cell sarcoma of the kidney has reasonable treatment outcomes, particularly for low stages. Rhabdoid tumors have poor outcomes except for stage 1; most present at stage 3-4 with terrible outcomes. — Peter Ehrlich (clinical) [Ep 258 · 57:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3421)
- Renal cell carcinoma in children has no good therapy, particularly for metastatic disease. — Peter Ehrlich (clinical) [Ep 258 · 56:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411)
- Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 258 · 57:46](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3466)
- The strategy for bilateral Wilms tumor is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy of at least one kidney (ideally both) to avoid dialysis. — Peter Ehrlich (guideline) [Ep 258 · 58:07](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3487)
- Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% compared to 88% for unilateral tumors; overall survival was 80% vs. 95%. — Peter Ehrlich (epidemiological) [Ep 258 · 58:40](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3520)
- Maximum tumor response to chemotherapy in most children with Wilms tumor occurs by 12 weeks, and early response at 6 weeks predicts late response. — Peter Ehrlich (clinical) [Ep 258 · 59:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577)
- In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. In a recent COG study of 250 enrolled patients, only one turned out to have rhabdoid tumor. — Peter Ehrlich (epidemiological) [Ep 258 · 60:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3631)
- Biopsy is recommended for bilateral tumors in older patients (8-10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely. — Peter Ehrlich (guideline) [Ep 258 · 61:56](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3716)
- If biopsying bilateral tumors, both kidneys should be biopsied because there is discordant pathology in up to 20% of patients. — Peter Ehrlich (clinical) [Ep 258 · 62:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3736)
- A small subset of very young patients (<24 months) with stage 1 favorable histology tumors <550g can be treated with surgery alone without chemotherapy, with >95% overall survival. Those who relapse (about 10%) have 100% salvage with chemotherapy. — Peter Ehrlich (clinical) [Ep 258 · 43:32](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612)
- There are around 250 new cases of hepatoblastoma per year. — Greg Tiao (epidemiological) [Ep 336 · 0:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=15)
- Hemangioma is the most common liver lesion in children. — Greg Tiao (epidemiological) [Ep 336 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=101)
- EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging and distinguishing biliary anatomy. — Greg Tiao (clinical) [Ep 336 · 3:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=180)
- Couinaud labeled the liver segments in a counterclockwise fashion after the districts of Paris, by injecting portal vessels. — Greg Tiao (clinical) [Ep 336 · 4:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=248)
- The right hepatic vein differentiates the anterior sections (segments 5 and 8) from the posterior sections (segments 6 and 7) of the right liver. — Greg Tiao (clinical) [Ep 336 · 4:45](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=285)
- The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) in the right liver. — Greg Tiao (clinical) [Ep 336 · 4:45](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=285)
- The change in practice for PRETEXT 3 and 4 tumors improved survival rates for patients with hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today. — Greg Tiao (epidemiological) [Ep 336 · 7:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=435)
- PRETEXT 3 tumors should generally be biopsied at diagnosis and then started on neoadjuvant chemotherapy, with readiness to send patients to a transplant center or a center with expertise in advanced liver resections depending on response. — Greg Tiao (guideline) [Ep 336 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- For PRETEXT 3 or 4 liver disease, specific indications for transplant include unresectable disease, unsafe resection, or resection that would leave the patient with an inadequate liver remnant. — Greg Tiao (guideline) [Ep 336 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- Teams are now trained to recognize hepatoblastoma tumors and send them to centers that offer transplant or can do aggressive resection, resulting in more patient referrals than 15 years ago. — Greg Tiao (clinical) [Ep 336 · 8:19](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=499)
- The FIT study has been ongoing for three years. — Greg Tiao (clinical) [Ep 336 · 9:06](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=546)
- Dr. Christina Theodoro states this study is a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myelomeningocele repair. — Christina Theodorou (clinical) [Ep 370 · 2:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174)
- The technique involves exposing the fetal back, re-exposing the spinal cord, identifying the myelomeningocele defect, placing an extracellular matrix patch with placental stem cells facing the spinal cord in direct contact, closing the skin, and returning the baby to the uterus to continue gestation until term. — Christina Theodorou (clinical) [Ep 370 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207)
- Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive the stem cells. — Christina Theodorou (clinical) [Ep 370 · 3:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234)
- Dr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation. — Todd Ponsky (clinical) [Ep 370 · 4:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248)
- The survey included self-identified specialists within the field of fetal surgery, yet only 4% of those people reported receiving formal training in fetal surgery. — Natalie Lopyan (epidemiological) [Ep 370 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313)
- Dr. Natalie Lopian suggests it will be interesting to see whether fetal surgery exposure becomes a requirement during training or whether fetal centers become the primary training ground for fetal surgeons as the field expands. — Natalie Lopyan (opinion) [Ep 370 · 6:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=378)
- Dr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery. — Todd Ponsky (opinion) [Ep 370 · 6:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398)
- The study was not designed to link subspecialization of fetal surgery to outcomes and was not designed to provide a clear definition of a fetal surgery center. — Natalie Lopyan (clinical) [Ep 370 · 7:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446)
- About 40% of patients can achieve a durable cure response after 5 years with complete metastatic site clearance. — Roshni Dasgupta (clinical) [Ep 376 · 2:08](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=128)
- Complete surgical resection of all metastatic tumor sites is an independent positive prognostic factor and affects overall survival, not just disease recurrence. — Roshni Dasgupta (clinical) [Ep 376 · 2:23](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=143)
- In patients with metastatic osteosarcoma, even 1-millimeter nodules can contain malignant disease in about 60% of cases. — Roshni Dasgupta (clinical) [Ep 376 · 2:35](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=155)
- The bigger the nodule is, the more likely it contains malignancy, but all the way down to 1 millimeter, tumor can be found. — Roshni Dasgupta (clinical) [Ep 376 · 2:47](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=167)
- Thoracotomy has historically been standard of care because surgeons can use fingers and hands to feel tiny nodules. — Roshni Dasgupta (clinical) [Ep 376 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=193)
- Manual palpation during thoracotomy finds about 30 to 40% more lung nodules than are detected on CT scan, even with thin-cut CT scans. — Roshni Dasgupta (clinical) [Ep 376 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=199)
- ICG can be used with thoracotomy to find deeper nodules, though depth of penetration is a limitation. — Roshni Dasgupta (clinical) [Ep 376 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=230)
- It is uncertain whether removing tiny 1-millimeter nodules actually provides a survival advantage. — Roshni Dasgupta (opinion) [Ep 376 · 4:15](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=255)
- VATS is minimally invasive with shorter length of stay, and repeat thoracoscopy typically encounters fewer adhesions compared to repeat thoracotomy. — Roshni Dasgupta (clinical) [Ep 376 · 4:41](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=281)
- VATS often requires some sort of localization process and good interventional radiology support. — Roshni Dasgupta (clinical) [Ep 376 · 4:58](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=298)
- In oligometastatic disease (patients with fewer than 4 nodules on each side), there was no difference in mortality between open resection and thoracoscopy. — Roshni Dasgupta (clinical) [Ep 376 · 5:34](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=334)
- The survival curves for thoracotomy and thoracoscopy in oligometastatic disease are essentially identical, meaning the optimal operation is unknown. — Roshni Dasgupta (clinical) [Ep 376 · 5:44](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=344)
- The multi-institution study had significant selection bias and institutional selection bias, with patients unlikely to receive thoracoscopy if they had many nodules. — Roshni Dasgupta (epidemiological) [Ep 376 · 6:03](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=363)
- Metastatic disease is typically addressed after 4 cycles of chemotherapy, and residual nodules at that point are unlikely to change with additional chemotherapy. — Roshni Dasgupta (clinical) [Ep 376 · 6:34](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=394)
- Practice for bilateral lung metastases is highly varied, with options including median sternotomy, staged thoracotomies, or bilateral thoracoscopies. — Roshni Dasgupta (clinical) [Ep 376 · 7:02](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=422)
- Most practitioners perform staged procedures for bilateral disease, particularly with thoracotomy, typically 4 to 6 weeks apart to allow a cycle of chemotherapy in between. — Roshni Dasgupta (clinical) [Ep 376 · 7:13](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=433)
- Dr. Rothenberg's institution reported almost 20 years ago that survival didn't change when there were only 3 to 4 nodules per side. — Steven Rothenberg (clinical) [Ep 376 · 7:29](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=449)
- Because osteosarcoma is a systemic disease, the argument that manual palpation is necessary would logically require bilateral thoracotomy, not unilateral. — Steven Rothenberg (opinion) [Ep 376 · 7:52](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=472)
- Even with the best CTs, only 1 to 2 millimeter nodules can be visualized, and some are still missed. — Steven Rothenberg (clinical) [Ep 376 · 8:02](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=482)
- There are nodules that can be felt but not seen, and nodules that cannot be felt at all. — Steven Rothenberg (clinical) [Ep 376 · 8:05](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=485)
- Dr. Rothenberg's practice is to use thoracoscopy when there are only 3 to 4 nodules per side that are amenable to thoracoscopic resection, in order to reduce morbidity. — Steven Rothenberg (clinical) [Ep 376 · 8:12](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=492)
- For bilateral oligometastatic disease, Dr. Rothenberg performs bilateral thoracoscopy. — Steven Rothenberg (clinical) [Ep 376 · 8:23](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=503)
- Non-surgical methods such as CyberKnife using fiducials to localize and ablate lesions may be a future approach for lung metastases. — Todd Ponsky (opinion) [Ep 376 · 8:43](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=523)
- The Children's Oncology Group is starting a study to answer the question of thoracotomy versus VATS, with enrollment expected to begin late 2021 or early 2022. — Todd Ponsky (guideline) [Ep 376 · 8:56](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=536)
- Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership — Craig Lillehei (clinical) [Ep 383 · 3:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210)
- Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro' — Craig Lillehei (clinical) [Ep 383 · 4:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240)
- Bystanders who do not speak up compound the harm of microaggressions even if they address the issue later — Craig Lillehei (opinion) [Ep 383 · 4:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=270)
- Prematurity and premature rupture of membranes are significant complications of FETO — Craig Lillehei (clinical) [Ep 383 · 11:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=690)
- NPO guidelines for children are based on very poor evidence and vary considerably between institutions (clinical) [Ep 383 · 15:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900)
- Pulmonary aspiration is very scary but very rare, usually occurring in emergency surgeries in high-risk children rather than elective procedures (clinical) [Ep 383 · 15:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=930)
- Prolonged NPO periods generate ketone bodies, cause hypoglycemia, and make children irritable preoperatively (clinical) [Ep 383 · 18:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1080)
- In C-arm fluoroscopy, the x-ray source is conventionally placed below the table with the image intensifier above (clinical) [Ep 383 · 25:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500)
- Placing radiation shields on top of the patient does nothing to protect them because radiation comes from below the table (clinical) [Ep 383 · 25:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530)
- If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy to compensate, increasing patient exposure (clinical) [Ep 383 · 26:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1560)
- Collimation focuses the x-ray beam to a specific area, increasing detail and clarity while decreasing total patient dose and room exposure (clinical) [Ep 383 · 27:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1620)
- Pulse mode fluoroscopy is feasible for most pediatric surgery applications and does not require the temporal resolution of continuous fluoroscopy (clinical) [Ep 383 · 28:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1680)
- Using magnification setting on fluoroscopy significantly increases radiation dose to both patient and room (clinical) [Ep 383 · 28:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1710)
- The strongest data for preventing surgical site infection is appropriate timing of preoperative intravenous antibiotics — Paul Yzotrak (clinical) [Ep 383 · 52:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3120)
- For NEC survival in the first 24-48 hours, it is unclear whether there is a survival advantage or disadvantage for drain versus laparotomy (opinion) [Ep 383 · 58:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3480)
- Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old. — Stephen Scoville (epidemiological) [Ep 419 · 0:26](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=26)
- Compared to adults, childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement. — Stephen Scoville (clinical) [Ep 419 · 0:33](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=33)
- Childhood melanoma has unique disease mechanisms compared to adult melanoma. — Stephen Scoville (clinical) [Ep 419 · 0:42](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=42)
- Management of pediatric melanoma is based on adult studies despite differences from adult disease. — Stephen Scoville (guideline) [Ep 419 · 0:44](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=44)
- Melanoma management is largely based on depth of the tumor and presence of metastatic disease. — Stephen Scoville (guideline) [Ep 419 · 0:49](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=49)
- Tumors less than 0.8 millimeters thick are largely managed with wide local excision. — Stephen Scoville (guideline) [Ep 419 · 0:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=55)
- Tumors greater than or equal to 0.8 millimeters or less than 0.8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies. — Stephen Scoville (guideline) [Ep 419 · 1:07](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=67)
- If sentinel lymph node biopsy is positive, patients typically undergo ultrasound observation versus completion lymph node dissection, which has a high risk of morbidity. — Stephen Scoville (guideline) [Ep 419 · 1:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=80)
- Two adult trials (DCOG SLT and MSLT2) showed no significant difference in outcomes for low to intermediate risk patients with positive sentinel lymph node biopsies who were followed with ultrasound observation versus completion lymph node dissections. — Stephen Scoville (clinical) [Ep 419 · 1:29](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=89)
- There is no pediatric data to support ultrasound observation versus completion lymph node dissection for positive sentinel lymph node biopsies. — Stephen Scoville (clinical) [Ep 419 · 1:47](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=107)
- In this study of 252 pediatric melanoma patients, race was predominantly white, consistent with prior literature. — Stephen Scoville (epidemiological) [Ep 419 · 2:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=130)
- Breslow depth ranged from tumor in situ to 20 millimeters with a median of 2.55 millimeters. — Stephen Scoville (clinical) [Ep 419 · 2:21](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=141)
- Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 (approximately 51%) had positive sentinel lymph node biopsies. — Stephen Scoville (clinical) [Ep 419 · 2:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=160)
- Patients who underwent completion lymph node dissection were significantly older than those who underwent ultrasound observation. — Stephen Scoville (clinical) [Ep 419 · 3:22](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=202)
- Patients who underwent completion lymph node dissection were more likely to receive adjuvant therapy compared to ultrasound observation. — Stephen Scoville (clinical) [Ep 419 · 3:22](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=202)
- There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups. — Stephen Scoville (clinical) [Ep 419 · 3:34](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=214)
- Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group. — Stephen Scoville (clinical) [Ep 419 · 3:41](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=221)
- Only 21% of patients who underwent completion lymph node dissection had additional positive nodal disease. — Stephen Scoville (clinical) [Ep 419 · 3:52](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=232)
- Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden. — Stephen Scoville (clinical) [Ep 419 · 4:01](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=241)
- Recurrence was associated with positive sentinel lymph node disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death. — Stephen Scoville (clinical) [Ep 419 · 4:11](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=251)
- Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate. — Stephen Scoville (clinical) [Ep 419 · 4:23](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=263)
- Management of nodal disease (ultrasound observation vs completion lymph node dissection) had no significant impact on disease outcomes with respect to recurrence or death from disease. — Stephen Scoville (clinical) [Ep 419 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=270)
- Findings of additional nodal disease in completion lymph node dissection did not significantly correlate with recurrence. — Stephen Scoville (clinical) [Ep 419 · 4:38](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=278)
- Recurrence most strongly associated with positive sentinel lymph node biopsies and deeper Breslow depth. — Stephen Scoville (clinical) [Ep 419 · 4:47](https://library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=287)
- Serous cystadenomas are benign lesions that may grow and become symptomatic, with rare case reports of malignant transformation, and about one-third are identified incidentally. — david skarda (clinical) [Ep 433 · 2:15](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=135)
- Serous cystadenomas are cured by removal. — david skarda (clinical) [Ep 433 · 3:27](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=207)
- Mucinous cystadenomas are more common in females and the majority are located in the tail of the pancreas. — david skarda (epidemiological) [Ep 433 · 3:54](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=234)
- Mucinous cystadenomas are generally considered benign but potentially pre-malignant lesions and are removed. — david skarda (clinical) [Ep 433 · 4:17](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=257)
- Mature cystic teratomas can arise anywhere within the pancreatic parenchyma and are oftentimes adjacent to the pancreas in the retroperitoneum. — david skarda (clinical) [Ep 433 · 4:51](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=291)
- Mature cystic teratomas can contain malignancy and are resected based on symptoms and malignant potential. — david skarda (clinical) [Ep 433 · 5:19](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=319)
- With the exception of serous cystadenoma which is probably totally completely benign, the mucinous versions and teratomas have enough malignant potential that biopsy may not make sense due to sampling error, and most will ultimately require resection. — david skarda (opinion) [Ep 433 · 7:21](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=441)
- Solid pseudopapillary tumors are the most common in young women with a mean age of diagnosis of 28 years. — david skarda (epidemiological) [Ep 433 · 18:21](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1101)
- Solid pseudopapillary tumors have a fairly benign course with some malignant potential, and complete surgical resection with clear margins is the treatment of choice. — david skarda (clinical) [Ep 433 · 18:32](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1112)
- Enucleation is not considered adequate treatment for solid pseudopapillary tumors, unlike insulinomas. — david skarda (clinical) [Ep 433 · 18:55](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1135)
- Overall survival with complete resection of solid pseudopapillary tumors is really good, and lymph node metastases are fairly rare. — david skarda (clinical) [Ep 433 · 19:08](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1148)
- There is a relatively high percentage (15-20%) of solid pseudopapillary tumors that present with metastatic disease, but it's called a benign tumor, and survival is still quite good without adjuvant therapy even with metastases. — david skarda (clinical) [Ep 433 · 20:44](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1244)
- In cases of solid pseudopapillary tumor with lung metastases, reported cases suggest resecting the primary tumor and letting metastatic deposits remain without requiring resection. — david skarda (clinical) [Ep 433 · 20:52](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1252)
- Pancreatoblastoma is the most common malignant pancreatic tumor in young children, with a mean age of 5 years and occurring twice as commonly in males compared to females. — david skarda (epidemiological) [Ep 433 · 25:55](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1555)
- Pancreatoblastomas are associated with Beckwith-Wiedemann syndrome and FAP, with some tumors having genetic abnormalities on chromosome 11p15. — david skarda (clinical) [Ep 433 · 26:10](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1570)
- In a fairly high percentage of pancreatoblastomas, alpha-fetoprotein is elevated, which can be used to monitor for recurrence after removal of the mass. — david skarda (clinical) [Ep 433 · 27:19](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1639)
- Mucinous cystadenocarcinomas are challenging to differentiate from mucinous cystadenomas, and histologically they can appear benign but frequently have foci of dysplastic or frankly malignant epithelium, making sampling a problem. — david skarda (clinical) [Ep 433 · 31:20](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1880)
- Mucinous cystadenocarcinomas are managed by complete excision, usually consisting of spleen-sparing distal pancreatectomy with adequate margins, and adjuvant chemotherapy can be considered for unresectable or metastatic disease, though efficacy is poorly understood. — david skarda (clinical) [Ep 433 · 32:15](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1935)
- Acinar cell adenocarcinomas in young children (around 3 years old) tend to be well-circumscribed masses that occur more commonly in males than females and can be equally distributed throughout the pancreas. — david skarda (epidemiological) [Ep 433 · 32:48](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1968)
- Acinar cell adenocarcinomas have areas of necrosis on imaging, vascular invasion is rare, and complete removal essentially results in cure without need for adjuvant chemotherapy or radiation. — david skarda (clinical) [Ep 433 · 33:14](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1994)
- Acinar cell adenocarcinomas have a much better prognosis than typical ductal adenocarcinoma. — david skarda (clinical) [Ep 433 · 33:40](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2020)
- Pancreatic ductal adenocarcinomas are extremely rare in young people and when they occur are often associated with FAP, Peutz-Jeghers syndrome, or hereditary pancreatic cancer syndrome. — david skarda (epidemiological) [Ep 433 · 33:49](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2029)
- Pancreatic ductal adenocarcinomas are firm, invasive tumors that frequently occur in the head of the pancreas and can cause obstructive jaundice by blocking the common bile duct. — david skarda (clinical) [Ep 433 · 34:20](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2060)
- Treatment of pancreatic ductal adenocarcinoma depends on tumor size, location, invasion, and resectability at time of diagnosis, potentially requiring palliative bypass procedures similar to adult patients. — david skarda (clinical) [Ep 433 · 34:44](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2084)
- Insulinoma is the most common pancreatic neuroendocrine tumor and is a beta islet cell neoplasm that produces excessive insulin resulting in hypoglycemia. — david skarda (clinical) [Ep 433 · 36:12](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2172)
- Insulinomas tend to be small, relatively well encapsulated, and because they make insulin, can be diagnosed fairly early. — david skarda (clinical) [Ep 433 · 36:33](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2193)
- The classic diagnostic findings for insulinoma are Whipple's triad: signs and symptoms of hypoglycemia, documented hypoglycemia during the symptomatic period, and resolution of symptoms with glucose administration. — david skarda (clinical) [Ep 433 · 36:43](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2203)
- Children with insulinomas tend to have symptoms for less than a year before diagnosis. — david skarda (epidemiological) [Ep 433 · 36:58](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2218)
- C-peptide levels are checked in suspected insulinoma to ensure the insulin is not exogenous (not from insulin injections). — david skarda (clinical) [Ep 433 · 38:57](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2337)
- Biochemical diagnosis of insulinoma includes elevated insulin and C-peptide levels with beta-hydroxybutyric acid level less than 2.7, with blood sugar rising after glucose administration. — david skarda (clinical) [Ep 433 · 39:12](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2352)
- Insulinomas tend to be relatively well encapsulated and surprisingly do not have blood vessels attached to them despite being endocrine tumors that secrete into the bloodstream. — david skarda (clinical) [Ep 433 · 40:39](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2439)
- Insulinomas can be enucleated and they pop out like a grape, with the main concern being the relationship of the tumor to the pancreatic duct. — david skarda (clinical) [Ep 433 · 41:17](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2477)
- Endoscopic ultrasound is really good at finding insulinomas, and intraoperative ultrasound allows visualization of the relationship of the mass to the pancreatic duct. — david skarda (clinical) [Ep 433 · 41:52](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2512)
- Sporadic insulinomas in children are often isolated and benign, while those with MEN1 tend to be multifocal and have a higher incidence of malignancy. — david skarda (clinical) [Ep 433 · 45:20](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2720)
- Gastrinomas are very rare in children and result in unregulated secretion of gastrin leading to hypergastrinemia and excessive stomach acid production with resulting ulcers in the stomach and duodenum (Zollinger-Ellison syndrome). — david skarda (clinical) [Ep 433 · 45:35](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2735)
- Eighty percent of gastrinomas occur sporadically, while 20% occur in the setting of MEN1, with MEN1-associated lesions tending to be multicentric, malignant, presenting at higher rates of metastasis and at younger ages. — david skarda (epidemiological) [Ep 433 · 46:03](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2763)
- About 60% of gastrinomas are not in the pancreas but are located in the wall of the duodenum, typically between where the common bile duct inserts and the junction of the second and third portion of the duodenum. — david skarda (clinical) [Ep 433 · 47:12](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2832)
- Gastrinomas can be palpated surgically, though imaging is not super great for locating them. — david skarda (clinical) [Ep 433 · 47:31](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2851)
- In adult algorithms for small incidental pancreatic cysts less than 2 centimeters, if biopsy shows serous content, observation with surveillance is acceptable, though the appropriate surveillance duration in adolescents is uncertain. (opinion) [Ep 433 · 10:56](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=656)
- For cystic pancreatic lesions, fluid should be sent for amylase and lipase, which theoretically should be elevated in a pseudocyst and not necessarily in neoplastic lesions. (clinical) [Ep 433 · 12:17](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=737)
- The reason for surveillance of presumed benign pancreatic lesions may be primarily to ensure diagnostic accuracy rather than to monitor for malignant degeneration, and if a lesion is stable for 5 years in a child, annual MRI surveillance may not be necessary indefinitely. (opinion) [Ep 433 · 12:37](https://library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=757)
- The ileocecal region may not be important to preserve in short bowel syndrome and may actually be injurious — Brad Warner (clinical) [Ep 446 · 3:28](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=208)
- Administration of a specific bile acid that is more lipophilic and hepatoprotective could be potential therapy for patients with cholestatic liver disease after massive intestinal resection — Brad Warner (clinical) [Ep 446 · 3:37](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=217)
- In clinical practice, surgeons cannot choose which intestinal segment to remove - they must remove what is dead and preserve as much viable bowel as possible — Brad Warner (clinical) [Ep 446 · 4:13](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=253)
- Once NED status was achieved, 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk — Andrew Fleming (clinical) [Ep 446 · 7:10](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=430)
- There is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma — Andrew Fleming (opinion) [Ep 446 · 8:06](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=486)
- Having a formal aerodigestive team is the way to ensure esophageal atresia surveillance gets done — Todd Ponsky (opinion) [Ep 446 · 12:20](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=740)
- Osteosarcoma most commonly affects adolescents and young adults — Bailey Roberts (epidemiological) [Ep 463 · 1:08](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=68)
- Gross metastasis at the time of diagnosis is present about 20% of the time in osteosarcoma — Bailey Roberts (epidemiological) [Ep 463 · 1:11](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71)
- The most common site of metastasis in osteosarcoma is in the lung — Bailey Roberts (clinical) [Ep 463 · 1:11](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71)
- Overall survival in osteosarcoma worsens from 80% to about 20% for metastatic disease — Bailey Roberts (epidemiological) [Ep 463 · 1:19](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=79)
- Recurrence is very common in osteosarcoma, and the most common site of recurrence is in the lungs — Bailey Roberts (clinical) [Ep 463 · 1:25](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=85)
- Extracellular vesicles are carriers of amino acids, proteins, mRNA or other forms of cellular communication — Bailey Roberts (clinical) [Ep 463 · 1:38](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=98)
- EV content is unique and specific to the cells that released it, and therefore can be traced back to the cell type — Bailey Roberts (clinical) [Ep 463 · 1:45](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=105)
- EVs are involved in the metastatic cascade and implicated as potential markers for disease diagnosis and staging — Bailey Roberts (clinical) [Ep 463 · 1:52](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=112)
- EVs have been shown to change fibroblasts, inhibit T cell activity, and are involved in establishing a pre-metastatic niche — Bailey Roberts (clinical) [Ep 463 · 1:59](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=119)
- K12 is a spontaneous osteosarcoma with low metastatic capability — Bailey Roberts (clinical) [Ep 463 · 2:31](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=151)
- K7M2 is a highly metastatic osteosarcoma derived from a spontaneous osteosarcoma that went through two reiterations of harvesting spontaneous lung metastases and reimplanting them into the mouse — Bailey Roberts (clinical) [Ep 463 · 2:35](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=155)
- The K7M2 cell line is more aggressive and causes death at a much higher rate than K12 — Bailey Roberts (clinical) [Ep 463 · 2:57](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=177)
- Pre-education with K7M2 EVs drastically increases the metastatic burden in the lungs of mice with K7M2 tumors — Bailey Roberts (clinical) [Ep 463 · 3:59](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=239)
- Pre-education with K7M2 EVs increased the overall mortality during the five-week study period in mice with K7M2 tumors — Bailey Roberts (clinical) [Ep 463 · 4:18](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=258)
- K7M2 EV education led to increased metastatic burden in mice with K12 tumors — Bailey Roberts (clinical) [Ep 463 · 4:44](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=284)
- Pre-education with highly metastatic cell line EVs increases the metastasis seen in a normally low metastatic tumor — Bailey Roberts (clinical) [Ep 463 · 5:01](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=301)
- No mice with K12 tumors died in the study period — Bailey Roberts (clinical) [Ep 463 · 5:09](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=309)
- Extracellular vesicles delivered prior to tumor implantation from highly metastatic K7M2 increase the metastatic burden of K7M2 tumors — Bailey Roberts (clinical) [Ep 463 · 5:14](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=314)
- Increased metastatic burden from extracellular vesicles decreases overall survival — Bailey Roberts (clinical) [Ep 463 · 5:24](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=324)
- Extracellular vesicles from highly metastatic K7M2 increase the metastatic burden of less metastatic K12 tumors — Bailey Roberts (clinical) [Ep 463 · 5:30](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=330)
- All cells in the body release EVs, so we can't just generally target EVs and hope to decrease the establishment of a pre-metastatic niche — Bailey Roberts (clinical) [Ep 463 · 6:27](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=387)
- IRF5 is a molecule being explored as a potential immunotherapy target in osteosarcoma EVs — Bailey Roberts (clinical) [Ep 463 · 6:48](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=408)
- Surgically removing the primary tumor is the current standard of care for osteosarcoma — Bailey Roberts (guideline) [Ep 463 · 7:10](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=430)
- There are certain membrane EV markers, but they're shared by all types of EVs — Bailey Roberts (clinical) [Ep 463 · 7:31](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=451)
- The differences in EVs by cell type have more to do with the contents inside of them than the targets on them, which makes them difficult to target as far as treatment — Bailey Roberts (clinical) [Ep 463 · 7:40](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=460)
- Studies in dogs have shown ability to take serum of dogs with osteosarcoma and determine their likelihood of metastasis based on the EVs — Bailey Roberts (clinical) [Ep 463 · 7:57](https://library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=477)
- Neuroblastoma is surgically challenging to resect mainly due to adhesion and encasement to important structures, heterogeneity, and therapy-induced changes. — Dominique Simons (clinical) [Ep 462 · 0:35](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=35)
- The surgical goal for neuroblastoma is to resect more than 95% of the tumor tissue while sparing anatomical structures. — Dominique Simons (guideline) [Ep 462 · 0:45](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=45)
- 3D models of patient-specific anatomy are routinely made to prepare surgeons for neuroblastoma resection. — Dominique Simons (clinical) [Ep 462 · 0:53](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=53)
- Complete resection of neuroblastoma is often very difficult or even impossible due to tumor location. — Dominique Simons (clinical) [Ep 462 · 0:57](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=57)
- Surgeons face a dilemma of whether to resect more tumor tissue with possible complications such as bleeding or to leave residual tumor tissue. — Dominique Simons (clinical) [Ep 462 · 1:07](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=67)
- Biology can be used as a biomarker for tumor vitality in neuroblastoma. — Dominique Simons (opinion) [Ep 462 · 1:26](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=86)
- In ADC imaging, diffusion restriction is associated with viable tumor tissue and appears as a low signal. — Dominique Simons (clinical) [Ep 462 · 1:36](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=96)
- In MIBG SPECT-CT imaging, high uptake is associated with viable tumor tissue. — Dominique Simons (clinical) [Ep 462 · 1:36](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=96)
- MIBG uptake and diffusion restriction in neuroblastoma change over time, suggesting the biology and vitality of the tumor may also change. — Dominique Simons (clinical) [Ep 462 · 1:52](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=112)
- ADC and MIBG scans have different 3D positions from T1-weighted MRI, requiring image registration. — Dominique Simons (clinical) [Ep 462 · 2:10](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=130)
- Registration accuracy is evaluated using the Dice coefficient (which measures overlap between two structures) and target registration error (which measures distance between two points). — Dominique Simons (clinical) [Ep 462 · 2:18](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=138)
- Risk group delineation uses ADC and MIBG values within the tumor volume with thresholds based on literature. — Dominique Simons (clinical) [Ep 462 · 2:30](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=150)
- High-risk areas in the 3D model are associated with diffusion restriction and MIBG uptake. — Dominique Simons (clinical) [Ep 462 · 2:41](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=161)
- Seven patients with abdominal neuroblastoma eligible for surgery were included prospectively. — Dominique Simons (epidemiological) [Ep 462 · 2:58](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=178)
- Accurate initial registration was achieved for all patients with a median Dice of 0.81 for ADC and 0.77 for MIBG. — Dominique Simons (clinical) [Ep 462 · 3:10](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190)
- Median target registration error was 5.3 mm for ADC and 4.3 mm for MIBG. — Dominique Simons (clinical) [Ep 462 · 3:10](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190)
- Multimodal 3D models were successfully created for every patient in the study. — Dominique Simons (clinical) [Ep 462 · 3:10](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190)
- In some cases, ADC and MIBG risk models showed similar patterns, with the lateral side of the tumor marked as high risk and the medial side as low risk. — Dominique Simons (clinical) [Ep 462 · 3:37](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=217)
- In other cases, ADC and MIBG identified completely different regions as high risk (e.g., cranial part high-risk on ADC versus a different region on MIBG). — Dominique Simons (clinical) [Ep 462 · 3:52](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=232)
- The thresholds used for risk stratification are based on limited literature, which questions the reliability of the ADC and MIBG values used. — Dominique Simons (opinion) [Ep 462 · 4:53](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=293)
- The image registration is performed using Elastix software in programming environments such as Python or MATLAB. — Dominique Simons (clinical) [Ep 462 · 5:48](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=348)
- Segmentation of the neuroblastoma is the most time-consuming step; the actual registration takes only a few minutes. — Dominique Simons (clinical) [Ep 462 · 6:14](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=374)
- Simmons performs the 3D model creation herself with verification from radiologists, especially in early phases. — Dominique Simons (clinical) [Ep 462 · 7:07](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=427)
- Current practice believes that MIBG-positive areas should be resected, but discordant ADC/MIBG findings suggest this may need re-evaluation. — Dominique Simons (opinion) [Ep 462 · 7:22](https://library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=442)
- Neuroblastoma makes up about 8 to 10% of all pediatric cancers and about 15% of cancer-related deaths. — Meera Kotagal (epidemiological) [Ep 525 · 0:23](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=23)
- For patients with relapsed high risk neuroblastoma, the survival rate is 0%. — Meera Kotagal (epidemiological) [Ep 525 · 0:48](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=48)
- 90% of neuroblastomas have elevated HVA and VMA (catecholamine metabolites). — Meera Kotagal (clinical) [Ep 525 · 2:17](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=137)
- Neuroblastomas are not typically thought of as causing elevated blood pressure despite producing catecholamines. — Meera Kotagal (clinical) [Ep 525 · 2:22](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=142)
- Image-defined risk factors (IDRFs) are best understood as things that touch important structures: vessels, brachial plexus, or trachea. — Meera Kotagal (clinical) [Ep 525 · 5:09](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=309)
- Intermediate risk neuroblastoma patients receive neoadjuvant chemotherapy with 2, 4, 6, or 8 cycles depending on chromosomal factors, followed by surgical resection. — Meera Kotagal (guideline) [Ep 525 · 7:15](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=435)
- The key surgical principle for neuroblastoma resection is to stay on the vessels and work from normal to abnormal anatomy. — Meera Kotagal (clinical) [Ep 525 · 7:38](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=458)
- Image-defined risk factors (IDRFs) are associated with increased risk of surgical complications. — Meera Kotagal (clinical) [Ep 525 · 8:22](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=502)
- When percutaneous core biopsies are performed by experienced practitioners who obtain multiple cores, the adequacy of these biopsies significantly improves and they are not inferior to open surgical biopsies. — Meera Kotagal (clinical) [Ep 525 · 9:13](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=553)
- At Cincinnati Children's, radiologists obtain 25 cores from different parts of neuroblastoma tumors during percutaneous biopsy. — Meera Kotagal (clinical) [Ep 525 · 9:33](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=573)
- For neuroblastoma, unlike most tumors, the goal is to get as much tumor as possible but complete resection of every ounce of tumor is not expected. — Meera Kotagal (clinical) [Ep 525 · 10:44](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=644)
- Tumor extending into neural foramina or other difficult locations should not be aggressively pursued; the goal is maximal safe resection without causing harm. — Meera Kotagal (clinical) [Ep 525 · 10:55](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=655)
- The observation protocol for infants with neuroblastoma has been expanded from primary adrenal tumors to L1 tumors in children under 6 months. — Meera Kotagal (guideline) [Ep 525 · 12:48](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=768)
- Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. — Jose Peiro (clinical) [Ep 532 · 0:47](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=47)
- Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. — Jose Peiro (clinical) [Ep 532 · 1:27](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=87)
- Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. — Jose Peiro (clinical) [Ep 532 · 1:43](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=103)
- In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. — Jose Peiro (clinical) [Ep 532 · 2:13](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=133)
- Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. — Jose Peiro (clinical) [Ep 532 · 3:12](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=192)
- Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. — Jose Peiro (clinical) [Ep 532 · 3:30](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=210)
- Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. — Jose Peiro (clinical) [Ep 532 · 3:49](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=229)
- CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. — Jose Peiro (clinical) [Ep 532 · 4:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=265)
- Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. — Jose Peiro (epidemiological) [Ep 532 · 4:53](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=293)
- Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. — Jose Peiro (clinical) [Ep 532 · 5:01](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=301)
- Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. — Jose Peiro (clinical) [Ep 532 · 5:22](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=322)
- The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. — Jose Peiro (clinical) [Ep 532 · 5:32](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=332)
- Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. — Jose Peiro (guideline) [Ep 532 · 5:51](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=351)
- Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. — Jose Peiro (clinical) [Ep 532 · 6:04](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=364)
- In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. — Jose Peiro (clinical) [Ep 532 · 6:16](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=376)
- Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. — Jose Peiro (clinical) [Ep 532 · 7:28](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=448)
- The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. — Jose Peiro (clinical) [Ep 532 · 7:51](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=471)
- In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. — Jose Peiro (clinical) [Ep 532 · 8:34](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=514)
- The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. — Jose Peiro (clinical) [Ep 532 · 8:58](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=538)
- During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. — Jose Peiro (clinical) [Ep 532 · 9:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=565)
- During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. — Jose Peiro (clinical) [Ep 532 · 9:48](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=588)
- Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. — Jose Peiro (clinical) [Ep 532 · 10:10](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=610)
- Neuroblastoma is the most common extracranial solid tumor of childhood arising from aberrant differentiation of sympathoadrenal cells in neural crest. — Yujie Ma (epidemiological) [Ep 555 · 0:45](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=45)
- Retinoic acid is used to induce differentiation in treatment of high risk neuroblastoma. — Yujie Ma (clinical) [Ep 555 · 0:56](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=56)
- Retinoic acid efficacy varies in patients due to the highly heterogeneous nature of neuroblastoma. — Yujie Ma (clinical) [Ep 555 · 1:03](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=63)
- PCP4 was identified as one of the differentiation markers of neuroblastoma tumor cells in a previous Cancer Cell publication. — Yujie Ma (clinical) [Ep 555 · 1:19](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=79)
- PCP4 modulates the rate of calcium binding to calmodulin, which is a critical step in activating calmodulin dependent kinase. — Yujie Ma (clinical) [Ep 555 · 1:38](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=98)
- The binding of PCP4 with calmodulin was verified in neuroblastoma by co-immunoprecipitation. — Yujie Ma (clinical) [Ep 555 · 1:49](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=109)
- CAMK2G was identified as a target kinase of calmodulin using mass spectrometry. — Yujie Ma (clinical) [Ep 555 · 1:49](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=109)
- CAMK2G is a member of the serine/threonine protein kinase family. — Yujie Ma (clinical) [Ep 555 · 2:06](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=126)
- CAMK2G plays an important role in neuronal development and synaptic plasticity. — Yujie Ma (clinical) [Ep 555 · 2:10](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=130)
- When CAMK2G is activated by calmodulin, it gets autophosphorylated at the site of threonine 287. — Yujie Ma (clinical) [Ep 555 · 2:24](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=144)
- PCP4 overexpression upregulated the threonine 287 phosphorylation of CAMK2G in neuroblastoma cells. — Yujie Ma (clinical) [Ep 555 · 2:33](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=153)
- Low CAMK2G mRNA expression was associated with worse overall and event-free survival in neuroblastoma patients. — Yujie Ma (clinical) [Ep 555 · 3:02](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=182)
- Low CAMK2G expression was associated with advanced INSS stages and unfavorable histology in neuroblastoma. — Yujie Ma (clinical) [Ep 555 · 3:02](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=182)
- Low CAMK2G expression was associated with MYCN amplified status, high risk, and tumor progression in neuroblastoma. — Yujie Ma (clinical) [Ep 555 · 3:14](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=194)
- CAMK2G knockdown in SKNSH cells resulted in inhibited neurite outgrowth even under retinoic acid induction. — Yujie Ma (clinical) [Ep 555 · 3:30](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=210)
- Expression of neuronal differentiation markers were downregulated following CAMK2G knockdown. — Yujie Ma (clinical) [Ep 555 · 3:44](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=224)
- Gene enrichment analysis of downregulated genes following CAMK2G knockdown showed enriched terms related to neuronal differentiation including synaptic signaling, plasma membrane, and ion channel activity. — Yujie Ma (clinical) [Ep 555 · 3:58](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=238)
- CAMK2G knockdown promoted migration and invasion of neuroblastoma cells as shown by transwell assays. — Yujie Ma (clinical) [Ep 555 · 4:13](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=253)
- KEGG analysis of upregulated genes following CAMK2G knockdown identified enriched pathways associated with tumor migration and invasion, including extracellular matrix receptor interaction, focal adhesion, and regulation of actin cytoskeleton. — Yujie Ma (clinical) [Ep 555 · 4:21](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=261)
- CAMK2G is expressed at low levels in SKNSH neuroblastoma cell line. — Yujie Ma (clinical) [Ep 555 · 6:20](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=380)
- CAMK2G is highly expressed in BE2 and SKNS neuroblastoma cell lines, which are MYCN amplified cell lines. — Yujie Ma (clinical) [Ep 555 · 6:33](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=393)
- CAMK2G function is not strong enough to overcome the oncogenic function of MYCN in MYCN-amplified neuroblastoma cell lines. — Yujie Ma (clinical) [Ep 555 · 6:33](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=393)
- CAMK2G did not regulate neuronal differentiation in MYCN-amplified neuroblastoma cell lines. — Yujie Ma (clinical) [Ep 555 · 7:11](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=431)
- The CAMK2G differentiation mechanism is not universal for all neuroblastoma cell lines and patients, and can only be explained in MYCN non-amplified cell lines and corresponding patients. — Yujie Ma (opinion) [Ep 555 · 7:33](https://library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=453)
- Patients with high-risk neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. — Sabine Irtan (clinical) [Ep 557 · 0:40](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=40)
- The role of surgery in high-risk neuroblastoma remains controversial. — Sabine Irtan (opinion) [Ep 557 · 0:48](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=48)
- The study included 283 patients (108 females, 175 males) who had a diagnosis at a median age of 35 months. — Sabine Irtan (epidemiological) [Ep 557 · 1:48](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=108)
- The primary tumor site was the abdomen in 95% of patients. — Sabine Irtan (epidemiological) [Ep 557 · 1:57](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=117)
- The tumor origin was the adrenal gland in 81% of patients. — Sabine Irtan (epidemiological) [Ep 557 · 2:02](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=122)
- The postoperative imaging was performed at a median of 62 days after surgery and was mainly a CT scan or MRI. — Sabine Irtan (clinical) [Ep 557 · 2:06](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=126)
- Residue was present in half of the patients on post-operative imaging. — Sabine Irtan (epidemiological) [Ep 557 · 2:17](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=137)
- The median volume of the residue was 0.27 mL. — Sabine Irtan (epidemiological) [Ep 557 · 2:20](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=140)
- The residue was a microcalcification in 28 patients. — Sabine Irtan (epidemiological) [Ep 557 · 2:25](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=145)
- Excluding patients with microcalcifications, the median residue volume was 1.04 mL, and only 11% of patients had a residue of more than 5 mL. — Sabine Irtan (epidemiological) [Ep 557 · 2:29](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=149)
- The residue was linked to the presence of IDRF in 71% of patients. — Sabine Irtan (epidemiological) [Ep 557 · 2:40](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=160)
- MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available. — Sabine Irtan (epidemiological) [Ep 557 · 2:40](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=160)
- There was no impact of the radiological postoperative residue on event-free survival and overall survival. — Sabine Irtan (clinical) [Ep 557 · 2:58](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=178)
- MIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival. — Sabine Irtan (clinical) [Ep 557 · 3:08](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=188)
- Patients who had an MIBG-positive residue had 25% and 27% five-year event-free survival, whereas patients with no residue or no MIBG-positive residue had 51% five-year event-free survival. — Sabine Irtan (clinical) [Ep 557 · 3:20](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=200)
- External validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results, especially in patients with complete response of the metastasis. — Sabine Irtan (clinical) [Ep 557 · 3:45](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=225)
- The difference between patients with MIBG-positive residue and patients with no residue or no MIBG-positive residue was still present for patients with partial or minimal response with a 10% survival difference. — Sabine Irtan (clinical) [Ep 557 · 4:04](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=244)
- Half of the patients operated on in expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL. — Sabine Irtan (clinical) [Ep 557 · 4:26](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=266)
- The residue was MIBG-positive in around 20% of patients. — Sabine Irtan (epidemiological) [Ep 557 · 4:36](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=276)
- Radiologically detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies. — Sabine Irtan (clinical) [Ep 557 · 4:40](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=280)
- Complete resection should be maintained as a major surgical goal. — Sabine Irtan (guideline) [Ep 557 · 4:54](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=294)
- Metastatic response is an important prognostic cofactor in stage 4 neuroblastoma. — Sabine Irtan (clinical) [Ep 557 · 4:59](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=299)
- In COG data, there was zero correlation between what the surgeon said they resected and what was actually present on post-operative imaging. (clinical) [Ep 557 · 5:19](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=319)
- For patients for whom the surgeon said they left nothing, almost half of the patients had still something on the postoperative images. — Sabine Irtan (clinical) [Ep 557 · 5:43](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=343)
- For patients for whom the surgeon said they left something, residue was found in two-thirds of patients and no residue was found in one-third of patients. — Sabine Irtan (clinical) [Ep 557 · 5:57](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=357)
- Doctor Margaret Mutch's team has about 10 years of experience with chest wall reconstructions. — Margaret Mutch (clinical) [Ep 588 · 0:16](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=16)
- Examination revealed an incomplete cord injury with absent lower limb reflexes and altered motor and sensation below the level of T6. — Margaret Mutch (clinical) [Ep 588 · 0:27](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=27)
- The patient underwent an emergency posterior laminectomy and partial tumor debulking initially for cord decompression between the levels of T3 and T7. — Margaret Mutch (clinical) [Ep 588 · 0:42](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=42)
- PET scan showed a PET avid lesion on the right-hand side just next to the sternum. — Margaret Mutch (clinical) [Ep 588 · 1:04](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=64)
- Radio guided occult lesion localization using technetium 99 was performed, followed by anterior thoracotomy to remove the lesion, which confirmed aggressive osteosarcoma replacing a lymph node. — Margaret Mutch (clinical) [Ep 588 · 1:12](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=72)
- Most of the reconstruction needs to be tailored to the needs of each individual, location and size of defects, and the particular type of material used. — Margaret Mutch (opinion) [Ep 588 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=92)
- A lot of the literature on chest wall reconstruction is coming from adults. — Margaret Mutch (epidemiological) [Ep 588 · 1:55](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=115)
- The spinal surgeons removed all of the vertebral bodies between T4 and T7 and inserted a cage, and the thoracic team resected ribs 4 to 7. — Margaret Mutch (clinical) [Ep 588 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=126)
- During surgery, a tumor thrombus was found in the azygos, which extended into the SVC. — Margaret Mutch (clinical) [Ep 588 · 2:28](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=148)
- Doctor Mutch's team tends to use resorbable and biosynthetic materials to do the reconstruction. — Margaret Mutch (clinical) [Ep 588 · 2:44](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=164)
- In Australia, two systems are used for chest wall reconstruction: one by Stryker and one by KLS, using resorbable plates that are molded in a water bath to reconstruct the rigid part of the chest wall. — Margaret Mutch (clinical) [Ep 588 · 2:51](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=171)
- Following plate placement, Permacol is placed on top of the implant, and subsequently a muscular flap, in this case the latissimus dorsi, is used to cover the Permacol. — Margaret Mutch (clinical) [Ep 588 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=194)
- The delta plates or the sonic weld system are polylactide and polyglycolide and polylactide plates with a strength of 78% at 2 months and 50% at 6 months. — Margaret Mutch (clinical) [Ep 588 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=217)
- The patient had a relapse 18 months following surgery close to his sternum. — Margaret Mutch (clinical) [Ep 588 · 4:05](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=245)
- The patient is currently having adjuvant chemotherapy. — Margaret Mutch (clinical) [Ep 588 · 4:22](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=262)
- In the team's 10-year experience, there was early postoperative wound infection in one patient, which was treated with IV antibiotics. — Margaret Mutch (clinical) [Ep 588 · 4:31](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=271)
- There were sterile seromas in two patients in the early stages, one at 2 months and one at 8 months, both treated with IR drainage. — Margaret Mutch (clinical) [Ep 588 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=276)
- European colleagues following SIOP guidelines would offer chemotherapy without biopsy for Wilms tumor. (guideline) [Ep 595 · 0:47](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=47)
- At COG (Children's Oncology Group) sites in North America, the approach would be resection and diagnosis. (guideline) [Ep 595 · 0:59](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=59)
- Doxorubicin would be added to chemotherapy even for a low stage tumor under certain conditions. (clinical) [Ep 595 · 1:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=77)
- Doxorubicin is added when there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 595 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=137)
- Loss of heterozygosity at 1P and 16Q shows higher recurrence in Wilms tumor. (clinical) [Ep 595 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=145)
- For surgeons, there will be more waiting for the biology results before determining if chemotherapy is needed, affecting decisions about port placement. (clinical) [Ep 595 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=163)
- It is not accurate to tell patients that if they are less than 2 years of age and the tumor is less than 550g, they will not need chemotherapy, because biology studies may require adding chemotherapy. (clinical) [Ep 595 · 2:56](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=176)
- Chemotherapy must be added if there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 595 · 3:09](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=189)
- Even in stage 1 favorable histology, chemotherapy is still added if there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 595 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=206)
- Rib fractures or vertebral fractures are fairly common as a presentation factor with hepatic tumors in young children, particularly hepatoblastoma. — Katherine Somers (clinical) [Ep 666 · 14:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=891)
- Fractures in hepatoblastoma patients will heal as they go through their therapy, and kids tend to be rather unbothered by their fractures once cancer therapy is underway. — Katherine Somers (clinical) [Ep 666 · 15:29](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=929)
- Precocious puberty in a Tanner stage one patient is a sign that should prompt consideration of underlying malignancy on the differential. — Katherine Somers (clinical) [Ep 666 · 15:43](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=943)
- Weight loss or sarcopenia during active cancer therapy is associated with poor outcomes across all pediatric cancer diagnoses. — Katherine Somers (epidemiological) [Ep 666 · 19:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1179)
- Advanced nutritional support is a key part of care for pediatric liver tumor patients to ready them for surgical interventions. — Katherine Somers (clinical) [Ep 666 · 19:52](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1192)
- With a young child, pulmonary metastasis, and a large liver mass, hepatoblastoma is the diagnosis 99.9% of the time. — Alex Tobin (clinical) [Ep 666 · 22:03](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1323)
- There is data in pediatrics about the approach of a tumor board as it pertains to the success and long-term outcomes of patients whose cases are presented at a tumor board style multidisciplinary conference. — Alex Bondoc (epidemiological) [Ep 666 · 23:04](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1384)
- You get the maximal effect of tumor shrinkage after the first block or cycle of chemotherapy in intermediate risk patients; you typically won't get as much shrinkage after subsequent blocks. — Alex Bondoc (clinical) [Ep 666 · 24:34](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1474)
- Indocyanine green (ICG) is highly sensitive but not specific for tumor detection; it can help find multifocal disease. — Alex Bondoc (clinical) [Ep 666 · 26:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1565)
- In about 15% of lung resections for hepatoblastoma metastases, ICG fluorescence finds lesions not visible on high-resolution CT imaging. — Alex Bondoc (clinical) [Ep 666 · 26:21](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1581)
- You can see tumor through vessel walls with indocyanine green. — Alex Bondoc (clinical) [Ep 666 · 26:46](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1606)
- The FIT trial (AHEP 1531) mandated liver biopsy for diagnosis before starting treatment. — Ranga (Ranganathan) (guideline) [Ep 666 · 30:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1805)
- Once chemotherapy begins and the tumor gets replaced by pools of blood and fibrous tissue, there's nothing for the chemotherapy to kill, and the size doesn't decrease much further beyond a certain point. — Ranga (Ranganathan) (clinical) [Ep 666 · 33:19](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1999)
- For patients with successful primary tumor resection, the first surgical goal is always primary tumor resection whenever possible. — Katherine Somers (clinical) [Ep 666 · 34:31](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2071)
- After primary tumor resection, consolidation chemotherapy alternates carboplatin-doxorubicin cycles with staged lung metastasectomy procedures. — Katherine Somers (clinical) [Ep 666 · 34:49](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2089)
- In patients with known vascular invasion and metastatic disease, continuing chemotherapy despite beautiful response helps weed out any remaining circulating cells that remain active. — Katherine Somers (clinical) [Ep 666 · 35:47](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2147)
- Hematogenous metastases to the lungs are the primary metastatic site for hepatoblastoma. — Alex Bondoc (clinical) [Ep 666 · 36:56](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2216)
- PRETEXT criteria define metastatic disease as more than 2 nodules greater than 3 millimeters in diameter or 1 nodule greater than 5 millimeters in diameter. — Alex Tobin (guideline) [Ep 666 · 38:46](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2326)
- Even when one side of the chest shows no viable tumor after chemotherapy, the other side is still cleared surgically because that is the best pathway to long-term disease control and maintenance of remission. — Katherine Somers (clinical) [Ep 666 · 39:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2360)
- ICG fluorescence correlates with the viability of lung metastases; non-fluorescent masses may represent dead tumor. — Alex Bondoc (clinical) [Ep 666 · 40:42](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2442)
- Patients with hepatoblastoma are frequently born prematurely. — Alex Tobin (epidemiological) [Ep 666 · 45:00](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2700)
- Known risk factors for developing hepatoblastoma include Beckwith-Wiedemann syndrome, hemihypertrophy syndromes, trisomy 18, autosomal recessive polycystic kidney disease, and extreme prematurity. — Katherine Somers (epidemiological) [Ep 666 · 48:44](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2924)
- It's not just autosomal recessive polycystic kidney disease children who develop hepatoblastoma; there is increased incidence in end-stage renal disease early in life. — Katherine Somers (epidemiological) [Ep 666 · 49:18](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2958)
- Cisplatin's primary toxicity is renal, and it can cause chronic kidney disease. — Katherine Somers (clinical) [Ep 666 · 49:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2979)
- Platinum-based chemotherapy can be delivered to patients on peritoneal dialysis using advanced pharmacokinetic and pharmacodynamic modeling systems without typical mandated hyperhydration. — Katherine Somers (clinical) [Ep 666 · 50:02](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3002)
- Hepatoblastoma typically presents in the toddler range (first and second year of life), but predisposed patients can develop it as early as congenital or immediately post-delivery. — Katherine Somers (clinical) [Ep 666 · 50:59](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3059)
- For known predisposition patients, screening protocol includes ultrasound and alpha-fetoprotein levels, taking into account that AFP has a very different range of normal values in the first months of life. — Katherine Somers (clinical) [Ep 666 · 51:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3080)
- PRETEXT 4 multifocal disease mandates liver transplant as the surgical approach. — Alex Bondoc (clinical) [Ep 666 · 52:15](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3135)
- In deceased donor liver transplant for hepatoblastoma, you cannot have extrahepatic disease because of the huge induction of immunosuppression required. — Alex Bondoc (clinical) [Ep 666 · 58:50](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3530)
- In the United States, a child with hepatoblastoma automatically gets status 1B categorization on the deceased donor list, which is the second highest stratum for organ allocation. — Alex Bondoc (guideline) [Ep 666 · 59:46](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3586)
- A patient with hepatoblastoma typically does not have underlying liver disease, unlike most liver transplant candidates. — Alex Bondoc (clinical) [Ep 666 · 60:10](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3610)
- Vincristine-irinotecan is a less intensive regimen that can be used as maintenance therapy while waiting for organ offers during transplant listing. — Katherine Somers (clinical) [Ep 666 · 60:58](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3658)
- Conventional hepatoblastoma is genomically quiet with very low mutation burden and invariably has either a point mutation or small deletion in exon 3 of the CTNNB1 gene. — Ranga (Ranganathan) (clinical) [Ep 666 · 62:23](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3743)
- Hepatocellular neoplasm NOS shows more genomic instability with chromosomal gains and losses, characterized by CTNNB1 deletion, often with large deletions or complete exon 3 skipping (exon 2 joined to exon 4). — Ranga (Ranganathan) (clinical) [Ep 666 · 62:41](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3761)
- Beta-catenin immunohistochemistry is frequently very weak positive or even negative in hepatocellular neoplasm NOS, which is a clue to diagnosis along with pleomorphic appearance and macrotrabecular arrangement. — Ranga (Ranganathan) (clinical) [Ep 666 · 63:19](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3799)
- Hepatocellular neoplasm NOS can be targeted with high-risk hepatoblastoma therapy to shrink tumors and make them amenable to surgery in most cases. — Ranga (Ranganathan) (clinical) [Ep 666 · 63:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3831)
- Every child with a new cancer diagnosis meets with oncology genetic counseling team for complete genetic testing including germline testing if something is identified. — Katherine Somers (clinical) [Ep 666 · 64:50](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3890)
- Radiomics can predict pure fetal histology hepatoblastoma with area under the receiver operating curve of about 0.85. — Alex Tobin (clinical) [Ep 666 · 66:36](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3996)
- Pure fetal histology hepatoblastoma patients are cured with resection alone and don't need chemotherapy. — Alex Tobin (clinical) [Ep 666 · 66:58](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4018)
- Artificial intelligence can segment hepatoblastoma tumors very accurately at the level of an expert. — Alex Tobin (clinical) [Ep 666 · 67:13](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4033)
- Approximately 10% of pediatric ovarian tumors are malignant — Fred Rescorla (epidemiological) [Ep 22 · 4:56](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=296)
- Among malignant ovarian tumors in children, germ cell tumors comprise greater than 50% and in some series up to 80% — Fred Rescorla (epidemiological) [Ep 22 · 5:10](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=310)
- In benign ovarian tumors, mature teratoma represents at least half of cases — Fred Rescorla (epidemiological) [Ep 22 · 5:30](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=330)
- Immature teratoma comprises approximately 10-15% of benign ovarian tumors — Fred Rescorla (epidemiological) [Ep 22 · 5:45](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=345)
- Predominantly cystic ovarian masses have approximately 3-4% risk of malignancy — Fred Rescorla (clinical) [Ep 22 · 4:20](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=260)
- Heterogeneous ovarian masses have approximately 15-20% malignancy risk — Fred Rescorla (clinical) [Ep 22 · 4:35](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=275)
- Solid ovarian masses have over 25% malignancy risk — Fred Rescorla (clinical) [Ep 22 · 4:45](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=285)
- For large predominantly cystic ovarian masses with normal markers, the risk of malignancy is much less than 1% — Fred Rescorla (clinical) [Ep 22 · 15:50](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=950)
- There is no oncologic requirement to remove the fallopian tube with malignant ovarian tumors if it can be preserved — Fred Rescorla (clinical) [Ep 22 · 21:44](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1304)
- CT scans are effective at detecting retroperitoneal lymph nodes and distant metastases in ovarian tumors — Fred Rescorla (clinical) [Ep 22 · 22:29](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1349)
- Peritoneal washings are the main finding that can upstage an otherwise stage 1 ovarian tumor — Fred Rescorla (clinical) [Ep 22 · 22:50](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1370)
- Pediatric surgeons deal primarily with germ cell tumors which are very chemo-responsive, while gynecologic surgeons deal more with epithelial tumors — Fred Rescorla (clinical) [Ep 22 · 23:22](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1402)
- For ovarian germ cell tumors, chemotherapy consists of platinum-based regimen with platinum, etoposide, and bleomycin — Fred Rescorla (clinical) [Ep 22 · 24:17](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1457)
- Stage 1 ovarian germ cell tumors have 96% overall survival — Fred Rescorla (epidemiological) [Ep 22 · 30:10](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1810)
- Stage 1 ovarian germ cell tumors managed without chemotherapy have approximately 50% relapse rate — Fred Rescorla (epidemiological) [Ep 22 · 30:20](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1820)
- The salvage rate for relapsed stage 1 ovarian germ cell tumors is nearly 100% — Fred Rescorla (epidemiological) [Ep 22 · 30:40](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1840)
- Approximately 50% of stage 1 ovarian germ cell tumor patients receive no chemotherapy at all — Fred Rescorla (epidemiological) [Ep 22 · 30:55](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1855)
- Stage 2 and 3 ovarian germ cell tumors have 97% survival with chemotherapy — Fred Rescorla (epidemiological) [Ep 22 · 31:30](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1890)
- Stage 4 ovarian germ cell tumors have approximately 80% overall survival — Fred Rescorla (epidemiological) [Ep 22 · 31:45](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1905)
- For stage 4 ovarian germ cell tumors, survival is approximately 92% if patient is less than 11 years of age — Fred Rescorla (epidemiological) [Ep 22 · 31:55](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1915)
- For stage 4 ovarian germ cell tumors, survival is approximately 60% if patient is over 11 years of age — Fred Rescorla (epidemiological) [Ep 22 · 31:55](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1915)
- Black, torsed ovaries should be detorsed and preserved rather than removed — Fred Rescorla (clinical) [Ep 22 · 32:32](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1952)
- Ovarian-preserving procedures should be performed for cystic or cystic with small solid component masses; only solid tumors require oophorectomy — Fred Rescorla (clinical) [Ep 22 · 32:45](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1965)
- Endoscopic skull base surgery was slow to propagate into the pediatric world despite evolving as an adult specialty. (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=0)
- Many pediatric neurosurgeons felt there wasn't enough room and hadn't had enough training in endoscopic skull-based techniques. (opinion) [Ep 23 · 3:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=180)
- Strong collaboration between pediatric neurosurgery and adult endoscopic skull base surgery is the key to program success. (opinion) [Ep 23 · 4:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=240)
- Children are not just little adults - there are unique special things about the pediatric population that adult surgeons may not be aware of or able to manage as well as pediatric neurosurgeons. (clinical) [Ep 23 · 5:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=300)
- Age 4 and above is a comfortable threshold after which most endoscopic skull base procedures can be performed, though younger is possible. (clinical) [Ep 23 · 9:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=540)
- In the pediatric population, the conchal type of sphenoid sinus is most common, and this enlarges over time. (clinical) [Ep 23 · 10:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=600)
- Even with a conchal sphenoid sinus, much of the bone in the middle of the sphenoid is very soft and can be easily drilled out with a diamond drill to create a pneumatized sphenoid sinus. (clinical) [Ep 23 · 11:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=660)
- After age 4, most conchal sphenoid sinuses are eliminated based on radiographic studies. (clinical) [Ep 23 · 12:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=720)
- Inter-carotid distance increases from 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference doesn't make a dramatic difference to surgical procedures. (clinical) [Ep 23 · 13:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=780)
- 100% of encephaloceles are now done using an endonasal approach, even fairly large ones, whereas traditionally these would be removed with a bifrontal craniotomy. (clinical) [Ep 23 · 15:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=900)
- For encephalocele repair, intrathecal fluorescein is given, a lumbar drain is placed, and all encephalocele tissue must be resected until gone, with cauterization of the edges. (clinical) [Ep 23 · 16:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=960)
- The closure technique for encephaloceles involves an inlay of Duragard on the inside, then an onlay of fat and a nasal septal flap. (clinical) [Ep 23 · 17:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1020)
- For encephaloceles, a lumbar drain is left in for a couple of days postoperatively because some patients have increased intracranial pressure, allowing pressure decrease while the closure tightens. (clinical) [Ep 23 · 18:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- In pediatric patients, a small rim of craniopharyngioma tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment. (clinical) [Ep 23 · 19:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- The endonasal view for craniopharyngiomas provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches. (clinical) [Ep 23 · 20:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1200)
- For craniopharyngiomas, the surgical goal is to save the pituitary stalk as long as possible, but if the stalk is completely infiltrated, it will be sacrificed to achieve cure. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed superiorly to the chiasm, and their sacrifice could cause visual loss. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- The endonasal approach for craniopharyngiomas results in no retraction of the brain, so there is no FLAIR signal in the brain after tumor removal. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- Comparing endonasal to transcranial surgery for craniopharyngiomas, the extent of resection for endonasal surgery is greater than for transcranial surgeries. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- Visual outcome after endonasal surgery for craniopharyngiomas is better than after transcranial surgery because the approach is from below without manipulation of optic nerves. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- In a series of 85 craniopharyngioma patients, gross total resection rate was 86%, greater than 95% resection achieved in 95% of patients, visual improvement in 78%, and CSF leak rate 2.4%. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- For craniopharyngiomas, diabetes insipidus and panhypopituitarism are common when pursuing gross total resection. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- In the pediatric craniopharyngioma series, visual function was stable or improved in over 70%, and all children except one returned to an academic environment, with 10 in a grade appropriate for age. (clinical) [Ep 23 · 21:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- Craniopharyngiomas in the pediatric age group are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adults have both adamantinomatous and papillary types. (clinical) [Ep 23 · 19:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified. (clinical) [Ep 23 · 19:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery. (clinical) [Ep 23 · 18:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus. (clinical) [Ep 23 · 18:00](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- For encephalocele repair, the approach is to first repair the encephalocele and see if it holds; shunting is only performed for patients with recurrent encephaloceles or clear hydrocephalus. (clinical) [Ep 23 · 23:13](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393)
- Patients are placed on acetazolamide for about 2 weeks after encephalocele repair to ensure healing. (clinical) [Ep 23 · 23:13](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393)
- Out of approximately 40 encephalocele cases, 3 or 4 patients required shunting postoperatively. (clinical) [Ep 23 · 23:38](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1418)
- Intrathecal fluorescein protocol uses a low dose of 0.3mL of 10% fluorescein diluted in 10cc of CSF, with pretreatment using Decadron and Benadryl. (clinical) [Ep 23 · 23:58](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438)
- Literature has shown adverse effects to high doses of intrathecal fluorescein, but with low-dose protocol and steroid pretreatment, no allergic reactions or arachnoiditis have been observed. (clinical) [Ep 23 · 23:58](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438)
- The same instruments, scope holder, and scopes used in adult endoscopic skull base surgery are used in pediatric cases. (clinical) [Ep 23 · 22:22](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342)
- When nostril width is a concern, the irrigation sheath can be removed from the scope, reducing its diameter from 4 millimeters to 2.7 millimeters. (clinical) [Ep 23 · 22:22](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342)
- Other than age less than 4, there are no significant anatomical concerns in the pediatric population for endoscopic skull base surgery beyond the perceived limitations of limited nares size and non-pneumatized sinuses. (clinical) [Ep 23 · 21:57](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1317)
- The long-term implications of arrested skull base growth in a child with lack of pneumatization 10 years down the road are unknown, though followed patients have not shown long-term problems. (clinical) [Ep 23 · 24:20](https://library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1460)
- The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal. — Greenfield (clinical) [Ep 24 · 0:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=0)
- Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy. — Greenfield (clinical) [Ep 24 · 7:00](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case. — Greenfield (clinical) [Ep 24 · 11:40](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges. — Greenfield (clinical) [Ep 24 · 16:25](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=985)
- The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases. — Greenfield (clinical) [Ep 24 · 18:29](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces. — Greenfield (clinical) [Ep 24 · 18:29](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- Endonasal equipment and scopes are designed to work in very small spaces and work well in the pediatric nose; while it is a little tighter, it is not so tight that cases cannot be done, and the practice has never had to avoid using an instrument because the nose was too small. — Schwartz (clinical) [Ep 24 · 19:30](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1170)
- Age 4 and above is generally a comfortable threshold for pediatric endonasal skull base surgery, though procedures are possible at younger ages. (clinical) [Ep 25 · 4:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=240)
- In pediatric patients, conchral (non-pneumatized) sphenoid sinuses can be converted to pneumatized sinuses by drilling out soft, vascular bone in the middle with a diamond drill until reaching harder bone over the carotid artery and planum. (clinical) [Ep 25 · 6:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=360)
- After age 4, most conchral sphenoid sinuses are eliminated, with progressive pneumatization occurring over time. (clinical) [Ep 25 · 7:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=420)
- The intercarotid distance increases from approximately 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference does not dramatically affect surgical feasibility. (clinical) [Ep 25 · 7:30](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=450)
- Essentially 100% of encephaloceles are now managed using an endonasal approach rather than bifrontal craniotomy. (clinical) [Ep 25 · 9:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=540)
- For encephalocele repair, intrathecal fluorescein is administered, a lumbar drain is placed, all encephalocele tissue is resected and cauterized back to the edges, and closure is performed with inlay Duragen, onlay fat, and nasal septal flap. (clinical) [Ep 25 · 9:20](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=560)
- Lumbar drains are left in place for a couple of days after encephalocele repair because some patients have increased intracranial pressure, allowing pressure reduction while the closure tightens. (clinical) [Ep 25 · 9:50](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=590)
- In pediatric craniopharyngioma surgery, a small rim of tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment. (clinical) [Ep 25 · 12:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=720)
- Craniopharyngiomas have two age peaks of presentation; pediatric cases are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adult cases include both adamantinomatous and papillary types. (clinical) [Ep 25 · 18:20](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1100)
- Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified. (clinical) [Ep 25 · 18:40](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1120)
- The endonasal view for craniopharyngioma provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches. (clinical) [Ep 25 · 19:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1140)
- In craniopharyngioma surgery, the pituitary stalk is preserved when possible, but is sacrificed if completely infiltrated with tumor in favor of achieving a cure. (clinical) [Ep 25 · 20:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1200)
- Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed the chiasm superiorly, which is critical for preventing visual loss. (clinical) [Ep 25 · 20:10](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1210)
- After endonasal craniopharyngioma resection, there is no flare signal in the brain on postoperative imaging because there is no brain retraction during the procedure. (clinical) [Ep 25 · 21:00](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1260)
- In a series of 85 craniopharyngioma patients, gross total resection was achieved in 86%, with greater than 95% resection in 95% of patients. (epidemiological) [Ep 25 · 21:30](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1290)
- Visual improvement occurred in 78% of craniopharyngioma patients after endonasal surgery. (epidemiological) [Ep 25 · 21:40](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1300)
- The CSF leak rate in the craniopharyngioma series was 2.4%. (epidemiological) [Ep 25 · 21:45](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1305)
- Diabetes insipidus and panhypopituitarism are fairly frequent outcomes when pursuing gross total resection of craniopharyngioma. (clinical) [Ep 25 · 21:50](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1310)
- In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population. (epidemiological) [Ep 25 · 21:57](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1317)
- In the pediatric craniopharyngioma series, only 2 patients had greater than 9% increase in BMI, visual function was stable or improved in over 70%, and all children except one returned to an academic environment with 10 in grade-appropriate settings. (epidemiological) [Ep 25 · 22:10](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1330)
- Complications in the pediatric craniopharyngioma series included 1 CSF leak, 1 visual loss, and 1 abscess. (epidemiological) [Ep 25 · 22:30](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350)
- Extent of resection for craniopharyngioma is greater with endonasal surgery compared to transcranial approaches. (epidemiological) [Ep 25 · 21:20](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1280)
- Visual outcomes after endonasal craniopharyngioma surgery are better than after transcranial surgery because the approach is from below without manipulation of the optic nerves. (clinical) [Ep 25 · 21:25](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1285)
- Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery. (clinical) [Ep 25 · 14:30](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=870)
- Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus. (clinical) [Ep 25 · 14:50](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=890)
- For encephaloceles associated with intracranial hypertension, the approach is to first repair the encephalocele and see if it holds, placing patients on acetazolamide for about 2 weeks postoperatively. (clinical) [Ep 25 · 23:13](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1393)
- Shunting for encephaloceles is reserved for patients with clearly evident hydrocephalus or those with recurrent encephaloceles after initial repair. (clinical) [Ep 25 · 23:20](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1400)
- Out of approximately 40 encephalocele cases, shunting was required 3 or 4 times. (epidemiological) [Ep 25 · 23:38](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1418)
- Intrathecal fluorescein is administered at a low dose of 0.3 mL of 10% fluorescein diluted in 10 cc of CSF, with pretreatment using Decadron and Benadryl to prevent adverse effects. (clinical) [Ep 25 · 23:58](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1438)
- Literature has shown adverse effects including allergic reactions and arachnoiditis with high doses of intrathecal fluorescein, but low-dose protocols with steroid pretreatment have not resulted in such problems in the speaker's experience. (clinical) [Ep 25 · 24:05](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1445)
- The same instruments, scopes, and scope holders used in adult endonasal surgery are used in pediatric cases. (clinical) [Ep 25 · 22:40](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1360)
- When nostril width is limiting, the irrigation sheath can be removed from the endoscope, reducing the diameter from 4 millimeters to 2.7 millimeters. (clinical) [Ep 25 · 22:30](https://library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350)
- Over 80% of pediatric brain tumors are curable, including both benign and malignant tumors. — Erin Keena (epidemiological) [Ep 26 · 1:25](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=85)
- The immature pediatric brain is still undergoing myelination, and while cells may be more vulnerable to injury, there is ongoing neuroplasticity, synaptogenesis, and synaptic pruning allowing for unique recovery from surgery. — Erin Keena (clinical) [Ep 26 · 1:25](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=85)
- Modern WHO guidelines now include genomic and molecular analysis requirements for multiple tumor types, necessitating adequate tissue preservation. — Erin Keena (guideline) [Ep 26 · 2:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=150)
- All brain tissue is relevant; there is not just eloquent and non-eloquent cortex, and all fiber tracts en route to lesions must be preserved regardless of corridor. — Erin Keena (opinion) [Ep 26 · 3:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=200)
- From awake craniotomy data, 90% of new intraoperative neurological deficits occur during subcortical dissection. — Erin Keena (clinical) [Ep 26 · 4:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=280)
- A parafascicular trajectory minimizes shear forces applied to white matter tracts by running parallel to the main white matter tracts. — Erin Keena (clinical) [Ep 26 · 5:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=320)
- A trans-sulcal route with parafascicular trajectory reduces the amount of brain traversed en route to reach lesions. — Erin Keena (clinical) [Ep 26 · 6:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=360)
- Using a tubular retractor distributes forces radially, thereby protecting displaced tissue rather than simply retracting with malleable retractors. — Erin Keena (clinical) [Ep 26 · 6:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=390)
- Traditional craniotomies can cause brain collapse in children with large ventricles after corpus callosotomy, leading to CSF egress into subdural space, pseudomeningocele development, and prolonged recoveries. — Erin Keena (clinical) [Ep 26 · 9:00](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=540)
- Pure endoscopic resection is limited by inability to achieve simultaneous hemostasis, restriction to one-handed technique, poor retraction capability, and requirement to remove tumor in very small pieces or morsellate with devices. — Erin Keena (clinical) [Ep 26 · 9:50](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=590)
- BrainPath approach requires a small craniotomy 2.5 to 3 centimeters in diameter and has a slightly restrictive field requiring extra-long keyhole instruments. — Erin Keena (clinical) [Ep 26 · 10:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=630)
- The port cannot be moved around significantly once in place or it will disrupt fiber tracts. — Erin Keena (clinical) [Ep 26 · 10:30](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=630)
- Ideal BrainPath cases are lesions less than 4 centimeters that can be accessed down the long axis through a parafascicular corridor, including subcortical, deep, or metastatic lesions. — Erin Keena (opinion) [Ep 26 · 11:10](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=670)
- In Dr. Keena's personal series, mean operative time was 3 hours and 11 minutes with median length of stay of 48 hours. — Erin Keena (clinical) [Ep 26 · 15:50](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=950)
- In Dr. Keena's personal series, extent of resection matched intended resection in every case. — Erin Keena (clinical) [Ep 26 · 16:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=980)
- In Dr. Keena's personal series, all patients were neurologically intact with the exception of one pre-existing visual field deficit. — Erin Keena (clinical) [Ep 26 · 16:20](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=980)
- The broader BrainPath series includes over 200 cases used throughout the brain, predominantly for supratentorial indications including primary tumors and metastases. — Erin Keena (clinical) [Ep 26 · 16:49](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1009)
- BrainPath resection is safe and efficacious with similar or improved outcomes and shorter lengths of stay compared to traditional approaches. — Erin Keena (opinion) [Ep 26 · 16:49](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1009)
- For trans-sulcal BrainPath passage, the arachnoid is opened up to about 2 centimeters (though only 15mm is needed), then the patient is placed under Valsalva without mannitol or CSF pressure relief, the opening is widened with bipolar tips, and the blunt trocar is passed under navigation. — Erin Keena (clinical) [Ep 26 · 19:22](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1162)
- The blunt tip of the BrainPath trocar allows vessels to roll off radially, and Dr. Keena has not ruptured any veins or arteries using this technique. — Erin Keena (clinical) [Ep 26 · 20:40](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1240)
- The Nico Myriad preserves tissue architecture by morsellating tissue and provides the smallest obstruction in the surgical view due to its streamlined handpiece. — Erin Keena (clinical) [Ep 26 · 17:14](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1034)
- The exoscope provides more options for patient head positioning and approach angle compared to the microscope, which requires careful positioning so the port is as superior as possible for ergonomic downward viewing. — Erin Keena (clinical) [Ep 26 · 17:14](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=1034)
- Removing choroid plexus tumors en bloc with BrainPath preserves the architecture for pathologists to make critical diagnoses, unlike morsellation into small pieces. — Erin Keena (clinical) [Ep 26 · 14:10](https://library.globalcastmd.com/watch/minimally-disruptive-subcortical-neurosurgery-in-children-concepts-of-the-387?t=850)
- In the United States, approximately 85% of pediatric cancer patients now survive their initial disease, up from much lower rates in the 1970s, due to earlier diagnostics, improved chemotherapy, biologics, and changes in radiation. — Teresa Woodruff (epidemiological) [Ep 27 · 1:45](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=105)
- Approximately 1.4–1.5 million people are newly diagnosed with cancer annually in the US; globally there are ~10 million new cases per year. About 10% of US cases occur in patients aged ≤45, and 11% of breast cancers are diagnosed before age 40, totaling roughly 200,000 young patients annually. — Teresa Woodruff (epidemiological) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=180)
- Pediatric cancer survivors are significantly more likely to be infertile than their siblings. — Teresa Woodruff (epidemiological) [Ep 27 · 5:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=340)
- Fertility concerns extend beyond cancer to rheumatologic diseases (often female, treated with cytotoxic drugs), beta-thalassemia patients receiving stem-cell transplant with sterilizing whole-body radiation, Turner syndrome (mosaic cases with early ovarian failure), BRCA or other cancer-predisposition mutations, and disorders of sex development or gender transition where the biological gamete may be at risk. — Teresa Woodruff (clinical) [Ep 27 · 6:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=360)
- Sperm banking has been available for pubertal boys and men for many years at relatively low cost, but navigation to these services was historically poor. — Teresa Woodruff (clinical) [Ep 27 · 8:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=500)
- Young women historically had fewer fertility-preservation options than men due to three gaps: information (providers unaware of long-term infertility risk), data (inability to predict individual outcomes), and options (lack of techniques for prepubertal or young patients). — Teresa Woodruff (clinical) [Ep 27 · 9:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=540)
- It remains difficult to predict on an individual basis which patients will recover gonadal function after gonadotoxic treatment and which will be permanently sterile. — Teresa Woodruff (clinical) [Ep 27 · 10:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=620)
- The Oncofertility Consortium adopted an interdisciplinary framework requiring investment in basic follicle biology, creation of 'silo spanners' (patient navigators bridging oncology, reproductive endocrinology, surgery, genetics, and radiation oncology), training of new scholars in interdisciplinary thinking, and 360° patient support (legal, ethical, insurance, religious counseling). — Teresa Woodruff (clinical) [Ep 27 · 11:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=660)
- For women aged ≥18, embryo or egg banking is an established option; the Oncofertility Consortium lowered the recommended age threshold from 18 to 16 two years ago, but use below age 16 should occur only under IRB approval. — Teresa Woodruff (clinical) [Ep 27 · 17:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1060)
- Across Oncofertility Consortium sites, the average wait time for controlled ovarian stimulation and egg retrieval is 12 days. — Teresa Woodruff (clinical) [Ep 27 · 19:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1180)
- Tamoxifen holidays allow hormone-receptor-positive breast cancer survivors to become pregnant with good outcomes and may improve long-term compliance with adjuvant endocrine therapy. — Teresa Woodruff (clinical) [Ep 27 · 20:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1200)
- For prepubertal and adolescent patients up to age 16, ovarian tissue cryopreservation (removal of an entire ovary or cortical biopsy under IRB-approved consent) is the only available fertility-preservation option. — Teresa Woodruff (clinical) [Ep 27 · 20:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1240)
- Ovarian cortical tissue is dissected into small strips containing primordial through antral follicles and cryopreserved; tissue may need to remain frozen for 20–30 years if the patient is 5 or 6 years old at diagnosis. — Teresa Woodruff (clinical) [Ep 27 · 21:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1300)
- Oocytes that are released adventitiously during ovarian-tissue dissection are often allocated to research in pediatric cases (rather than cryopreserved for the patient) because oocyte quality and aneuploidy rates in patients under 18 are not well characterized; aneuploidy is known to rise both above age 35 and below age 18. — Teresa Woodruff (clinical) [Ep 27 · 22:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1360)
- Eighty-six live human births have been documented worldwide from autotransplantation of cryopreserved ovarian tissue, demonstrating that current cryopreservation methods maintain tissue function. — Teresa Woodruff (clinical) [Ep 27 · 25:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1500)
- The denominator for ovarian-tissue transplants (total number attempted) and cancer-recurrence rates are not known globally, limiting assessment of efficacy and safety. — Teresa Woodruff (clinical) [Ep 27 · 25:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1540)
- Pediatric ovarian cortex contains more primordial follicles than adult tissue (follicles are formed in utero between the second and third trimester), but may also harbor circulating cancer cells; transplanting such tissue risks reintroducing malignancy. — Teresa Woodruff (clinical) [Ep 27 · 27:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1620)
- Histologic staining of a 4-year-old patient's ovarian cortex revealed both abundant primordial follicles and circulating cancer cells, illustrating the contamination risk. — Teresa Woodruff (clinical) [Ep 27 · 28:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1700)
- Follicles cultured on flat plastic do not maintain three-dimensional architecture; mouse follicles form follicle-like structures but oocytes mature poorly, and human follicles simply flatten out. — Teresa Woodruff (clinical) [Ep 27 · 31:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1860)
- Encapsulating isolated follicles in alginate hydrogel maintains three-dimensional architecture, permits follicle expansion and granulosa-cell differentiation into theca cells, and supports estrogen production over time in both mouse and human follicles. — Teresa Woodruff (clinical) [Ep 27 · 32:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1920)
- Alginate-encapsulated mouse follicles undergo in-vitro ovulation (antrum formation, oocyte migration to one pole, rupture, and cumulus–oocyte-complex release) and yield live healthy mouse pups after fertilization. — Teresa Woodruff (clinical) [Ep 27 · 33:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2000)
- A microfluidic 'organ-on-chip' system (Evatar) linking mouse ovary with human fallopian tube, uterus, cervix, and liver has reproduced a full 28-day menstrual cycle in vitro, including follicular-phase estradiol rise, mid-cycle HCG-triggered ovulation, and luteal-phase progesterone, and can model early pregnancy by maintaining progesterone. — Teresa Woodruff (clinical) [Ep 27 · 34:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2060)
- Human ovarian follicles have been grown in alginate for 30–40 days; after 40 days, germinal-vesicle-intact oocytes can be recovered and matured in vitro. — Teresa Woodruff (clinical) [Ep 27 · 36:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2160)
- In 2015, Woodruff's group reported the first human metaphase-II eggs matured entirely in vitro from encapsulated follicles, a milestone for fertility preservation without tissue transplantation. — Teresa Woodruff (clinical) [Ep 27 · 36:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2200)
- Mature human and mouse oocytes release a 'zinc spark'—a burst of zinc fluorescence—at fertilization; immature oocytes do not. This assay may serve as a non-invasive marker of oocyte developmental competence. — Teresa Woodruff (clinical) [Ep 27 · 37:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2240)
- Decellularized ovarian scaffolds ('ovary paper') can be repopulated with follicles and sutured to soft tissue; when transplanted into ovariectomized prepubertal mice, 100% of recipients underwent puberty. — Teresa Woodruff (clinical) [Ep 27 · 38:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2300)
- Three-dimensional-printed gelatin scaffolds seeded with GFP-labeled prepubertal mouse follicles become vascularized after transplant and yield live GFP-positive pups, representing the first soft-organ transplant with fully 3D-printed bio-inspired tissue. — Teresa Woodruff (clinical) [Ep 27 · 39:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2360)
- Woodruff's group is translating bioprosthetic ovary work to minipigs and plans to transplant small scaffold pieces subcutaneously in consenting human recipients to assess biocompatibility. — Teresa Woodruff (clinical) [Ep 27 · 40:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2420)
- Dr. Soo Yung Kim is developing next-generation neoadjuvant fertoprotective drugs with the goal of eliminating the need for ovarian-tissue removal in future cancer patients. — Teresa Woodruff (clinical) [Ep 27 · 41:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2460)
- In a one-year National Physicians Cooperative study, 44 pediatric patients (ages 1 month to 15 years) contributed fresh (not cryopreserved) ovarian tissue; 44 follicles were isolated, approximately 20 formed antra, and 4 yielded metaphase-II eggs (the remainder were germinal-vesicle stage). Results were published in Scientific Reports 2015. — Teresa Woodruff (clinical) [Ep 27 · 43:03](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2583)
- A 2016 analysis of NPC pediatric cases (ICD-10 codes) confirmed that clinicians appropriately selected patients at high risk for gonadotoxicity; this work was presented at the 2016 Oncofertility meeting and is pending publication. — Teresa Woodruff (clinical) [Ep 27 · 45:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2720)
- For males, sperm banking is recommended regardless of risk level if the family is concerned, because it is non-operative and relatively inexpensive (though it costs money and ~6 hours). For females, ovarian-tissue cryopreservation is a surgical intervention and should be reserved for high-risk cases identified by oncologists using established criteria. — Teresa Woodruff (opinion) [Ep 27 · 46:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2800)
- At the beginning of the Oncofertility Consortium, all tissue-banking cases were adults with breast cancer; today nearly no adults participate in the NPC tissue program because they have other options (egg/embryo banking), and the program focuses on pediatric patients. — Teresa Woodruff (clinical) [Ep 27 · 48:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2880)
- Cone beam CT can be performed on a C-arm fluoroscopy unit in an OR, hybrid OR, or interventional suite by rotating around the patient to create stacked CT images — Todd Ponsky (clinical) [Ep 396 · 23:59](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=1439)
- Ultrasound guidance for foreign body removal becomes difficult after tissue dissection introduces air around the foreign body, making visualization nearly impossible — Todd Ponsky (clinical) [Ep 396 · 33:13](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=1993)
- Cryoablation for thoracotomy pain control results in 2-3 fold reduction in narcotic use during hospitalization compared to epidural or IV pain management alone — Todd Ponsky (clinical) [Ep 396 · 97:07](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=5827)
- New cryoprobe technology reduces freeze cycle from 2 minutes to 90 seconds, with improved shaft insulation allowing contact with lung tissue without freezing — Todd Ponsky (clinical) [Ep 396 · 86:23](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=5183)
- MMP-7 (matrix metalloproteinase-7) is a validated diagnostic biomarker for biliary atresia with sensitivity demonstrated across multiple international studies — Todd Ponsky (clinical) [Ep 396 · 115:48](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=6948)
- Lipiodol marking for pulmonary nodules achieves 100% sensitivity and remains visible for up to 3 months, allowing delayed surgery without wire dislodgement risk — Todd Ponsky (clinical) [Ep 396 · 126:37](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=7597)
- ChatGPT can perform title/abstract screening for systematic reviews with excellent inter-rater reliability compared to human reviewers when using custom GPT with serial prompts — Todd Ponsky (clinical) [Ep 396 · 149:03](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=8943)
- Ultrasound can identify 30-40% more lung nodules through palpation and visualization than CT scan alone — Todd Ponsky (clinical) [Ep 396 · 16:47](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=1007)
- The majority of splenectomies nationwide happen before patients receive blood transfusion — Todd Ponsky (epidemiological) [Ep 396 · 62:39](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=3759)
- Cone beam CT can be performed on a C-arm fluoroscopy unit in an OR, hybrid OR, or interventional suite by rotating around the patient to create stacked CT images — Todd Ponsky (clinical) [Ep 395 · 23:55](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=1435)
- Ultrasound-guided foreign body removal becomes difficult after tissue dissection introduces air around the foreign body, making it virtually invisible on ultrasound — Todd Ponsky (clinical) [Ep 395 · 33:13](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=1993)
- For pulmonary nodule localization, coil placement avoids wire dislodgement risk and can be combined with cone beam CT in the OR if the nodule is difficult to locate — Todd Ponsky (clinical) [Ep 395 · 36:02](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=2162)
- The Shehata technique for intraabdominal testes achieves 88% success rate by fixing the testis to the contralateral abdominal wall for 2-3 months to allow vessel elongation without dividing testicular blood supply (clinical) [Ep 395 · 51:27](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=3087)
- Internal hernia has never been reported after Shehata technique in over 430 cases over 15 years, and is anatomically unlikely when attempting to bring bowel behind the spermatic cord (clinical) [Ep 395 · 52:15](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=3135)
- 18% of lateral cutaneous nerve branches are posterior to the mid-axillary line, so cryoablation must be performed posterior enough (4 cm from vertebral column in posterior axillary line) to ensure effective nerve block — Todd Ponsky (clinical) [Ep 395 · 89:09](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5349)
- For cryoablation during thoracotomy, going 1-2 levels above and below the incision with 60-second freeze cycles provides effective pain control; must avoid T10 or lower to prevent pseudo-hernias from motor branch involvement — Todd Ponsky (clinical) [Ep 395 · 95:43](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5743)
- Cryoablation for thoracotomy pain showed 2-3 fold reduction in narcotic use during hospitalization compared to regional blocks, with patients discharged without narcotic prescriptions — Todd Ponsky (clinical) [Ep 395 · 97:05](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5825)
- The new cryoprobe reduces freeze time from 2 minutes to 90 seconds, reaches temperature 20 seconds faster, and has improved shaft insulation that only reaches room temperature so it can safely touch lung or skin — Todd Ponsky (clinical) [Ep 395 · 86:23](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5183)
- Double-freeze cryoablation technique targeting both the main intercostal nerve and the collateral branch on the rib below reduced peak pain scores from 5 to 3 in 20 patients, with 9 of 22 patients in Dr. Kim's study reporting pain scores of zero — Todd Ponsky (clinical) [Ep 395 · 91:51](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5511)
- Lipiodol marking for pulmonary nodules achieved 100% sensitivity in 33 nodules across multiple patients, with the radiopaque dye persisting for 3 months and allowing surgery to be performed days after marking — Todd Ponsky (clinical) [Ep 395 · 125:56](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=7556)
- For slipping rib syndrome, intercostal nerve block with steroid and long-acting local anesthetic serves as a diagnostic test; if effective, percutaneous cryoablation can provide longer-term relief before considering surgery — Todd Ponsky (clinical) [Ep 395 · 100:44](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=6044)
- REBOA (resuscitative endovascular balloon aortic occlusion) can be used in children but is not commonly performed in pediatric hospitals, requires significant expertise for rapid deployment, and does not show clear survival advantage even in adult studies — Todd Ponsky (clinical) [Ep 395 · 79:10](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=4750)
- For adolescent trauma patients with orthopedic injuries requiring prolonged non-weight bearing, aspirin 81mg BID is being used as an alternative to Lovenox for outpatient DVT prophylaxis based on adult data, with better compliance expected — Todd Ponsky (clinical) [Ep 395 · 76:56](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=4616)
- Subpleural intercostal nerve blocks with 0.25% marcaine with epinephrine work immediately (versus 8-10 hour delay with cryo), take 15 seconds per interspace, and allow zero opioid use in the OR — Todd Ponsky (clinical) [Ep 395 · 84:49](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=5089)
- In North America, the Children's Oncology Group recommends primary nephrectomy and ureterectomy with lymph node sampling for the majority of children with renal tumors. — Peter Ehrlich (guideline) [Ep 65 · 6:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=383)
- Preoperative chemotherapy is recommended if the tumor compromises the child's respiratory status, making them a poor operative candidate. — Peter Ehrlich (guideline) [Ep 65 · 7:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=421)
- If tumor extends into the inferior vena cava beyond the intrahepatic level (behind the liver or up to the atrium), preoperative chemotherapy is recommended. — Peter Ehrlich (guideline) [Ep 65 · 7:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=453)
- Massive tumors that would require resection of large parts of liver or bowel should receive preoperative chemotherapy because the majority will respond. — Peter Ehrlich (guideline) [Ep 65 · 7:57](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=477)
- If the child has only one functioning kidney, preoperative chemotherapy is recommended to avoid nephrectomy. — Peter Ehrlich (guideline) [Ep 65 · 8:21](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=501)
- Children with bilateral renal tumors, Wilms tumor predisposition syndromes (Wagr, Denys-Drash, Beckwith-Wiedemann), or multicentric tumors should not undergo primary nephrectomy. — Peter Ehrlich (guideline) [Ep 65 · 8:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=513)
- Complication rates are higher if liver or bowel must be resected at the same time as the kidney. — Peter Ehrlich (clinical) [Ep 65 · 10:38](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=638)
- If gross tumor is left behind or the tumor is only biopsied, it is treated as a stage 3 abdominal tumor requiring 3-drug chemotherapy plus flank radiation. — Peter Ehrlich (guideline) [Ep 65 · 11:18](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=678)
- The maximum response of most children with Wilms tumor to chemotherapy occurs by 12 weeks. — Peter Ehrlich (clinical) [Ep 65 · 59:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3577)
- In the COG staging system, treatment is determined by both local abdominal stage and disease stage. — Peter Ehrlich (guideline) [Ep 65 · 19:44](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1184)
- Stage 1 tumor is limited to the kidney, completely resected, with no capsular invasion, no rupture or biopsy prior to removal, no renal sinus vessel involvement, negative margins, and negative regional lymph nodes. — Peter Ehrlich (guideline) [Ep 65 · 20:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1201)
- Stage 2 tumor is completely resected with negative margins but extends beyond the kidney through capsular penetration, renal sinus soft tissue invasion, or blood vessel involvement outside the primary kidney. — Peter Ehrlich (guideline) [Ep 65 · 20:28](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1228)
- Stage 3 includes tumors that are biopsied with gross residual, have positive lymph nodes, penetrate the peritoneal surface with implants, have positive margins, have microscopic residual from intraoperative spill, cannot be completely resected, or must be removed in pieces. — Peter Ehrlich (guideline) [Ep 65 · 21:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1260)
- Stage 4 is hematogenous metastasis to lung, liver, bone, or brain. — Peter Ehrlich (guideline) [Ep 65 · 21:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1318)
- Stage 5 is bilateral renal tumor involvement. — Peter Ehrlich (guideline) [Ep 65 · 22:06](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1326)
- Patients with stage 1 or 2 abdominal disease without lung metastases receive only 2-drug chemotherapy (vincristine and dactinomycin) for shorter duration with lower toxicity and significantly lower risk of late effects. — Peter Ehrlich (guideline) [Ep 65 · 23:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1388)
- The main late effects of Wilms tumor treatment are renal failure, second malignancies, pregnancy problems in females, hypertension, and cardiovascular disease, primarily caused by radiation and doxorubicin. — Peter Ehrlich (clinical) [Ep 65 · 23:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1417)
- If a child has stage 1 or 2 abdominal disease, they do not require abdominal radiation regardless of lung metastases status. — Peter Ehrlich (guideline) [Ep 65 · 24:06](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1446)
- A recent COG study showed that approximately 40% of patients with pulmonary metastases who achieve complete response by 6 weeks of chemotherapy do not need pulmonary radiation, with 80-85% remaining relapse-free. — Peter Ehrlich (clinical) [Ep 65 · 26:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1584)
- Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer. — Peter Ehrlich (epidemiological) [Ep 65 · 26:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1568)
- Pulmonary radiation causes pneumonitis and long-term restrictive lung disease. — Peter Ehrlich (clinical) [Ep 65 · 26:20](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1580)
- In the SIOP protocols, all patients start with chemotherapy without biopsy in most cases, using higher doses of two drugs, with evaluation at 4 and 8 weeks before proceeding to resection. — Peter Ehrlich (guideline) [Ep 65 · 30:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1831)
- SIOP uses post-chemotherapy, post-nephrectomy classification into low risk, intermediate risk, and high risk based on percentage of blastemal components and presence of anaplasia. — Peter Ehrlich (guideline) [Ep 65 · 31:06](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1866)
- Some children with Wilms tumor develop acquired von Willebrand disease; in the majority of cases it is meaningless, but a few case series report significant bleeding during surgery until the tumor is removed. — Peter Ehrlich (clinical) [Ep 65 · 35:11](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2111)
- Wilms tumors characteristically show a 'claw sign' on imaging where normal kidney is displaced into a horseshoe pattern, appearing to grab the mass coming out of it. — Peter Ehrlich (clinical) [Ep 65 · 3:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=229)
- Wilms tumor tends to push structures out of the way rather than growing around them, whereas neuroblastoma grows around structures like blood vessels. — Peter Ehrlich (clinical) [Ep 65 · 4:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=256)
- Positive surgical margins or tumor rupture (intraoperative or microscopic) automatically makes the patient stage 3. — Peter Ehrlich (guideline) [Ep 65 · 41:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2484)
- Taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided. — Peter Ehrlich (guideline) [Ep 65 · 42:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2551)
- Very low-risk patients (stage I, <550g, <2 years, favorable histology) can be treated with surgery alone; 90-95% are cured without chemotherapy, and those who relapse have 100% survival with delayed chemotherapy. — Peter Ehrlich (clinical) [Ep 65 · 43:32](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2612)
- IVC tumor extension is not a negative prognostic factor if the tumor is completely resected. — Peter Ehrlich (clinical) [Ep 65 · 46:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2774)
- If IVC tumor thrombus extends into the renal vein but is not adherent and comes out in one piece, it is considered stage 2. — Peter Ehrlich (guideline) [Ep 65 · 46:38](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2798)
- Major complication rates (including mortality, blood transfusions, ICU stay) increase significantly when tumor extends beyond the infrahepatic IVC to the hepatic veins or atrium, with 26-30% major morbidity in primary resection cases. — Peter Ehrlich (clinical) [Ep 65 · 47:43](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2863)
- Loss of heterozygosity at both 1p and 16q occurs in 5-7% of patients and is associated with significantly worse outcomes regardless of stage. — Peter Ehrlich (clinical) [Ep 65 · 54:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3281)
- Stage 1-2 patients with loss of heterozygosity at 1p and 16q have approximately 10% lower overall survival than those without these genetic changes. — Peter Ehrlich (epidemiological) [Ep 65 · 55:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3323)
- Stage 3-4 patients with loss of heterozygosity at 1p and 16q have approximately 18% lower overall survival and receive 5-drug regimen M chemotherapy. — Peter Ehrlich (clinical) [Ep 65 · 55:45](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3345)
- Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 65 · 57:46](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3466)
- Event-free survival for unilateral Wilms tumor is approximately 88% with overall survival of 95%. — Peter Ehrlich (epidemiological) [Ep 65 · 58:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3531)
- Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% with overall survival of only 80%. — Peter Ehrlich (epidemiological) [Ep 65 · 58:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3531)
- In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. — Peter Ehrlich (clinical) [Ep 65 · 60:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3631)
- Open biopsy to determine favorable vs. unfavorable histology in Wilms tumor is not very accurate initially. — Peter Ehrlich (clinical) [Ep 65 · 61:02](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3662)
- In a recent COG bilateral Wilms study of 250 patients, only one patient who met enrollment criteria turned out to have rhabdoid tumor instead of Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 65 · 61:12](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3672)
- Discordant pathology occurs in up to 20% of bilateral Wilms tumor patients when both kidneys are biopsied. — Peter Ehrlich (epidemiological) [Ep 65 · 62:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3734)
- Childhood cancer represents less than 1% of the nearly 1.6 million new diagnoses of cancer in the United States every year, which amounts to over 15,000 children diagnosed with cancer annually — Karen Burns (epidemiological) [Ep 59 · 0:55](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=55)
- Less than 1% of cancer diagnoses amounts to 43 children diagnosed every single day and about 40,000 children in treatment in any given year in the United States — Karen Burns (epidemiological) [Ep 59 · 3:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=180)
- The average age at diagnosis for childhood cancer is 6 years old — Karen Burns (epidemiological) [Ep 59 · 3:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=200)
- Childhood cancer affects all ethnic, gender, and socioeconomic groups with no bias — Karen Burns (epidemiological) [Ep 59 · 3:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=210)
- Most pediatric cancers result from DNA changes that can be found early in life, even if the disease does not manifest for several more years — Karen Burns (clinical) [Ep 59 · 3:50](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=230)
- Unlike adult cancers, pediatric cancers are usually not linked to any environmental factors and not linked to any lifestyle factors — Karen Burns (clinical) [Ep 59 · 4:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=260)
- Most pediatric cancer patients are treated at a children's oncology group center, and children are more likely to be treated on a therapeutic trial than in the adult population — Karen Burns (clinical) [Ep 59 · 4:40](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=280)
- In children under 14 years old, leukemia and lymphomas make up the vast majority of diagnoses, followed closely by CNS or brain tumors — Karen Burns (epidemiological) [Ep 59 · 5:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=300)
- In adolescent or young adult patients, leukemia and lymphomas are still common, but lymphomas make up a larger proportion largely due to Hodgkin's lymphoma, and sarcomas and solid tumors take up a greater percentage of diagnoses — Karen Burns (epidemiological) [Ep 59 · 5:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=330)
- Childhood cancers typically grow very quickly and some will also spread very quickly, with minimal time between presentation, diagnostic workup, and start of therapy—sometimes within just a couple of days or just a week or two — Karen Burns (clinical) [Ep 59 · 6:10](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=370)
- Childhood cancer patients respond very well to traditional chemotherapy and can tolerate much higher doses and compressed chemotherapy schedules compared to adult counterparts — Karen Burns (clinical) [Ep 59 · 6:40](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=400)
- Traditional chemotherapy is specific for the cell cycle but not necessarily specific for the cell type, so it will affect non-cancerous cells just as much as cancerous cells, which can lead to late effects — Karen Burns (clinical) [Ep 59 · 7:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=420)
- There is a tendency to try to minimize radiation in the pediatric population as much as possible because of the late effects associated with radiation and the fact that they can accumulate as the years go on — Karen Burns (clinical) [Ep 59 · 7:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=450)
- Most oncology therapies now are risk-adapted therapy, where disease is staged at diagnosis and restaged after one or two cycles to identify rapid early responders who receive less intense therapy and slow early responders who continue more intense therapy — Karen Burns (clinical) [Ep 59 · 8:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=480)
- Risk-adapted therapy allows delivery of therapy appropriate to the patient to achieve optimal cures while minimizing late effects, so patients responding well to therapy do not get extra therapy they don't need — Karen Burns (clinical) [Ep 59 · 8:50](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=530)
- Newer immunotherapies include CAR T cell therapy where the patient's own T cells are harvested and genetically engineered to attack a specific target on cancer cells — Karen Burns (clinical) [Ep 59 · 9:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=560)
- Targeted therapies specific to cancer cells include monoclonal antibodies, bispecific T cell engineered therapy, kinase inhibitors, PDL1 inhibitors, small molecules, and anti-angiogenesis agents, which are more specific for cell type so fewer non-cancerous cells are damaged — Karen Burns (clinical) [Ep 59 · 9:50](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=590)
- The current 5-year cancer-free survival rate in pediatrics is over 83% — Karen Burns (epidemiological) [Ep 59 · 10:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=630)
- In 2013 it was estimated that about 420,000 childhood cancer survivors were living in the United States, with an estimation of 500,000 or half a million cancer survivors by the year 2020 — Karen Burns (epidemiological) [Ep 59 · 10:50](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=650)
- Gonadotoxicity associated with cancer therapy includes delayed puberty, early menopause, azospermia, and loss of fertility — Karen Burns (clinical) [Ep 59 · 7:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=420)
- Research has shown that fertility is extremely important to patients and their quality of life post therapy, regardless of their age, diagnosis, and whether or not they've already had children — Karen Burns (clinical) [Ep 59 · 7:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=440)
- Premature menopause may allow a window of opportunity to do fertility preservation in female survivor patients — Karen Burns (clinical) [Ep 59 · 7:40](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=460)
- Data presented at ASCO in 2016 by Doctor Levine from the CCSS showed that female childhood cancer survivors between ages 20 and 29 did not have any statistically significant difference in pregnancy rate compared to their sibling controls — Karen Burns (epidemiological) [Ep 59 · 7:55](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=475)
- Female childhood cancer survivors between ages 30 and 39 had a significantly decreased rate of pregnancy compared to controls, indicating a window of opportunity but requiring quick action due to risk of early menopause — Karen Burns (epidemiological) [Ep 59 · 8:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=510)
- Male patients have been shown to be very interested in knowing their risk status and being offered a review of their risk as well as a semen analysis to know where they stand post therapy — Karen Burns (clinical) [Ep 59 · 9:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=540)
- All patients benefit from counseling and from reviewing their fertility risks — Karen Burns (opinion) [Ep 59 · 9:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=560)
- The ASCO consensus statement says that informed consent about fertility should happen before cancer therapy and as early as possible to allow the greatest number of fertility preservation options — Karen Burns (guideline) [Ep 59 · 9:30](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=570)
- If fertility preservation services are not available in your area, they should be offered through a referring center who can provide that service for the patients — Karen Burns (guideline) [Ep 59 · 10:00](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=600)
- It is important to talk to the parents of children and minors as well as patients of consenting age about fertility preservation, and this treatment should continue through survivorship — Karen Burns (guideline) [Ep 59 · 10:20](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=620)
- Some fertility preservation techniques really don't require a lot of time to complete and don't interfere very much with the timing of therapy—they can be done quickly and efficiently — Karen Burns (clinical) [Ep 59 · 12:25](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=745)
- Patients really embrace fertility preservation discussions and are extremely appreciative of the knowledge and the chance to even just think about having children in the future, as it gives them hope for the future — Karen Burns (opinion) [Ep 59 · 12:50](https://library.globalcastmd.com/watch/unique-aspects-of-pediatric-care-delivery-model-pediatric-oncofertility-2017-898?t=770)
- Oocyte cryopreservation was made standard of care by the Society for Reproductive Medicine in 2012, removing barriers for adolescents who previously required long-term partners or sperm donation for embryo cryopreservation. — Hefkin (guideline) [Ep 60 · 2:22](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=142)
- Controlled ovarian stimulation for oocyte/embryo cryopreservation historically required 4-6 weeks, but recent luteal-phase protocols can achieve consultation to cryopreservation in less than 2 weeks. — Hefkin (clinical) [Ep 60 · 5:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=350)
- Live birth rates for embryo and oocyte cryopreservation average 33-52%, with oocyte outcomes approaching embryo outcomes due to improved freezing and thawing techniques. — Hefkin (epidemiological) [Ep 60 · 5:00](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=300)
- Connecticut is the first state with mandated fertility preservation coverage, achieved by changing the definition of infertility from 'otherwise healthy females trying for 6-12 months' to 'medical necessity.' — Hefkin (guideline) [Ep 60 · 7:30](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=450)
- Ovarian transposition achieves 50-90% reductions in radiation to the ovary and 30-50% maintenance of ovarian function, but fertility preservation outcomes are not well studied in pediatric populations. — Hefkin (clinical) [Ep 60 · 10:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=650)
- In 2013, ASCO guidelines recommended that patients be informed there is insufficient evidence to recommend GnRH analogs as fertility protection. — Hefkin (guideline) [Ep 60 · 15:00](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=900)
- The POEMS study (Prevention of Early Menopause Study) in breast cancer patients using goserelin plus chemotherapy versus chemotherapy alone showed statistically significant reduction in ovarian failure and decreased odds ratio for pregnancies. — Hefkin (clinical) [Ep 60 · 15:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=950)
- Ovarian tissue cryopreservation is the only method of fertility preservation available for prepubertal patients. — Hefkin (clinical) [Ep 60 · 17:30](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1050)
- Current cryopreservation standard is slow-freeze technique; vitrification studies show it is likely better, but it should not be considered standard until outcome data exists. — Hefkin (clinical) [Ep 60 · 19:10](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1150)
- There have been 86 live births in the literature from orthotopic ovarian tissue transplantation, with 2 from patients in the prepubertal population (only 1 reported in literature). — Hefkin (epidemiological) [Ep 60 · 20:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1250)
- In the Jadoul study of 545 ovarian tissue cryopreservation procedures, there were only 5 minor complications, 1 major complication requiring repeat surgery for bleeding, and only 1 death reported in all literature from OTC procedures. — Hefkin (epidemiological) [Ep 60 · 21:40](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1300)
- In the Jadoul study, 30% of patients were under age 18 and 15% were prepubertal, with a deceased rate of 10% overall and 13.5% in patients under 18. — Hefkin (epidemiological) [Ep 60 · 22:30](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1350)
- Tissue utilization rate in the Jadoul study was 4%, compared to less than 10% for oncology patients who return to use cryopreserved semen. — Hefkin (epidemiological) [Ep 60 · 22:40](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1360)
- 96% of patients surveyed were satisfied with having undergone ovarian tissue cryopreservation, including those who did not utilize their tissue, showing satisfaction comes from having the choice rather than needing to use it. — Hefkin (epidemiological) [Ep 60 · 22:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1370)
- Cincinnati Children's ovarian tissue cryopreservation protocol allows females ages 1 month to 41 years undergoing gonadotoxic treatment, with FSH less than 20, and no restrictions based on risk assessment (though most patients electing OTC are high-risk). — Hefkin (clinical) [Ep 60 · 18:20](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1100)
- Cincinnati Children's has performed over 70 ovarian tissue cryopreservations with 4 complications (3 minor, 1 small bowel obstruction 1 year post-procedure in patient with bowel GVHD), 5 deaths (9.6%, all disease-related, none procedure-related), and no complications since the 52-patient review. — Hefkin (epidemiological) [Ep 60 · 20:00](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1200)
- In prepubertal patients, it is technically difficult to remove cortical strips from already very small ovaries, which is why some institutions remove whole ovaries in younger patients while adult centers typically remove cortical strips from larger ovaries. — Hefkin (clinical) [Ep 60 · 29:11](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1751)
- Three breast cancer studies showed GnRH analogs decreased amenorrhea, while three lymphoma studies showed no protection in ovarian reserve, with two studies stopped early due to lack of benefit. — Hefkin (epidemiological) [Ep 60 · 14:10](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=850)
- Pediatric gynecology services are the minority in freestanding children's hospitals; many have gynecologists from the adult world who come in a few days or have clinic once a week, which may not fit timely fertility preservation needs. (clinical) [Ep 60 · 26:38](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=1598)
- The testes has a greater chemo and radio sensitivity than the ovaries. — Shrine (clinical) [Ep 63 · 0:08](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=8)
- Chemotherapeutic agents used for pediatric cancer treatment readily cross the blood testes barrier and primarily affect cells undergoing spermatogenesis due to their high mitotic rate. — Shrine (clinical) [Ep 63 · 0:08](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=8)
- Leydig cells that produce testosterone are less sensitive to chemotherapy but can have sensitivity to radiation at very high doses. — Shrine (clinical) [Ep 63 · 0:08](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=8)
- Males have no protective effect of receiving treatment at a younger age, which differs from females. — Shrine (clinical) [Ep 63 · 0:08](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=8)
- Retroperitoneal lymph node dissections for testicular cancer can damage sympathetic nerves that control antegrade ejaculation, leading to fertility issues. — Shrine (clinical) [Ep 63 · 0:08](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=8)
- Electroejaculation with insertion of a probe into the rectum can harvest a specimen and needs to be performed under general anesthesia. — Shrine (clinical) [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Sperm cryopreservation should be offered prior to treatment, as the quality of semen analysis and DNA integrity can be compromised after even a single course of treatment. — Shrine (clinical) [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Stage of puberty development (typically Tanner stage 3 or above) is a better indicator than age for determining when to offer sperm cryopreservation. — Shrine (opinion) [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Testicular sperm extraction (TESE) involves retrieval of sperm from focal areas of spermatogenesis in the seminiferous tubules for later use with ICSI. — Shrine (clinical) [Ep 63 · 6:20](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=380)
- Microscopic assistance in TESE allows better identification of tubules that potentially contain sperm and has improved retrieval rates in adult literature. — Shrine (clinical) [Ep 63 · 7:45](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=465)
- Fertility preservation before puberty in males is challenging due to the absence of mature sperm that can be cryopreserved. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- Preserving fertility in prepubertal males is contingent on future development of experimental therapies for maturation of spermatogonial stem cells to sperm. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- Spermatogonial stem cell therapies developed in animal models include direct transplantation into the testicle, transplantation of testicular tissue as autologous or xenograft, and in vitro sperm maturation, but none have been performed successfully in humans. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- Testicular tissue cryopreservation involves harvesting immature testicular tissue prior to treatment initiation and cryopreservation with slow freezing techniques. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- At Cincinnati Children's, testicular tissue cryopreservation eligibility includes pediatric males 6 months to 17 years with >80% risk of long-term azoospermia, and adults 18-25 years with 21-79% risk. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- The excisional biopsy is coordinated with other surgical procedures to minimize anesthetic risk and expedite treatment initiation, performed through a transscrotal approach. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- 75% of harvested testicular tissue is stored at Reprotech for patient use and 25% is designated for research at McGee Women's Research Institute. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- No successful retrieval of mature sperm or pregnancies from cryopreserved testicular tissue have been reported to date in humans. — Shrine (clinical) [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- Risk categories for testicular tissue cryopreservation are based on chemotherapy regimen, radiation therapy, and cumulative dosing using cyclophosphamide equivalent dosing published by Dan Green in 2014. (clinical) [Ep 63 · 13:59](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=839)
- The patient navigator role is crucial to fertility programs for laterally integrating all disciplines involved in making fertility preservation happen for patients and families. — Olivia (opinion) [Ep 64 · 0:31](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=31)
- The patient navigator works with patients with both malignant and non-malignant conditions that have treatment impairing their fertility. — Olivia (clinical) [Ep 64 · 3:20](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=200)
- Cincinnati Children's works with UC (University of Cincinnati) to send older patients for oocyte cryopreservation. — Olivia (clinical) [Ep 64 · 4:40](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=280)
- The Cancer and Blood Diseases Institute at Cincinnati Children's is broken up into 4 teams: bone marrow transplant, liquids and lymphoma, solid tumor, and neuro-oncology. — Olivia (clinical) [Ep 64 · 7:30](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=450)
- The fertility consult email address has a 24-hour response time for urgent cases, with a pager available Monday to Friday and on-call gynecologist or urologist coverage on weekends. — Olivia (clinical) [Ep 64 · 9:40](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=580)
- Cincinnati Children's grabs baseline fertility labs on each patient, including anti-mullerian hormone levels for females, to have something to compare when they're off therapy. — Olivia (clinical) [Ep 64 · 12:30](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=750)
- The program provides standardized educational folders with specific handouts tailored to each patient's preservation options, including materials from LiveWell and LiveStrong. — Olivia (clinical) [Ep 64 · 13:40](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=820)
- Every patient who has an option to elect fertility preservation receives follow-up conversation within 72 hours, either over the phone or inpatient. — Olivia (clinical) [Ep 64 · 14:30](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=870)
- The program works with the social work team to identify patients with financial burden and allocate philanthropic funds, as even a $75 storage fee may be too much for some families. — Olivia (clinical) [Ep 64 · 15:30](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=930)
- The program aims to see patients one year post-chemotherapy to repeat the fertility panel and compare with baseline to assess how fertility was impacted. — Olivia (clinical) [Ep 64 · 16:40](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=1000)
- Fertility labs are drawn each year in survivorship because there could be a window for post-therapy intervention such as ovarian tissue cryopreservation or oocyte cryopreservation. — Olivia (clinical) [Ep 64 · 17:30](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=1050)
- The navigator position at Cincinnati Children's started with 4 hours of FTE, increased to 8 hours, and eventually became a full-time job. — Olivia (clinical) [Ep 64 · 18:15](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-funding-the-904?t=1095)
- Successful pregnancies from ovarian tissue transplantation were initially reported in 2004 or 2005 (clinical) [Ep 61 · 0:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=0)
- Significant experience with ovarian tissue transplantation comes from Belgium, Denmark, Israel, and Germany (epidemiological) [Ep 61 · 1:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=60)
- Ovarian tissue can be transplanted on or into a remaining ovary, or in a pocket of the pelvic peritoneum, most commonly in the ovarian fossa (clinical) [Ep 61 · 4:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=240)
- Peritoneal pocket placement allows natural conception with good communication between the fallopian tube and transplanted ovarian tissue (clinical) [Ep 61 · 6:30](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=390)
- FertiPROTECT network was founded in 2006 and has more than 100 participating centers with centralized cryobanks (epidemiological) [Ep 61 · 10:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=600)
- FertiPROTECT reported 95 transplantations in 74 women through June 2015 (epidemiological) [Ep 61 · 10:30](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=630)
- In FertiPROTECT subgroup 5 (POI patients with 6 months amenorrhea), 62.5% had active tissue one year after transplant, 27.5% achieved pregnancy, and 22.5% had deliveries (epidemiological) [Ep 61 · 12:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=720)
- All pregnancies in the POI subgroup were spontaneous without IVF (clinical) [Ep 61 · 13:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=780)
- For peritoneal pocket placement specifically, 68% had active tissue one year after transplant, 28% became pregnant, and 23% achieved delivery (epidemiological) [Ep 61 · 13:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=800)
- Interseed (cellulose barrier) has been used in the GYN community for many years in the area of the ovaries and fallopian tubes to decrease adhesions and has not been a fertility concern (clinical) [Ep 61 · 14:08](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=848)
- Different cryoprotectants are used at different sites, including DMSO and glucose (clinical) [Ep 61 · 15:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=900)
- The Brussels group typically had an upper age limit of 35 years for transplant (clinical) [Ep 61 · 17:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1020)
- In the Brussels cohort, 15% of patients who underwent cryopreservation were pre-pubertal (epidemiological) [Ep 61 · 18:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1080)
- Follow-up time in the Brussels study was about 7.5 years plus or minus 3.5 years when questionnaires were sent (epidemiological) [Ep 61 · 18:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1100)
- Patients who were younger at the time of cryopreservation were more likely to respond to the questionnaire than older patients (epidemiological) [Ep 61 · 19:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1140)
- 9.9% overall of patients who had OTC died from their disease since the procedure, with higher rates in younger patients (epidemiological) [Ep 61 · 20:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1200)
- 24 of 545 patients (4.4%) returned for transplantation, of whom 21 were transplanted and 3 were declined due to leukemia diagnosis (epidemiological) [Ep 61 · 21:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1260)
- 7 of 21 transplanted patients conceived after transplantation, representing a 33% delivery rate (epidemiological) [Ep 61 · 21:30](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1290)
- Reported pregnancy rates across published papers range from about 25% to 35% in best case scenarios (epidemiological) [Ep 61 · 22:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1320)
- BMT (bone marrow transplant) is a high risk population for ovarian tissue transplantation (clinical) [Ep 61 · 22:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1340)
- 96% of patients in the Brussels study did not report any complications from the procedure (epidemiological) [Ep 61 · 23:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1400)
- 96% of patients were satisfied with the ovarian tissue cryopreservation procedure (epidemiological) [Ep 61 · 24:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1440)
- Of 3 dissatisfied patients, one could not understand the procedure fully, one found it unnecessary after spontaneous conception, and one was declined transplant due to leukemia risk (epidemiological) [Ep 61 · 24:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1460)
- The highest risk of premature ovarian insufficiency outside of oophorectomy is associated with bone marrow transplant (clinical) [Ep 61 · 25:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1500)
- Techniques to assess tissue for malignancy before transplant include histology on frozen specimens, immunochemistry, molecular biology techniques, and xenograft models using immunocompetent mice (clinical) [Ep 61 · 25:40](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1540)
- Factors influencing graft longevity include patient age at cryopreservation, baseline ovarian reserve, graft site, degree of ischemia at transplantation, freezing and thawing techniques, and patient medical history (clinical) [Ep 61 · 27:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1620)
- Belgian group data from 2015 showed FSH fell significantly over the first several months after transplant, with some grafts functioning for several years (clinical) [Ep 61 · 27:30](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1650)
- Building street credibility with oncology teams by not delaying treatment was critical to program success (opinion) [Ep 62 · 0:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=0)
- A minority of patients and families choose to intervene with fertility preservation, but every patient and family should have the opportunity to understand their risks and options (clinical) [Ep 62 · 1:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=60)
- Focusing on care managers (nurses and nurse practitioners) rather than physician providers, using standardized Epic orders, and making fertility consultation opt-out instead of opt-in improved program uptake (clinical) [Ep 62 · 2:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=120)
- After 8 years, the oncology team now proactively identifies when fertility consult orders are missed (clinical) [Ep 62 · 2:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=120)
- Having a stable, consistent fertility navigator that the oncology team knows and trusts is the most significant factor in program success (opinion) [Ep 62 · 3:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=180)
- Run charts show observable decline in program success metrics during fertility navigator maternity leave or absences (clinical) [Ep 62 · 3:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=180)
- The team received a 2017 faculty clinical team award from their institution (clinical) [Ep 62 · 5:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=300)
- Institutional leadership recognized return on mission rather than return on investment for the fertility preservation program (opinion) [Ep 62 · 5:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=300)
- The program initially leveraged gynecology divisional resources to fund the fertility navigator position (clinical) [Ep 62 · 6:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=360)
- US News and World Report rankings now include questions about fertility preservation services, including what is offered and what percentage of patients receive services (clinical) [Ep 62 · 6:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=360)
- The program offers discounted bundled research costs for investigational procedures including testicular tissue cryopreservation and ovarian tissue cryopreservation (clinical) [Ep 62 · 6:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=360)
- Philanthropic funds are available to support families so fertility preservation is not a choice between preserving fertility and paying rent (clinical) [Ep 62 · 6:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=360)
- In April 2017, 46 patients were seen, of whom 25 were ineligible and 21 were eligible for fertility preservation (epidemiological) [Ep 62 · 7:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=420)
- The program runs at approximately 50 to 60% patient eligibility rate by their institutional definition (epidemiological) [Ep 62 · 7:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=420)
- Four patients were missed during a fertility navigator transition period (clinical) [Ep 62 · 8:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=480)
- The median percentage of eligible patients who elect to proceed with fertility preservation is 16.9% (epidemiological) [Ep 62 · 9:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=540)
- The majority of patients are satisfied hearing about fertility preservation options and making a decision not to proceed at that time (clinical) [Ep 62 · 9:00](https://library.globalcastmd.com/watch/keys-to-building-a-successful-interdisciplinary-program-905?t=540)
- There is a documented increase in pediatric thyroid disease over two decades based on SEER database analysis, including large thyroid nodules not attributable to better screening alone. — Jason (epidemiological) [Ep 66 · 0:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=0)
- Approximately 4-5% of children have thyroid nodules, and of those, roughly 30% are malignant, which is an inverse ratio compared to adults where nodules are more prevalent but malignancy rates are lower. — Jason (epidemiological) [Ep 66 · 2:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=120)
- In pediatric populations, thyroid cancers tend to have more nodal disease, are more multifocal, and are more likely to be metastatic to lung or bone compared to adult populations. — Jason (clinical) [Ep 66 · 3:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=180)
- Predictors of malignancy in pediatric thyroid nodules include male gender, compression symptoms, palpable lymphadenopathy, higher TSH levels, microcalcifications, indistinct margins, hypochoic pattern, and increased nodular vascularization on ultrasound. — Jason (clinical) [Ep 66 · 4:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=240)
- The incidence of differentiated thyroid cancer in hyperfunctioning nodules is upwards of 10 times higher in children than in adults, leading to general recommendations to remove hyperfunctioning nodules in pediatric patients. — Jason (clinical) [Ep 66 · 5:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=300)
- In 10-40 year follow-ups of pediatric thyroid cancer, 98% overall survival is achieved, but of the deaths that occur, two-thirds are from non-thyroid malignancies, and most of those patients had received radiation treatment. — Jason (epidemiological) [Ep 66 · 6:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=360)
- A Washington group analyzing the National Cancer Database found no difference in 15-20 year outcomes between partial thyroidectomy (ipsilateral thyroidectomy and isthmectomy) and total thyroidectomy for nodules over 1 centimeter, suggesting total thyroidectomy may not be necessary for all papillary thyroid cancers. — Jason (clinical) [Ep 66 · 7:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=420)
- National Inpatient Sample data on 16,000 adult patients over 10 years shows surgeons performing fewer than 25 thyroidectomies per year have approximately 90% higher risk of overall complications compared to high-volume surgeons. — Jason (epidemiological) [Ep 66 · 8:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=480)
- Pediatric-specific National Inpatient Sample data shows low-volume surgeons (1-2 cases per year) have nearly twofold higher rates of inpatient complications compared to high-volume surgeons. — Jason (epidemiological) [Ep 66 · 9:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=540)
- Only 5% of pediatric surgeons performing thyroid surgery in the National Inpatient Sample qualified as high-volume surgeons, meaning most pediatric surgeons doing thyroid surgery are low-volume surgeons. — Jason (epidemiological) [Ep 66 · 11:30](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=690)
- Overall rate of hypoparathyroidism after partial or total thyroidectomy is 5-15%, with most cases being transient. Low-volume surgeons have approximately 2.5% permanent hypoparathyroidism rate, representing nearly a fivefold higher rate than high-volume surgeons. — Jason (epidemiological) [Ep 66 · 12:30](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=750)
- Central node dissection significantly increases rates of both recurrent laryngeal nerve palsy and hypocalcemia (transient or permanent) compared to thyroidectomy without node dissection. — Jason (clinical) [Ep 66 · 14:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=840)
- Risk factors for recurrent laryngeal nerve injury include large tumor, non-visualized nerve, malignancy, nodal dissection, and redo operations. — Jason (clinical) [Ep 66 · 15:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=900)
- Overall statistics show approximately 0.3-1% risk of permanent recurrent laryngeal nerve injury and 1-6% risk of transient palsy in pediatric thyroidectomy patients. — Jason (epidemiological) [Ep 66 · 16:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=960)
- Approximately 15% of children presenting with thyroid cancer already have nerve dysfunction at baseline, making preoperative laryngoscopy valuable for documentation. — Todd (clinical) [Ep 66 · 17:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1020)
- The 2016 American Thyroid Association guidelines state that ultrasound characteristics of thyroid nodules are important beyond size alone, and fine needle aspiration must be done under ultrasound guidance rather than by palpation. — Jason (guideline) [Ep 66 · 18:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1080)
- There is insufficient evidence in pediatrics to suggest that specific cancer genetic characteristics can predict outcomes or determine which patients should receive certain treatments. — Jason (clinical) [Ep 66 · 19:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1140)
- Surgical resection is recommended for any hyperfunctioning nodule in children. Controlling hyperthyroidism is important for operative safety but does not eliminate the need for nodule removal, which typically means lobectomy. — Jason (guideline) [Ep 66 · 20:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1200)
- Radioactive iodine ablation is not recommended across the board for low-risk pediatric thyroid cancer patients (those with disease confined to the thyroid or only incidentally found in surrounding lymph nodes), representing a significant change from adult practice. — Jason (guideline) [Ep 66 · 21:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1260)
- The American Thyroid Association guidelines state that children with differentiated thyroid cancer should be taken care of at a center of excellence. — Jason (guideline) [Ep 66 · 22:00](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1320)
- Thyroid tumor boards that include nuclear medicine, surgery, endocrinology, pathology, and oncology produce dramatically different and more nuanced treatment discussions than email communication, particularly for complex cases involving rising thyroglobulin levels and decisions about re-ablation versus re-exploration. — Kurt (opinion) [Ep 66 · 23:21](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1401)
- Dave Wesson presented data at ABPSA showing that double-scrubbing (two attendings operating together) in a smaller-volume thyroid surgery practice resulted in very low complication rates and drew patients back into the Texas Children's Hospital system from the community. — Kurt (clinical) [Ep 66 · 24:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1480)
- Aggressive parathyroid reimplantation has dramatically dropped hypoparathyroidism rates. The approach is to assess parathyroid glands intraoperatively: if they look dusky, cut them to check for red blood; if there is red blood, leave them in place; if not, remove and reimplant them. Reimplanted glands take about one month to return to function. — Kurt (clinical) [Ep 66 · 25:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1540)
- Intraoperative parathyroid hormone (iPTH) is measured in the recovery room and again at 6 and 8 hours postoperatively. If iPTH is less than 10, patients are started on vitamin D and calcium. If iPTH is in the 30s, patients are supported expectantly as function is expected to improve. — Kurt (clinical) [Ep 66 · 27:20](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1640)
- Thyroid surgery is a profession that has changed more than almost any other in the last 10 years, with thyroid guidelines being rewritten four times in that period. — David (opinion) [Ep 66 · 28:20](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1700)
- Anyone performing thyroid surgery must read the pediatric thyroid surgery guideline to ensure compliance, as these guidelines are developed by experts who specialize in this area. Surgeons doing one-off cases once or twice a year are not providing the quality of care that defines pediatric surgery in other areas. — David (opinion) [Ep 66 · 29:20](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1760)
- Pediatric surgery has completely changed in the last 15-20 years, with the specialty increasingly focused on abscesses and appendectomies while fine cases are lessening. This trend suggests increasing benefit from having two attendings operate together to maintain adequate case volumes. (opinion) [Ep 66 · 30:20](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1820)
- Thyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant. — Diana Diesen (epidemiological) [Ep 67 · 6:15](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=375)
- When children present with thyroid cancer, they are more likely to have extension outside the thyroid, regional lymph node involvement, and distant metastasis compared to adults. — Diana Diesen (epidemiological) [Ep 67 · 6:15](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=375)
- Risk factors for thyroid nodules and cancer include previous radiation exposure, alkylating agent exposure (treatment for Hodgkin's lymphoma, leukemia, CNS tumors), and family history including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes. — Diana Diesen (clinical) [Ep 67 · 2:51](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=171)
- If TSH is suppressed, the first imaging modality should be nuclear thyroid scintigraphy to identify hyperfunctioning nodules, which do not need FNA biopsy if they are going to be resected. — Diana Diesen (clinical) [Ep 67 · 7:42](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=462)
- Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, and association with abnormal lymph nodes. — Diana Diesen (clinical) [Ep 67 · 9:13](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=553)
- In pediatric patients, size cutoffs cannot be used as in adults (1 cm threshold); instead ultrasound characteristics and clinical context determine FNA indications. — Diana Diesen (guideline) [Ep 67 · 10:59](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=659)
- Suspicious lymph node characteristics include loss of hilum, irregularity, and increased blood flow, not just size (1 cm cutoff used in adults but not applicable to children). — Diana Diesen (clinical) [Ep 67 · 13:14](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=794)
- For patients with large fixed thyroid mass and bulky metastatic lymphadenopathy, CT or MRI of the neck is recommended to visualize retropharyngeal and superior mediastinal nodes, and chest CT may be considered for high cervical lymph node burden. — Diana Diesen (clinical) [Ep 67 · 13:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=820)
- Current recommendations for papillary thyroid cancer are total or near-total thyroidectomy (near-total leaving only 1-2% tissue near critical structures) due to 30% risk of bilateral disease and 65% risk of multifocal disease in pediatric patients. — Diana Diesen (guideline) [Ep 67 · 14:39](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=879)
- Total thyroidectomy for papillary cancer reduces recurrence risk, avoids need for secondary surgery, optimizes radioactive iodine therapy if needed, and allows use of thyroglobulin as a marker without needing to ablate residual thyroid tissue. — Diana Diesen (clinical) [Ep 67 · 14:39](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=879)
- Nerve monitoring is used routinely in thyroid surgery; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease. — Diana Diesen (opinion) [Ep 67 · 16:14](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=974)
- There is no evidence to support prophylactic lateral neck dissection; lateral dissection is performed only when lateral nodes are pathologically confirmed. — Diana Diesen (guideline) [Ep 67 · 18:33](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1113)
- After total thyroidectomy, PTH and calcium levels are checked in recovery; PTH <10-15 indicates higher risk for hypocalcemia and prompts calcium or calcitriol replacement. — Diana Diesen (clinical) [Ep 67 · 19:03](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1143)
- About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after hemithyroidectomy. — Diana Diesen (epidemiological) [Ep 67 · 26:39](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1599)
- Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal metastasis) require TSH suppression to 0.5-1, surveillance ultrasound at 6 months then annually for 5 years, and thyroglobulin monitoring. — Diana Diesen (guideline) [Ep 67 · 20:42](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1242)
- Radioactive iodine is indicated for ATA pediatric intermediate-risk (extensive central neck or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, with or without distant metastasis). — Diana Diesen (guideline) [Ep 67 · 21:48](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1308)
- High-risk papillary thyroid cancer patients require TSH suppression to <0.1. — Diana Diesen (guideline) [Ep 67 · 27:23](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1643)
- The most recent ATA recommendations are that all indeterminate follicular lesions be resected in children, which differs from adult guidelines, due to higher malignancy risk in pediatric population. — Diana Diesen (guideline) [Ep 67 · 22:56](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1376)
- For follicular lesions of undetermined significance, adult literature reports 5-15% malignancy risk, but pediatric literature shows approximately 28% malignancy rate. — Diana Diesen (epidemiological) [Ep 67 · 22:56](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1376)
- For follicular neoplasms, reported malignancy rate was 15-30% but more recent data suggests 50-60% in pediatric patients. — Diana Diesen (epidemiological) [Ep 67 · 22:56](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1376)
- Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary component. — Diana Diesen (clinical) [Ep 67 · 23:57](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1437)
- For follicular carcinoma, completion thyroidectomy is recommended if there is significant vascular invasion or tumor >4 cm; minimal vascular invasion with smaller tumor can be monitored. — Diana Diesen (guideline) [Ep 67 · 24:54](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1494)
- For benign thyroid lesions >4 cm, the sensitivity and specificity of FNA is decreased, so follow-up is important with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features. — Diana Diesen (clinical) [Ep 67 · 28:19](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1699)
- For inadequate FNA specimens (occurs 1-3% of the time), repeat ultrasound with FNA should be done in 3-6 months, not immediately, to avoid picking up atypia from trauma of initial FNA. — Diana Diesen (clinical) [Ep 67 · 29:49](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1789)
- Sporadic medullary thyroid cancer is unusual in children; current recommendations do not support routine calcitonin monitoring in every pediatric patient with a thyroid nodule. — Diana Diesen (guideline) [Ep 67 · 30:32](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1832)
- For medullary thyroid cancer, calcitonin and CEA levels are measured for extent of disease assessment and tracking surgical response, and RET germline mutation testing is sent. — Diana Diesen (clinical) [Ep 67 · 30:32](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1832)
- MEN2B patients (RET 918 mutation) have up to 50% risk of pheochromocytoma, which can present in teenage years; screening begins at age 11 or at initial diagnosis. — Diana Diesen (clinical) [Ep 67 · 31:50](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1910)
- For medullary thyroid cancer with initial calcitonin >500, imaging to exclude metastatic disease is needed: CT neck, CT chest, MRI or CT abdomen (looking at liver), and possibly bone scan. — Diana Diesen (clinical) [Ep 67 · 32:50](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=1970)
- MEN2B patients can develop medullary thyroid cancer as early as 3 months of age; if family has MEN2B, genetic screening should occur right after birth, and if positive for 918 mutation, thyroidectomy is recommended before 1 year of age. — Diana Diesen (guideline) [Ep 67 · 33:32](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2012)
- De novo RET mutations are more likely to be MEN2B than MEN2A. — Diana Diesen (epidemiological) [Ep 67 · 34:44](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2084)
- MEN2A high-risk patients (most common being 634 mutation) should have total thyroidectomy before age 5, but surveillance with calcitonin, CEA, and ultrasound should start at age 3; if calcitonin elevates or ultrasound abnormalities appear, proceed with thyroidectomy at that point. — Diana Diesen (guideline) [Ep 67 · 35:25](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2125)
- If calcitonin levels reach above 40 in MEN2A surveillance, central neck dissection is recommended at time of thyroidectomy. — Diana Diesen (guideline) [Ep 67 · 36:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2200)
- Children under age 10 have increased risk of complications from thyroid surgery including hypoparathyroidism and nerve injury due to smaller anatomy and smaller parathyroid glands. — Diana Diesen (clinical) [Ep 67 · 36:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2200)
- For MEN2A moderate-risk patients, total thyroidectomy is performed when serum calcitonin becomes elevated or if parents prefer not to proceed with frequent surveillance; prophylactic thyroidectomy may occur in childhood or early adulthood depending on mutation. — Diana Diesen (guideline) [Ep 67 · 36:40](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2200)
- MEN2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above; screening begins at age 16. — Diana Diesen (clinical) [Ep 67 · 37:34](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2254)
- For prophylactic thyroidectomy in MEN patients, central lymph node dissection is not necessary if performed before calcitonin levels exceed 40 (in MEN2A patients). — Diana Diesen (guideline) [Ep 67 · 38:26](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2306)
- There is debate about whether MEN2B patients need central lymph node dissection; decision depends on ability to identify, preserve, or transplant parathyroid glands, which are particularly small and translucent in infants. — Diana Diesen (opinion) [Ep 67 · 38:26](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2306)
- After medullary thyroid cancer surgery, if calcitonin levels are undetectable or normal, follow with physical exam, ultrasound every 6 months for a year then annually, and close monitoring. — Diana Diesen (clinical) [Ep 67 · 39:51](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2391)
- If postoperative calcitonin is >150, imaging for metastatic disease is needed: CT neck, CT chest, MRI or CT abdomen for liver metastasis, bone scan, and MRI of pelvis and axial skeleton. — Diana Diesen (clinical) [Ep 67 · 39:51](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2391)
- Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) is reserved for progressive disease not treatable with surgery, not used routinely for elevated calcitonin alone due to significant side effects. — Diana Diesen (clinical) [Ep 67 · 41:10](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2470)
- For Graves disease in young children, concerns about secondary malignancy risk from radioactive iodine often lead to thyroidectomy for disease not controlled with methimazole; in school-age children, radioactive iodine vs surgery is discussed; as patients approach adulthood, radioactive iodine is often treatment of choice. — Diana Diesen (clinical) [Ep 67 · 42:11](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2531)
- Subacute thyroiditis, thought to be viral in origin, presents with painful swollen thyroid, initial thyrotoxicosis followed by hypothyroidism, and usually resolves with normal thyroid function returning at 1-2 years. — Diana Diesen (clinical) [Ep 67 · 43:02](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2582)
- Diffuse infiltrative papillary thyroid cancer is more common in children than adults; if a patient demonstrates infiltrative thyroid process especially with clinically suspicious nodes, consider biopsy to rule out papillary thyroid cancer. — Diana Diesen (clinical) [Ep 67 · 43:45](https://library.globalcastmd.com/watch/pediatric-thyroid-disorders-with-dr-diana-diesen-954?t=2625)
- Upfront resection was indicated for this localized Wilms tumor in an effort to minimize adjuvant therapy (clinical) [Ep 216 · 0:00](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=0)
- Preferred incision for nephrectomy is bilateral subcostal, though others may use midline or thoracoabdominal for very large tumors (opinion) [Ep 216 · 1:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=90)
- Care must be taken not to violate the surface of the tumor during dissection (clinical) [Ep 216 · 1:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=90)
- Initial dissection and tumor mobilization is preferably performed laterally rather than starting medially to control vessels early, since occasionally the wrong vessels may be divided (opinion) [Ep 216 · 2:00](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=120)
- Lateral and posterior dissection planes are generally avascular with only small vessels present which can be controlled easily (clinical) [Ep 216 · 2:00](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=120)
- Even large Wilms tumors typically only push away adjacent organs but rarely invade them (clinical) [Ep 216 · 3:00](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=180)
- The adrenal gland does not always need to be taken with the nephrectomy specimen if it appears to be uninvolved with tumor (clinical) [Ep 216 · 3:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=210)
- Despite preoperative imaging that doesn't identify an intravascular tumor thrombus, the vein should be palpated to be sure that no tumor exists within the vein (clinical) [Ep 216 · 4:00](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=240)
- Some surgeons prefer to take the artery first to avoid congestion of the kidney and tumor, but this has not been found to be a concern since the two vessels can be taken in rapid succession (opinion) [Ep 216 · 4:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=270)
- The artery which generally courses behind the vein is easier to access once the vein has been divided (clinical) [Ep 216 · 4:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=270)
- By saving vessel ligation until the end of the dissection and mobilization of the kidney tumor, there is greater reassurance that they are the correct vessels to take (clinical) [Ep 216 · 4:30](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=270)
- Periaortic lymph nodes are sampled to ensure appropriate staging of the patient regardless of whether they appear to be pathologically involved or not (guideline) [Ep 216 · 4:50](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=290)
- This particular tumor weighed almost 2000 grams (clinical) [Ep 216 · 4:50](https://library.globalcastmd.com/watch/left-nephrectomy-davidoff-mansfield-2873?t=290)
- The Midwest Consortium data suggests chest tubes should not be placed in spontaneous pneumothorax patients because those whose hole is already sealed can go home after aspiration, and those whose hole remains open (83%) will need VATS anyway, making chest tubes an unnecessary source of pain. — Todd Ponsky (opinion) [Ep 237 · 6:40](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=400)
- At Cincinnati Children's, the current practice for spontaneous pneumothorax is to aspirate, wait 6 hours, check X-ray, and if no recurrence send home; if recurrence, go straight to VATS without placing a chest tube. — Todd Ponsky (clinical) [Ep 237 · 8:05](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=485)
- The speaker stopped sending home narcotics after uncomplicated appendectomy based on the data showing 85% of patients do not need opioids on post-op day 1. — Todd Ponsky (clinical) [Ep 237 · 14:10](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=850)
- One participant uses monopolar cautery for circumcision but wraps the base of the penis with saline-soaked gauze and keeps the penis attached to the body to prevent electrical injury, and has never seen penile necrosis. (clinical) [Ep 237 · 29:44](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1784)
- One participant always uses a knife for circumcision incision and cautery only for hemostasis, never for cutting. (clinical) [Ep 237 · 31:14](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1874)
- The localization procedure from patient entry to surgical readiness takes approximately 45 minutes total. — Denise Liu (clinical) [Ep 367 · 1:03](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=63)
- The surgeon retrieves the localization wire into the chest before lung deflation to prevent wire dislodgement during lung collapse, as the wire can become stuck in chest musculature. (clinical) [Ep 367 · 1:31](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=91)
- The localization wire is cut at skin level after CT-confirmed placement because the wires are quite long and cutting facilitates surgical handling. — Denise Liu (clinical) [Ep 367 · 2:33](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=153)
- Cutting the wire at skin level prevents inadvertent removal during patient repositioning and prevents the wire from bending or jamming at the skin surface during transport. (clinical) [Ep 367 · 3:02](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=182)
- In one historical case, OR nurses unfamiliar with the wire localization mistook the wire for a retained stitch and removed it, prompting the current protocol of cutting wires short. (clinical) [Ep 367 · 3:02](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=182)
- Fluoroscopy during resection is used only when a coil has been placed, to confirm the coil has been removed with the specimen and is not retained in the patient. (clinical) [Ep 367 · 3:02](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=182)
- Indocyanine green (ICG) is metabolized by the liver, making it useful for visualizing hepatoblastoma metastases. (clinical) [Ep 367 · 4:35](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=275)
- Enhancement of pulmonary nodules with ICG depends on the primary cancer's vascularity; sarcomas show hyperenhancement due to increased angiogenesis. (clinical) [Ep 367 · 4:35](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=275)
- ICG is not specific for tumor type because multiple primary cancers can be hypervascular. (clinical) [Ep 367 · 4:35](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=275)
- ICG has limited depth of penetration, restricting visualization of deep lung lesions thoracoscopically; the specimen often must be opened to confirm nodule removal. (clinical) [Ep 367 · 5:33](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=333)
- Needle localization is important for nodules not at the lung periphery because ICG cannot reliably visualize them thoracoscopically. (opinion) [Ep 367 · 5:33](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=333)
- At Cincinnati Children's, interventional radiology moved from the radiology department into the operating room in 2000. (clinical) [Ep 367 · 6:39](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=399)
- Interventional radiology procedures are scheduled on the operating room schedule with OR anesthesia, making IR part of the operating room rather than radiology. (clinical) [Ep 367 · 6:39](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=399)
- Physical integration of interventional radiology into the operating room is uncommon; few hospitals have achieved this despite attempts. (epidemiological) [Ep 367 · 6:39](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=399)
- Pre-hybrid OR, lung nodule localization was done in CT scan downstairs, then patient brought upstairs to operating room, requiring movement of the patient. — Rajni Dasgupta (clinical) [Ep 366 · 1:17](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=77)
- Localization typically done with Copan's breast localization needle and wire plus minus methylene blue blood patch. (clinical) [Ep 366 · 1:49](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=109)
- More recently, localization done with microembolization coils, coils typically used for vascular embolization, advanced through Copan's needle with combination of microcoil and Copan's wire coming out in case wire becomes inadvertently pulled out during thoracoscopic resection. (clinical) [Ep 366 · 1:58](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=118)
- Microcoil technique is very technically challenging; IR needs to practice beforehand to control the coil because it must be deployed in the right place. (clinical) [Ep 366 · 2:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=160)
- Coils are smaller than guide needle for Copan; must be very careful and practice outside patient beforehand, must have holder for coils firmly established in hub, otherwise coil delivers in hub of Copan needle. (clinical) [Ep 366 · 2:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=160)
- Patients always have double-lumen ET tube or bronchial blocker depending on size of patient. — Rajni Dasgupta (clinical) [Ep 366 · 3:45](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=225)
- Pre-hybrid OR workflow: intubate in OR, transfer patient on stretcher down to CT, get off stretcher onto CT gantry/table, do CT scan and localization, get off CT table with wire in place protecting it hoping it won't get dislodged, transfer back up to OR, position in thoracoscopic position. — Rajni Dasgupta (clinical) [Ep 366 · 3:45](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=225)
- There are a number of opportunities for wire to get dislodged in pre-hybrid OR workflow. (clinical) [Ep 366 · 4:35](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=275)
- In hybrid OR, everything done more efficiently with less chance of wire becoming dislodged; when possible, position patient in thoracoscopic position to begin with so there's single prep and single draping. (clinical) [Ep 366 · 4:35](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=275)
- Cone beam CT is a type of tomography where C-arm rotates around patient completely 360 degrees while capturing multiple images from different angles, basically like a CT but done with C-arm. — Denise Liu (clinical) [Ep 366 · 5:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=328)
- Problems have been based on anesthesia staff not understanding the procedure. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- One of most important aspects of chest procedures is respiration motion; anesthesia plays crucial role in controlling respiration and giving apnea at precise moment for targeting lung lesion. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- Positioning important so procedure can be done in same position as thoracoscopy without having to re-drape. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- To localize lesion, go to workstation, put green line on, click on lesion with mouse, click on skin, system draws the line; advantage is line can be adjusted to go directly through middle of intercostal space above ribs to avoid arteries and nerves below rib. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- System arranges C-arm automatically in exactly the right position after planning line is drawn. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- Put needle into pleura to check position and stabilize with blue towels; very important to do it quickly—don't put needle in, do scan, then wait and fiddle around or you get pneumothorax or other complications. (clinical) [Ep 366 · 6:28](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=388)
- Really important to talk to anesthesiologist and explain need for same respiratory excursion whenever doing cone beam CT imaging, and that has to correspond to when actually advancing needle. (clinical) [Ep 366 · 7:54](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=474)
- If cone beam CT done with full inspiration, location of nodule will be different in 3D than if done in full expiration; planned paths are planned from respiratory excursion from first CT, so unless same respiratory excursion when advancing needle, will be off target. (clinical) [Ep 366 · 7:54](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=474)
- Even if complication occurs, most common one being pneumothorax, it's not a disaster—just put 5 French sheath or catheter and connect to low wall suction, which will take care of pneumothorax. (clinical) [Ep 366 · 9:14](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=554)
- For lung biopsy, nodule has to be at least 1 centimeter because chasing after lung nodule is difficult. — Denise Liu (clinical) [Ep 366 · 9:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=580)
- Cone beam CT can see nodules like traditional CT; for big nodules, turn dose down and use enough X-ray dose to get job done. (clinical) [Ep 366 · 10:23](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=623)
- Cone beam CT has lung optimization module; able to see every small lesion seen on traditional CT downstairs diagnostically beforehand in hybrid OR upstairs. (clinical) [Ep 366 · 10:23](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=623)
- Contrast resolution and spatial resolution of cone beam CT is just as good as traditional CT, in fact slightly better. (opinion) [Ep 366 · 10:23](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=623)
- Can localize multiple lesions at same time; up to 3 have been done. (clinical) [Ep 366 · 11:04](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=664)
- When doing multiple localizations, increased chance of pneumothorax, but just put small catheter in and suck it out. (clinical) [Ep 366 · 11:04](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=664)
- If lesions all within same lobe, thoracic surgeon can take it all out; if in different lobes and worried they're of different etiology, can localize them, but usually just pick biggest one. — Denise Liu (clinical) [Ep 366 · 11:21](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=681)
- Can give nodule segmentation coloring (e.g., little green dot) and do 3D rendering; can rotate image around in 3D space to understand nodule position relative to needle tip. (clinical) [Ep 366 · 12:59](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=779)
- Actual imaging is super helpful, but also helpful to have interventionists in room for real-time discussion of needle position (medial, anterior, posterior) and confirmation. — Rajni Dasgupta (clinical) [Ep 366 · 13:24](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=804)
- Radiologists and surgeons think slightly differently in 3D space; good to have trusted colleagues in all areas discussing together so it's very clear. (opinion) [Ep 366 · 13:50](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=830)
- Interventionalists stay in room while positioning and surgery are done, or come back to room fairly frequently if must do something else. (clinical) [Ep 366 · 13:50](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=830)
- Goal is to prep and drape once; rare occasion may require supine position rather than lateral decubitus depending on nodule location, but that's relatively rare. — Rajni Dasgupta (clinical) [Ep 366 · 15:00](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=900)
- Limiting changing and movement helps ensure wire stays in place and saves time. — Rajni Dasgupta (clinical) [Ep 366 · 15:00](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=900)
- Ideally, as advancing through parietal pleura and puncturing visceral pleura, inject a little methylene blue blood patch going down toward target. (clinical) [Ep 366 · 15:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=940)
- For very peripheral nodules, if don't have decisive puncture through visceral pleura and are injecting fluid/methylene blue blood patch, can push away visceral pleural surface of lung; think you've got deep enough but haven't actually punctured through visceral pleura, so when deploy wire, wire won't be within lung. (clinical) [Ep 366 · 15:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=940)
- Must be decisive when puncturing visceral pleura to avoid wire deployment outside lung. (clinical) [Ep 366 · 15:40](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=940)
- Achieving complete tumor resections without major complications remains challenging because some tumors are difficult to distinguish from healthy tissue and in other tumors the margin is very narrow. — Bernadette Jeremiasse (clinical) [Ep 421 · 0:12](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=12)
- Fluorescence guided surgery with tumor-specific probes can visually assist the surgeon in discriminating tumors from healthy tissue. — Bernadette Jeremiasse (clinical) [Ep 421 · 0:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=50)
- Tumor-specific probes are currently screened one by one and per tumor type. — Bernadette Jeremiasse (clinical) [Ep 421 · 1:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=70)
- The imaging platform combines tumor organoid biobanks with 3D live imaging and is able to screen fluorescent guided surgery probes in a tumor-specific and patient-specific way. — Bernadette Jeremiasse (clinical) [Ep 421 · 1:25](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=85)
- Organoids maintain molecular tumor characteristics and can be held in culture for a long time. — Bernadette Jeremiasse (clinical) [Ep 421 · 1:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=110)
- The platform uses both adult and pediatric tumor organoid biobanks, specifically neuroblastoma and breast cancer. — Bernadette Jeremiasse (clinical) [Ep 421 · 2:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=125)
- Control organoids were chosen based on the tissue surrounding the tumor: kidney organoids for neuroblastoma and healthy breast organoids for breast cancer. — Bernadette Jeremiasse (clinical) [Ep 421 · 2:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=140)
- Surface markers upregulated in neuroblastoma or breast cancer were identified based on RNA profiling, the human protein atlas, and literature review. — Bernadette Jeremiasse (clinical) [Ep 421 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=180)
- Probes targeting surface markers were conjugated to six different fluorophores ranging between 488 and 647 nanometers. — Bernadette Jeremiasse (clinical) [Ep 421 · 3:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=200)
- Seven-colored 3D live imaging using confocal microscopy on living organoids was performed, including six probe fluorophores plus the general marker eFluor. — Bernadette Jeremiasse (clinical) [Ep 421 · 3:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=215)
- Segmentation analysis was performed using the STAPLE pipeline developed in the laboratory, and fluorescent signals were quantified. — Bernadette Jeremiasse (clinical) [Ep 421 · 3:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=235)
- The three most promising probes for neuroblastoma were validated in vivo using a mouse xenograft model with tumors originating from neuroblastoma organoids. — Bernadette Jeremiasse (clinical) [Ep 421 · 4:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=250)
- Probe fluorescence varies between patients and even within a patient in neuroblastoma organoid lines. — Bernadette Jeremiasse (clinical) [Ep 421 · 4:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=280)
- Different probes work on tumor organoids compared to healthy control organoids. — Bernadette Jeremiasse (clinical) [Ep 421 · 4:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=295)
- The STAPLE pipeline performs 3D segmentation by first segmenting membrane and nuclear signals, generating cells, and combining cells to form single organoids. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=305)
- An organoid is determined to be positive when the intensity of the tumor organoid is at least twice the fluorescence of the healthy control organoid. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:25](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=325)
- Thousands of organoids were quantified using this methodology. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=345)
- Four markers showed promise for neuroblastoma based on high percentages of positive organoids and high fluorescent intensities. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=355)
- The platform can predict which combinations of probes are most promising by screening six probes simultaneously. — Bernadette Jeremiasse (clinical) [Ep 421 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=375)
- The three most promising probes tested in vivo for neuroblastoma were GD2, L1CAM, and NCAM. — Bernadette Jeremiasse (clinical) [Ep 421 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=390)
- These three probes resulted in tumor-to-background ratios above 2, indicating good intraoperative visibility. — Bernadette Jeremiasse (clinical) [Ep 421 · 6:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=405)
- In vitro imaging patterns resemble the efficacy in vivo, with L1CAM showing higher signal than GD2 in both settings. — Bernadette Jeremiasse (clinical) [Ep 421 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=420)
- The order of neuroblastoma organoid line performance was similar in vitro and in vivo, with line 129 being highest and line 67 being lowest. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=335)
- One of the tested probes is advancing to a clinical trial this year. — Bernadette Jeremiasse (clinical) [Ep 421 · 5:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=335)
- ICG can be used as an adjunct to sentinel node identification in pediatric surgical oncology — Seth Goldstein (clinical) [Ep 447 · 3:16](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=196)
- Sentinel node biopsy in pediatric rhabdomyosarcoma is standard of care and dictates drug regimen and indicates radiation to lymph node basin if positive — Seth Goldstein (guideline) [Ep 447 · 1:36](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=96)
- ICG technique allows real-time intraoperative control of injection location (intratumoral vs. four quadrants, dermal vs. subdermal) by surgeons rather than radiologists — Seth Goldstein (clinical) [Ep 447 · 4:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=240)
- ICG fluorescence visualization occurs over 45-75 seconds after injection, allowing direct observation of lymphatic drainage to sentinel node — Seth Goldstein (clinical) [Ep 447 · 5:20](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=320)
- Near-infrared fluorescence penetrates approximately 1-2 centimeters through soft tissue — Tom Isch (clinical) [Ep 447 · 7:23](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=443)
- ICG enables laparoscopic sentinel node identification in paratesticular rhabdomyosarcoma, which is not feasible with radiotracer methods — Seth Goldstein (clinical) [Ep 447 · 8:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=520)
- In children under 10 years old with paratesticular rhabdomyosarcoma, sentinel node biopsy may be performed instead of full ipsilateral lymph node clearance — Seth Goldstein (guideline) [Ep 447 · 8:40](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=520)
- Indocyanine green was developed by Kodak company after World War II and has been FDA approved since the 1960s — Seth Goldstein (clinical) [Ep 447 · 9:47](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=587)
- ICG is approved for all adult and pediatric applications with no on-label or off-label concerns — Seth Goldstein (guideline) [Ep 447 · 10:30](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=630)
- ICG is exclusively cleared through the biliary system — Seth Goldstein (clinical) [Ep 447 · 11:41](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=701)
- For hepatic metastases in the chest, ICG administered 24 hours preoperatively will be retained only in liver tissue by the time of thoracotomy, enabling metastasis localization — Seth Goldstein (clinical) [Ep 447 · 12:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=720)
- ICG technique for hepatic metastases is successful for hepatoblastoma but has not been successful for Wilms tumor — Tom Isch (clinical) [Ep 447 · 12:32](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=752)
- Sarcomas other than hepatic primaries require much higher ICG dosage and are less specific — Seth Goldstein (clinical) [Ep 447 · 12:39](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=759)
- Wilms tumor metastases in the lungs are avid for ICG, though the primary kidney tumor is not — Seth Goldstein (clinical) [Ep 447 · 13:34](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=814)
- ICG fluorescence identifies additional pulmonary metastases beyond what visual inspection and palpation detect during thoracotomy — Seth Goldstein (clinical) [Ep 447 · 14:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=840)
- Infrared ureteral stents emit light that travels through centimeters of tissue and can be detected by standard fluorescence imaging systems — Seth Goldstein (clinical) [Ep 447 · 16:20](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=980)
- A renally-cleared fluorophore is under investigation that could enable ureteral identification without stent placement — Seth Goldstein (clinical) [Ep 447 · 17:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1020)
- ICG can identify accessory cystic ducts during cholecystectomy by showing separate fluorescence of the accessory duct, main cystic duct, and common bile duct — Tom Isch (clinical) [Ep 447 · 19:00](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1140)
- ICG is used for vascular mapping in partial nephrectomy for Wilms tumor — Tom Isch (clinical) [Ep 447 · 18:45](https://library.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1125)
- For pediatric patients with Bethesda 3 thyroid nodules, lobectomy is recommended rather than molecular testing or repeat FNA because there is a higher rate of malignancy in pediatric populations compared to adults — Ben Hamm (guideline) [Ep 684 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=52)
- For a nodule with intermediate risk of cancer (approximately 30%), thyroidectomy is not recommended because the patient probably only needs a hemithyroidectomy — Ben Hamm (clinical) [Ep 684 · 1:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=70)
- The 2015 pediatric guidelines recommend thyroid surgery being done by a high volume thyroid surgeon — Ben Hamm (guideline) [Ep 684 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=88)
- One recent study published the rate of recurrent laryngeal nerve injury decreasing from 8% to 1.5% with monitoring — Ben Hamm (clinical) [Ep 684 · 2:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=147)
- Studies in adults have shown that nerve monitoring helps identify the nerve more, but maybe doesn't change injury rates — Ben Hamm (clinical) [Ep 684 · 2:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=170)
- There are no studies in pediatrics showing significant decrease in injury rates with nerve monitoring, but there are several that show absolute decrease — Ben Hamm (clinical) [Ep 684 · 2:57](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=177)
- Recurrent laryngeal nerve injuries may happen more in children because it's a smaller nerve that may be harder to identify, with a rate of 9% in children versus about 6% in adults — Ben Hamm (epidemiological) [Ep 684 · 3:20](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=200)
- If injury is detected on one side with nerve monitoring, the surgeon may want to wait and see if it's just a transient thing that can recover later — Ben Hamm (clinical) [Ep 684 · 3:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=218)
- Expense is one consideration as a downside to nerve monitoring, and some have questioned its use if it doesn't change injury rates or outcomes — Ben Hamm (opinion) [Ep 684 · 3:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=229)
- Recent endotracheal tube electrode publications show nerve monitoring has been tried in children down to age 0 — Ben Hamm (clinical) [Ep 684 · 4:04](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=244)
- Nerve monitoring is most beneficial when doing a total thyroidectomy where the contralateral cord is paralyzed, to help decrease the risk of tracheotomy with bilateral paralysis — Ben Hamm (clinical) [Ep 684 · 4:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=268)
- If a child is too small for the 5.0 or 3.0 endotracheal tube electrodes, the electrodes come separate and can be placed directly into the vocalis muscle via direct laryngoscopy for monitoring (clinical) [Ep 684 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=280)
- A recent paper suggested that if you adjust the size criteria in TIRRADS, it actually performs better than the 2015 pediatric guidelines — Ben Hamm (clinical) [Ep 684 · 5:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=300)
- A larger institutional study through the Pediatric Surgical Oncology Research Collaborative using the modified PES-TIRRADS recommends biopsy for every TIRRADS 3 nodule over 1 cm or TIRRADS 4 or 5 over 0.5 cm (guideline) [Ep 684 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=313)
- The ileocecal region may not be important to preserve in short bowel syndrome and may actually be injurious to the liver. — Brad Warner (clinical) [Ep 683 · 3:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=208)
- Administration of a specific bile acid that is more lipophilic and hepatoprotective could be potential therapy for patients with cholestatic liver disease after massive intestinal resection. — Brad Warner (clinical) [Ep 683 · 3:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=217)
- In clinical practice, surgeons cannot choose which segment of intestine to remove—they must remove what is dead and would never intentionally remove viable tissue. — Brad Warner (clinical) [Ep 683 · 4:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=253)
- Once no-evidence-of-disease status was achieved, the 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk. — Andrew Fleming (epidemiological) [Ep 683 · 7:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=430)
- There is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma. — Andrew Fleming (opinion) [Ep 683 · 8:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=486)
- The way to achieve esophageal atresia surveillance is to have a formal aerodigestive team. — Todd Ponsky (opinion) [Ep 683 · 12:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=745)
- The 5 millimeter cool seal with its fine dissecting tips and dual action jaws allows for excellent dissection around delicate structures. (opinion) [Ep 674 · 1:25](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=85)
- In smaller patients, the surgeon will often take the pulmonary artery vessel at the segmental level, using the cool seal to seal the vessel and safely divide it. (clinical) [Ep 674 · 2:30](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=150)
- In a larger patient, it is often more efficient to find the pulmonary artery to the lower lobe as it crosses through the fissure, allowing the surgeon to get the main trunk above the bifurcation to the apical and basal segments and use a vascular stapler to safely take the vessel, saving time compared to dissecting into the lung to find the segmental vessels. (clinical) [Ep 674 · 2:50](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=170)
- In many cases, the surgeon will take the bronchus next after the pulmonary artery as it presents itself before taking the inferior pulmonary vein. (clinical) [Ep 674 · 4:00](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=240)
- In this case, because of the large tumor and the large amount of inflammation in this area, dissection of the bronchus was difficult, and the surgeon did not want to injure the vein in dissecting this out, so approached the inferior pulmonary ligament instead. (clinical) [Ep 674 · 4:15](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=255)
- Cancer treatments can cause gonadal failure, limiting or destroying the patient's ability to produce offspring in the future. — Monica Laronda (clinical) [Ep 657 · 0:43](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=43)
- Loss of control over reproductive future is one of the top quality of life parameters of importance for childhood cancer survivors. — Monica Laronda (epidemiological) [Ep 657 · 1:30](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=90)
- Most cancer survivors prefer to have a biological offspring over a gamete donation or a gestational carrier. — Monica Laronda (epidemiological) [Ep 657 · 1:50](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=110)
- The American Society of Clinical Oncology guidelines underscore the importance of discussing with newly diagnosed cancer patients that their future fertility may be affected by cancer treatments. — Monica Laronda (guideline) [Ep 657 · 2:05](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=125)
- Parents want fertility preservation options presented for their children regardless of their infertility risk or prognosis. — Monica Laronda (epidemiological) [Ep 657 · 2:35](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=155)
- Fertility preservation is important for any child at risk for premature gonadal insufficiency, including Turner syndrome and mixed gonadal dysgenesis. — Monica Laronda (clinical) [Ep 657 · 2:50](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=170)
- Children with ovaries can undergo ovarian stimulation and oocyte retrieval if they've gone through puberty, or ovarian tissue cryopreservation for pediatric, adolescent and young adult patients. — Monica Laronda (clinical) [Ep 657 · 3:30](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=210)
- Children with testes can bank sperm if they've gone through puberty or opt for testicular tissue cryopreservation. — Monica Laronda (clinical) [Ep 657 · 4:00](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=240)
- Patient risk for premature gonadal insufficiency is determined by calculating cumulative cyclophosphamide equivalent dose, imminent surgery, chemotherapy with alkalating agents, or radiation therapy. — Monica Laronda (clinical) [Ep 657 · 4:20](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=260)
- A normal ovary has about 300,000 follicles at the time of birth, declining steadily until reaching menopause around age 50. — Monica Laronda (clinical) [Ep 657 · 4:50](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=290)
- A 12-year-old that receives radiation of 10 gray can undergo menopause at approximately 19.5 years old. — Monica Laronda (clinical) [Ep 657 · 5:20](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=320)
- Life expectancy can be reduced by 2 years from additional comorbidities that result from the lack of gonadal hormones in patients experiencing early menopause. — Monica Laronda (epidemiological) [Ep 657 · 5:40](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=340)
- The Lurie Children's fertility preservation program first started collaborating with Northwestern University Oncofertility Consortium in 2011, with the first patient enrolled in March 2011. — Monica Laronda (clinical) [Ep 657 · 6:30](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=390)
- The program has performed over 200 ovarian tissue cryopreservation patients and approximately 170 testicular tissue cryopreservation patients. — Monica Laronda (epidemiological) [Ep 657 · 7:00](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=420)
- Approximately 25% of ovarian tissue cryopreservation patients are referrals from outside of Lurie Children's Hospital. — Monica Laronda (epidemiological) [Ep 657 · 7:10](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=430)
- Ovarian tissue cryopreservation is performed with a unilateral oophorectomy, and the other ovary compensates and maintains the same level of hormones. — Monica Laronda (clinical) [Ep 657 · 7:30](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=450)
- There is little difference in age at menopause after unilateral oophorectomy. — Monica Laronda (clinical) [Ep 657 · 7:50](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=470)
- When able, the laparoscopic oophorectomy is done at the time of another procedure required for the patient's cancer diagnosis to decrease the number of times the patient will be under general anesthesia. — Monica Laronda (clinical) [Ep 657 · 8:00](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=480)
- The first successful ovarian tissue cryopreservation and transplantation in a large animal model was done in sheep in 1994. — Monica Laronda (clinical) [Ep 657 · 8:53](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=533)
- The first live births following an ovarian autotransplant from frozen thawed tissue happened between 2004 and 2006 in Israel. — Monica Laronda (clinical) [Ep 657 · 9:05](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=545)
- There are approximately 140 reported live births from ovarian tissue autotransplantation. — Monica Laronda (epidemiological) [Ep 657 · 9:20](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=560)
- The rate of autotransplantation for recipients who have restored fertility is between 20% and 40%. — Monica Laronda (epidemiological) [Ep 657 · 9:30](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=570)
- Hormone production from ovarian tissue autotransplantation lasts an average of 2 to 5 years and has been reported to exceed 12 years. — Monica Laronda (clinical) [Ep 657 · 9:40](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=580)
- For many cancer patients, there is a possibility of reintroducing cancer cells from their tissue during autotransplantation. — Monica Laronda (clinical) [Ep 657 · 9:55](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=595)
- The bioprosthetic ovary concept involves removing primordial follicles from any cancer cells and placing them into a supportive engineered microenvironment that produces continuous hormones and regular ovulation for spontaneous pregnancies. — Monica Laronda (clinical) [Ep 657 · 9:09](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=549)
- A 3D printed scaffold composed of 10% gelatin was able to grow healthy oocytes from mice. — Monica Laronda (clinical) [Ep 657 · 10:00](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=600)
- Green fluorescent protein expressing follicles added to 3D printed scaffolds and transplanted into mice without this protein were able to spontaneously produce pups that expressed the green fluorescent protein. — Monica Laronda (clinical) [Ep 657 · 10:15](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=615)
- Infants with very young ovaries are significantly different in their makeup of different cell types compared to prepubertal and postpubertal ovaries from slightly older individuals. — Monica Laronda (clinical) [Ep 657 · 11:00](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=660)
- 82 different matrosome proteins were found in the ovary, with 42 significantly differentially expressed across different compartments. — Monica Laronda (clinical) [Ep 657 · 11:40](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=700)
- 11 matrosome proteins were discovered that had not yet been previously identified within the ovary. — Monica Laronda (clinical) [Ep 657 · 11:55](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=715)
- The density of extracellular matrix protein matched the rigidity curve of atomic force microscopy analysis in the ovary. — Monica Laronda (clinical) [Ep 657 · 12:20](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=740)
- The rigidity of the ovary might be in part due to the amount of extracellular matrix proteins that exist within a region. — Monica Laronda (clinical) [Ep 657 · 12:35](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=755)
- Pafolacianine (Cytalux) is an FDA-approved targeted fluorescence molecule used in adult cancer patients that binds folate to a fluorescent marker, exploiting the high folate receptor expression in rapidly dividing cancer cells. — Gloria Gonzalez (clinical) [Ep 593 · 3:17](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=197)
- Pediatric solid tumors have really high folate receptor expression, making them candidates for pafolacianine-based fluorescence-guided surgery. — Gloria Gonzalez (clinical) [Ep 593 · 7:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=450)
- ICG (indocyanine green) is excreted through the liver, so liver tumor cells that don't excrete ICG well will retain the dye and appear fluorescent during surgery. — Gloria Gonzalez (clinical) [Ep 593 · 2:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=150)
- Subcutaneous tumors do not highlight well with ICG, which is a known limitation of non-targeted fluorescence. — Gloria Gonzalez (clinical) [Ep 593 · 8:20](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=500)
- Two ongoing pediatric studies are evaluating pafolacianine safety: one at Lurie Children's Hospital for metastatic patients and one at Mayo Clinic for all solid tumors. — Gloria Gonzalez (clinical) [Ep 593 · 7:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=420)
- Pafolacianine is currently used off-label at Cleveland Clinic specifically for patients with desmoplastic small round cell tumors. — Gloria Gonzalez (clinical) [Ep 593 · 7:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=430)
- Dinutuximab is a monoclonal antibody used in neuroblastoma that can be conjugated with fluorescent markers for intraoperative tumor visualization. — Gloria Gonzalez (clinical) [Ep 593 · 5:40](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=340)
- Current near-infrared fluorescence imaging only allows visualization of superficial tumors (approximately one centimeter depth), but newer molecules in development will allow deeper tissue penetration. — Gloria Gonzalez (clinical) [Ep 593 · 8:40](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=520)
- The COG renal tumor trial AREN2231 requires at least one lymph node for enrollment, though ideally five to seven lymph nodes should be sampled based on retrospective data. — Aldrinck (guideline) [Ep 593 · 14:08](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=848)
- The modified very-low-risk group in AREN2231 includes stage I patients less than four years old (expanded from previous age two cutoff) regardless of tumor size, without adverse biomarkers (LOH 1p/16q, 1q gain, or LOH 11p15), with epithelial predominant Wilms tumor. — Aldrinck (guideline) [Ep 593 · 14:35](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=875)
- The aim of the modified very-low-risk arm is to demonstrate that patients can be treated effectively with nephrectomy only and avoid chemotherapy. — Aldrinck (guideline) [Ep 593 · 15:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=930)
- Patients in the modified very-low-risk group must have upfront total nephrectomy without tumor spill; partial nephrectomies are not eligible for this arm. — Aldrinck (guideline) [Ep 593 · 15:50](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=950)
- For right-sided renal tumors, lymph nodes should be sampled from hilar, paracaval, and aortic-caval regions, not including periportal, iliac, or mesenteric nodes. — Aldrinck (guideline) [Ep 593 · 16:44](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1004)
- The renal tumor biology study (Renal PEC) allows enrollment as soon as a renal mass is identified, before surgery or pathology confirmation, and provides rapid central review for risk assessment. — Aldrinck (guideline) [Ep 593 · 12:50](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=770)
- Central venous access placement should be delayed in patients under age four without obvious rupture, tumor spill, or stage IV disease, as approximately 50-70% more patients may avoid chemotherapy under the new protocol. — Aldrinck (guideline) [Ep 593 · 20:20](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1220)
- Intraoperative frozen section of suspicious lymph nodes can guide the decision to place a central line at the time of surgery and avoid a subsequent anesthetic. — Aldrinck (clinical) [Ep 593 · 20:40](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1240)
- Patients with negative biomarkers (LOH 1p/16q, 1q gain, or LOH 11p15) have been shown to have increased risk of recurrence and are excluded from the modified very-low-risk group. — Aldrinck (clinical) [Ep 593 · 21:03](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1263)
- ICG injection for lymph node identification in renal tumors requires injection in the perihilar region but often results in dye oozing out, making everything appear green and limiting utility. — Aldrinck (clinical) [Ep 593 · 18:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1116)
- ICG can be used for partial nephrectomy planning by creating inverse fluorescence where normal kidney lights up and tumor does not, helping identify margins. — Aldrinck (clinical) [Ep 593 · 17:50](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=1070)
- The Chilean Society of Pediatric Surgery Journal Hive team screens through 1200 articles each month using a method to select high-quality publications — Jose Campos (clinical) [Ep 592 · 0:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=48)
- The failure rate over 30% in nonoperative management of appendicitis is concerning, but nonoperative management is still safe with no adverse events in both groups (opinion) [Ep 592 · 6:37](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=397)
- In pediatric trauma, the cutoff of approximately 12 years or puberty is used as the breaking point for when to think about VTE prophylaxis — Katie Rossel (guideline) [Ep 592 · 11:04](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=664)
- VTE prophylaxis should be started as soon as the patient is stable unless there are contraindications like TBI, and conversations with neurosurgeons can often clarify when it is safe to start — Katie Rossel (clinical) [Ep 592 · 11:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=717)
- Only one in every 1000 appendectomy patients will have a tumor in the appendix, and not all are neuroendocrine tumors, meaning every surgeon will only treat a handful of these cases in their lifetime — Jose Campos (epidemiological) [Ep 592 · 13:37](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=817)
- Multiple retrospective studies and the large database study have shown that appendectomy alone is sufficient for appendiceal neuroendocrine tumors, and additional imaging is not needed because it does not change management (clinical) [Ep 592 · 17:18](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1038)
- A review of 5000 children who had appendectomy at SickKids found about 30 had a carcinoid, only 10 underwent right hemicolectomy, and of these 10 maybe only half actually needed it (clinical) [Ep 592 · 17:44](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1064)
- The biology of appendiceal neuroendocrine tumors is totally different in children compared to adults, and the behavior in pediatric patients and adolescents is entirely different than in adults, with margins not making a difference when doing appendectomy alone — Jose Campos (clinical) [Ep 592 · 18:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1131)
- Previous studies on appendiceal neuroendocrine tumors drew the line at 15 years, but the database study compared up to 18 years, so conclusions are valid up to 18 years of age — Jose Campos (clinical) [Ep 592 · 19:35](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1175)
- Four out of approximately 30 attendees perform robotic surgery; another 12 have robot access but do not use it — Juan Gurria (epidemiological) [Ep 591 · 0:24](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=24)
- Robotic instruments have seven degrees of freedom compared to six for the human hand — Juan Gurria (clinical) [Ep 591 · 0:24](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=24)
- Learning curve for basic proficiency is 20-30 cases for laparoscopy versus 10-15 cases for robotics — Juan Gurria (clinical) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- Initial cost premium for robotic surgery is approximately $4000 per case in most institutions — Juan Gurria (clinical) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- Each additional 15 minutes of operative time costs the same for robotic and laparoscopic surgery — Juan Gurria (clinical) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- Room turnover time for robotic cases can be reduced to 30 minutes with trained personnel — Juan Gurria (clinical) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- There is no FDA approval for robotic systems in pediatric surgery — Juan Gurria (guideline) [Ep 591 · 3:38](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=218)
- All pediatric surgery fellowships are integrating robotic training — Juan Gurria (epidemiological) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- Robotic surgery shows lower conversion to open rates compared to laparoscopy in colorectal cases — Juan Gurria (clinical) [Ep 591 · 2:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=171)
- Median arcuate ligament release should not be performed laparoscopically or open anymore due to difficulty accessing the angle near the celiac trunk — Juan Gurria (opinion) [Ep 591 · 3:15](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=195)
- Robotic surgery is not recommended for appendectomy — Juan Gurria (opinion) [Ep 591 · 7:16](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=436)
- Choledochal cyst is a perfect case for robotic surgery — Juan Gurria (opinion) [Ep 591 · 0:24](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=24)
- Adrenalectomy for neuroblastoma confined to the adrenal is a perfect robotic case — Juan Gurria (opinion) [Ep 591 · 0:24](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=24)
- ICG fluorescence allows visualization of adrenal arteries supplied by renal, diaphragmatic, and aortic vessels — Juan Gurria (clinical) [Ep 591 · 7:16](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=436)
- The next generation of surgeons will not be proficient in laparoscopy if robotic surgery becomes dominant in training — Todd Ponsky (opinion) [Ep 591 · 11:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=702)
- Robotic surgery is not a standard of care but a tool to aid efficiency and access to difficult angles — Juan Gurria (opinion) [Ep 591 · 12:55](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=775)
- Studies comparing robotic to laparoscopic surgery consistently show equivalence rather than superiority (clinical) [Ep 591 · 14:05](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=845)
- Surgeons trained primarily in robotics cannot tie, sew, or work with 3mm instruments effectively — Juan Gurria (opinion) [Ep 591 · 15:59](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=959)
- Patients are seeking out centers that offer robotic surgery, particularly in adult centers — Todd Ponsky (epidemiological) [Ep 591 · 16:50](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=1010)
- ICG fluorescence in choledochal cyst surgery allows visualization far back to the head of the pancreas to achieve proper tapering, decreasing future cancer risk — Juan Gurria (clinical) [Ep 591 · 17:14](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=1034)
- New robotic systems with tactile sensors reduce force application by 83% — Juan Gurria (clinical) [Ep 591 · 17:14](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=1034)
- ERAS stands for Enhanced Recovery After Surgery and consists of many elements and principles that can be applied to most all elective surgeries. — Ben Hamm (clinical) [Ep 590 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=36)
- Successful ERAS implementation requires significant system design, education, and reinforcement of that education. — Ben Hamm (clinical) [Ep 590 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=36)
- At the speaker's center, opioid prescribing after appendectomy was reduced from 84% to 0% using ERAS principles. — Ben Hamm (epidemiological) [Ep 590 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=36)
- The World Journal of Surgery published consensus guidelines around 2020 for ERAS in neonatal intestinal surgery. — Cassie Hoffman (guideline) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Broader ERAS guidelines were developed for essentially all neonatal surgery following the initial intestinal surgery guidelines. — Cassie Hoffman (guideline) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- The 2020 World Journal of Surgery consensus guidelines for neonatal intestinal surgery include moderate-to-high quality evidence for regional anesthesia and opioid-sparing analgesia. — Cassie Hoffman (guideline) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- The quadratus lumborum (QL) block provides dermatomal coverage from T6 to L1-L2 depending on dosing and has no limitations with anticoagulation. — Cassie Hoffman (clinical) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Caudal blocks can be performed with ultrasound guidance using the 'frog eyes view' (sacral cornua on either side with sacrococcygeal ligament in between) if landmark technique is difficult. — Cassie Hoffman (clinical) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Spinal anesthesia in neonates is limited to surgeries under 90–120 minutes and is not appropriate for every abdominal case. — Cassie Hoffman (clinical) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Adding preservatives to caudal blocks can prolong their duration, according to a 2021 meta-analysis in children less than one year old. — Cassie Hoffman (clinical) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Most institutions now run preservative infusions in the NICU, reducing hesitancy to use preservatives in regional blocks. — Cassie Hoffman (clinical) [Ep 590 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=246)
- Neonatology colleagues do not know what ERAS stands for or what enhanced recovery means, making implementation challenging. (opinion) [Ep 590 · 11:02](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=662)
- The concepts that underpin enhanced recovery protocols are challenging in a complex environment like a NICU. (opinion) [Ep 590 · 11:02](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=662)
- An 18-center step-wedge randomized clinical trial enrolled about 600 patients aged 10–18 years undergoing elective GI surgery to study ERAS implementation. (epidemiological) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- At Lurie Children's, anesthesia and nursing colleagues worked together to change the enterprise-wide policy to allow clear liquids up until one hour before surgery for all surgeries (horizontal integration). (clinical) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- Other departments (plastic surgery, orthopedic surgery) adopted the same ERAS preoperative scheduling and order sets after seeing the colorectal surgery implementation. (clinical) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- At Children's Memorial Hermann Hospital in Houston, patients were motivated to ambulate postoperatively by walking child life support dogs, with social workers documenting ambulation distance in the chart. (clinical) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- Cohen Children's in New York celebrated the ERAS protocol launch with C-suite buy-in, T-shirts, cake, and balloons in the lobby to change institutional culture. (clinical) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- In the 18-center trial, the median number of ERAS elements delivered was 13, and reaching this threshold was associated with a significant decrease in length of stay. (epidemiological) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- Delivering 13 or more ERAS elements decreased the proportion of patients with prolonged length of stay (≥7 days), reduced opioid exposure, and lowered complication rates. (epidemiological) [Ep 590 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=748)
- Mechanical bowel prep should not be done without oral antibiotics (e.g., neomycin, flagyl) due to increased surgical site infection and anastomotic leak rates. (clinical) [Ep 590 · 19:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1188)
- Mechanical bowel prep causes fluid shifts that may require IV fluid boluses, which can counteract ERAS goals of limiting fluids to enhance recovery. (clinical) [Ep 590 · 19:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1188)
- Surgical volume impacts outcomes for thyroidectomy, as shown in the literature. (epidemiological) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- At the speaker's institution, one ENT surgeon and the speaker collaborate on thyroid cases as a subspecialist program. (clinical) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- The institution developed an Epic order set for thyroid surgery that standardizes care from clinic through postoperative care to facilitate same-day discharge. (clinical) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- A key intervention is adding a preoperative selective COX-2 inhibitor (celecoxib) starting the night before and morning of surgery, continued twice daily postoperatively. (clinical) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- In a single-center study over one year, 100% compliance with the thyroid ERAS protocol was achieved, with one patient staying overnight due to substance abuse history and postoperative nausea. (epidemiological) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- The thyroid ERAS study had no complications, no significant change in emergency room or urgent care visits, and all patients expressed high satisfaction with same-day discharge. (epidemiological) [Ep 590 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1302)
- A multi-center study (Colorado, Cincinnati, St. Jude's) on ERAS for oncology cases showed significant reductions in intraoperative and postoperative opioids, early feeding, and reduced complications. (epidemiological) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- The oncology ERAS study showed significantly improved pain scores, particularly in the neuroblastoma subset. (epidemiological) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- Over time, postoperative length of stay for large abdominal tumor resections has decreased from 5–7 days to approximately 3 days using ERAS. (clinical) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- ERAS is feasible for large abdominal operations including large retroperitoneal dissections and big tumors. (clinical) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- Using regional anesthesia and minimizing opioids is key to successful ERAS in oncology cases. (clinical) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- For oncology patients, earlier discharge allows patients to get to chemotherapy earlier, which is key to long-term survival in diseases like neuroblastoma. (clinical) [Ep 590 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-protocols-10886?t=1661)
- Primary chest wall tumors are a rare entity in pediatric population with Ewing sarcoma being the most common one. — Chiara Oreglio (epidemiological) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Surgery remains the mainstay of treatment for primary chest wall tumors, composed of a demolitive phase and a reconstructive phase. — Chiara Oreglio (guideline) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The material of choice for chest wall reconstruction must encompass features of both stiffness and malleability while being biologically compatible. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The reconstructive material must be able to physiologically integrate with tissues and cope with the ongoing growing process in pediatric patients. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The series includes the youngest patient affected by chest wall Ewing sarcoma reported in literature, an 18-month-old female. — Chiara Oreglio (epidemiological) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The institution used porcine acellular dermal collagen (Permacol) for chest wall reconstruction. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Three patients were treated: two males and one female (18 months old at diagnosis). — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The surgical technique aims for 'drum-like tension'—tension strong enough to guarantee internal organ protection while accommodating chest wall growth. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- A latissimus dorsi muscular flap is created, rotated, and fixated over the prosthesis with sparing of the thoracodorsal artery. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- In all patients, at least three ribs were removed in accordance with oncological guidelines. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- In two cases, there was diaphragmatic involvement that was removed and reconstructed with Permacol. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- In one case with a large defect, two Stratos bars (rigid material) were used in addition to Permacol, instead of the usual four bars. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- None of the patients reported any perioperative complications according to the Clavien classification. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- R0 resection was reached in all cases. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- All patients were able to restart chemotherapy within two months from surgery. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- No limitations of movement are reported by any of the patients. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The youngest case shows no paradoxical chest wall movement at follow-up and is disease-free. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Permacol mesh presents good adaptability to the growing process with a reduced risk of rejection and infection. — Chiara Oreglio (opinion) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Permacol is highly versatile for reconstruction of highly mobile tissues such as the diaphragm. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- The thickness of the Permacol mesh can be adjusted according to age, region to be reconstructed, and defect size, making it feasible even in very young children. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Permacol can be associated with other synthetic materials in hybrid reconstruction. — Chiara Oreglio (clinical) [Ep 556 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- Compared to rigid structures like titanium bars or Stratos bars, bioprosthesis integrates with tissue and grows with surrounding tissue as the patient grows. — Chiara Oreglio (clinical) [Ep 556 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- Rigid bars like Stratos bars oblige surrounding ribs to remain fixed, modifying chest wall shape and leading to scoliosis or chest wall deformation as the most common complication. — Chiara Oreglio (clinical) [Ep 556 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- With bioprosthesis, tissues are free to grow in their own way without chest wall deformity. — Chiara Oreglio (clinical) [Ep 556 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- The oldest patient treated with Permacol did not develop any difficulty in movement, and imaging shows the rib cage is not deformed. — Chiara Oreglio (clinical) [Ep 556 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- Up to 50% of pediatric oncology patients have lung metastasis during their disease — Gloria Gonzalez (epidemiological) [Ep 537 · 0:50](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=50)
- Surgery can improve survival in patients with lung metastases — Gloria Gonzalez (clinical) [Ep 537 · 1:10](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=70)
- Complete resection of all nodules is necessary for optimal outcomes — Gloria Gonzalez (clinical) [Ep 537 · 1:20](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=80)
- Minimally invasive surgery is feasible for patients with one or two nodules — Gloria Gonzalez (clinical) [Ep 537 · 1:30](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=90)
- The conversion rate due to failure to localize subdural nodules during thoracoscopy is 47% — Gloria Gonzalez (epidemiological) [Ep 537 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=100)
- Conversion rate is much higher without double lung ventilation — Gloria Gonzalez (clinical) [Ep 537 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=120)
- CT guidance during thoracoscopy exposes the patient to radiation continuously — Gloria Gonzalez (clinical) [Ep 537 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=140)
- Ultrasound is difficult for localizing very small nodules — Gloria Gonzalez (clinical) [Ep 537 · 2:30](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=150)
- Calcified lesions in osteosarcoma are difficult to visualize with ultrasound — Gloria Gonzalez (clinical) [Ep 537 · 2:40](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=160)
- Hook wire dislodgement rate is reported as 2.4 to 22% — Gloria Gonzalez (epidemiological) [Ep 537 · 2:50](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=170)
- Hook wire dislodgement rate is higher when patients must travel from CT scan to OR under anesthesia — Gloria Gonzalez (clinical) [Ep 537 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=180)
- Methylene blue often spreads throughout the chest rather than remaining localized to nodules — Gloria Gonzalez (clinical) [Ep 537 · 3:10](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=190)
- ICG cannot be used for nodules deeper than 2 centimeters — Gloria Gonzalez (clinical) [Ep 537 · 3:20](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=200)
- Lipiodol marking is performed under CT guidance by interventional radiologists — Gloria Gonzalez (clinical) [Ep 537 · 3:30](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=210)
- Lipiodol remains in place for up to 3 months after injection — Gloria Gonzalez (clinical) [Ep 537 · 3:40](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=220)
- Surgery can be performed up to one week after Lipiodol marking — Gloria Gonzalez (clinical) [Ep 537 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=230)
- Intraoperative C-arm fluoroscopy is used to localize Lipiodol-marked nodules — Gloria Gonzalez (clinical) [Ep 537 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=240)
- Complete resection is verified by radioscopy and palpation of the resected specimen — Gloria Gonzalez (clinical) [Ep 537 · 4:10](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=250)
- Dr. Gonzalez used Lipiodol in 33 patients with three or four nodules per patient — Gloria Gonzalez (epidemiological) [Ep 537 · 4:20](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=260)
- The technique was used across multiple histologies including osteosarcoma, Ewing sarcoma, Wilms tumor, and infectious disease — Gloria Gonzalez (epidemiological) [Ep 537 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=270)
- Lipiodol marking achieved 100% sensitivity in localizing 50 nodules — Gloria Gonzalez (epidemiological) [Ep 537 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=280)
- Sacrococcygeal teratoma is the most common germ cell tumor in neonates with an estimated incidence of one per 14,000 to 35,000 live births. — Lieke van de Hurk (epidemiological) [Ep 420 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=0)
- The likelihood of malignant transformation increases with age, with malignancy rates up to 70% if SCCT is diagnosed at the age of one year. — Lieke van de Hurk (epidemiological) [Ep 420 · 0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=30)
- More than 150 centers from 65 countries participated in the SCCT study. — Lieke van de Hurk (clinical) [Ep 420 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=120)
- Data was collected for patients treated for SCCT between 1980 and 2020. — Lieke van de Hurk (clinical) [Ep 420 · 2:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=150)
- Data of patients where SCCT was associated with Currarino syndrome was not analyzed because it is unknown whether SCCT associated with Currarino has the same risk of malignant transformation as SCCT. — Lieke van de Hurk (clinical) [Ep 420 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=180)
- All participating centers included 3,614 patients with SCCT, with 205 patients with Currarino syndrome excluded, leaving 3,409 SCCT patients included in analysis. — Lieke van de Hurk (epidemiological) [Ep 420 · 3:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=210)
- During the first six years of life, the probability of malignant transformation increases strongly, and after six years of age, the probability remains stable at 60%. — Lieke van de Hurk (epidemiological) [Ep 420 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=240)
- After six years of age, almost no malignancies have been found. — Lieke van de Hurk (epidemiological) [Ep 420 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=270)
- Malignancy-free survival stabilized at the age of five years with a malignancy-free survival rate of 81%. — Lieke van de Hurk (epidemiological) [Ep 420 · 4:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=280)
- Late malignancies up to 15 years of age have been found. — Lieke van de Hurk (epidemiological) [Ep 420 · 5:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=310)
- Most recurrences were found four years after initial resection, with probability of recurrence-free survival at 85% four years after initial resection. — Lieke van de Hurk (epidemiological) [Ep 420 · 5:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=320)
- Incidental late recurrences up to 20 years after primary resection have been found in this study. — Lieke van de Hurk (epidemiological) [Ep 420 · 5:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=350)
- Altman type 2 and 3 were significant risk factors for recurrent SCCT in multivariate analysis. — Lieke van de Hurk (clinical) [Ep 420 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=360)
- Malignant histology of the primary tumor increases the risk of recurrent SCCT with an odds ratio of 4.7. — Lieke van de Hurk (clinical) [Ep 420 · 6:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=380)
- Income country was not a risk factor for recurrent SCCT. — Lieke van de Hurk (epidemiological) [Ep 420 · 6:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-lieke-josephine-van-heurn-eupsa-presentation-6354?t=400)
- All patients and families should receive fertility counseling, as this is a standard recommended by major societies including ASCO, AAP, and ASRM. — Aaron Rowell (guideline) [Ep 454 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=114)
- Around 20 to 30% of families will intervene and ask to do something to preserve fertility. — Aaron Rowell (epidemiological) [Ep 454 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=114)
- Counseling should occur and be documented prior to the start of high-risk chemotherapy, even if families don't proceed with any surgery. — Aaron Rowell (guideline) [Ep 454 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=114)
- For a pre-pubertal girl, a CED (cyclophosphamide equivalent dose) of 8 to 12 grams or more places them at high level of risk for premature ovarian insufficiency, making them a candidate for oophorectomy. — Aaron Rowell (clinical) [Ep 454 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=195)
- For a post-pubertal patient, a CED of 4 grams per meter squared or more indicates high risk for premature ovarian insufficiency. — Aaron Rowell (clinical) [Ep 454 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=195)
- A pre-pubertal child's ovary is about 2 centimeters in size, approximately the size of a grape. — Aaron Rowell (clinical) [Ep 454 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=276)
- Laparoscopic oophorectomy rather than biopsy is the best recommendation for pre-pubertal patients because a biopsy can damage the ovary and put the child at high risk for hemorrhage, which would impact the child's ability to start stem cell transplant or chemotherapy. — Aaron Rowell (clinical) [Ep 454 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=276)
- Re-implanted ovarian strips can restore ovarian function for about two to five years and can result in live birth. — Aaron Rowell (clinical) [Ep 454 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=276)
- Live birth from re-implanted ovarian tissue has occurred in two children who were nine years old, but has not yet happened in anyone younger in the United States. — Aaron Rowell (epidemiological) [Ep 454 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=276)
- A small biopsy of one ovary would not give enough tissue to sustain a child's entire reproductive future. — Aaron Rowell (clinical) [Ep 454 · 4:36](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=276)
- Surgeons should stay at least a centimeter away from the ovarian capsule because that's where all the follicle pool is located. — Aaron Rowell (clinical) [Ep 454 · 6:51](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=411)
- In a piglet model that mimics a pre-pubertal child, if surgeons stay at least a centimeter away from the ovarian capsule, there were healthier tissue parameters including production of glucose, decreased lactose, and increased estradiol from ovarian follicles in culture. — Aaron Rowell (clinical) [Ep 454 · 6:51](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=411)
- The fimbria are very fragile and can develop scarring leading to hydrosalpinx later if not protected during surgery. — Aaron Rowell (clinical) [Ep 454 · 6:51](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=411)
- The Cool Seal device has a 3 mm option suitable for really small children and can help maintain distance from the ovarian capsule. — Aaron Rowell (clinical) [Ep 454 · 6:51](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=411)
- In Dr. Rowell's experience with about 140 patients, 17 had abdominal pelvic tumor surgery within a month of their laparoscopic oophorectomy, at a median of 29 days after open surgery. — Aaron Rowell (epidemiological) [Ep 454 · 9:26](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=566)
- Of 17 patients who had recent abdominal pelvic tumor surgery, 16 underwent laparoscopic oophorectomy with no trouble, and one was done open by choice because they needed another tumor biopsy. — Aaron Rowell (epidemiological) [Ep 454 · 9:26](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=566)
- Neoplastic ovarian masses are classified into three types based on tissue of origin: epithelial ovarian tumors, stromal/sex cord tumors, and germ cell tumors (from the yolk sac). — Roshni Dasgupta (clinical) [Ep 384 · 0:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=55)
- Malignancy from neoplastic ovarian processes is rare, making up only 2% of cancers in children overall. — Roshni Dasgupta (epidemiological) [Ep 384 · 1:35](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=95)
- Ovarian malignancy is more common in the 10-19 year age group and any malignant lesion under age 5 is reportable. — Roshni Dasgupta (clinical) [Ep 384 · 1:45](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=105)
- Peutz-Jeghers syndrome is associated primarily with granulosa cell tumors and sex cord tumors. — Roshni Dasgupta (clinical) [Ep 384 · 2:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=120)
- Ollier and Maffucci syndromes are associated with ovarian tumors. — Roshni Dasgupta (clinical) [Ep 384 · 2:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=130)
- Chediak-Higashi and McCune-Albright syndromes are also associated with ovarian tumors. — Roshni Dasgupta (clinical) [Ep 384 · 2:18](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=138)
- Workup for suspected ovarian tumor with precocious puberty includes renal panel, CBC, estradiol, progesterone, tumor markers, and ultrasound. — Roshni Dasgupta (clinical) [Ep 384 · 3:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=180)
- CT scan advantages for ovarian mass evaluation include better determination of tumor location and extent, and superior detection of calcifications compared to MRI. — Roshni Dasgupta (clinical) [Ep 384 · 3:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=230)
- CT scan disadvantage is radiation exposure to the child. — Roshni Dasgupta (clinical) [Ep 384 · 4:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=250)
- MRI provides better tissue detail, can help distinguish ovarian from parovarian masses, and is excellent at detecting lymph nodes. — Roshni Dasgupta (clinical) [Ep 384 · 4:18](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=258)
- Tumor markers commonly associated with ovarian tumors include AFP, beta-hCG, CA-125 (for epithelial tumors), inhibin A and B, hormones (estradiol, progesterone), LDH, CBC, and renal function tests. — Roshni Dasgupta (clinical) [Ep 384 · 5:01](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=301)
- Elevated inhibin B is associated with granulosa cell tumor, a sex cord tumor that causes virilizing effects. — Roshni Dasgupta (clinical) [Ep 384 · 5:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=340)
- CA-125 can be elevated in benign conditions such as endometriosis and other inflammatory conditions, sometimes to levels that overlap with malignancy. — Roshni Dasgupta (clinical) [Ep 384 · 6:34](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=394)
- Primordial germ cells form in the first week of gestation, and by week three they form the wall of the yolk sac and migrate along the mesentery of the hindgut. — Roshni Dasgupta (clinical) [Ep 384 · 7:15](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=435)
- Germ cell tumors can be gonadal (when germ cells migrate to the gonads) or extragonadal (sacrococcygeal teratomas, mediastinal lesions). — Roshni Dasgupta (clinical) [Ep 384 · 7:45](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=465)
- Within gonadal germ cell tumors, if cells differentiate properly, extraembryonic differentiation produces choriocarcinomas and yolk sac tumors, while embryonic differentiation produces teratomas and mixed germ cell tumors. — Roshni Dasgupta (clinical) [Ep 384 · 8:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=490)
- If germ cells do not differentiate properly, they are classified as seminomas in boys and dysgerminomas in girls. — Roshni Dasgupta (clinical) [Ep 384 · 8:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=530)
- About 20% of germ cell tumors are malignant. — Roshni Dasgupta (epidemiological) [Ep 384 · 9:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=560)
- Dysgerminomas are the most common malignant histology, comprising 30% of germ cell tumors, and can be bilateral. — Roshni Dasgupta (epidemiological) [Ep 384 · 9:35](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=575)
- Dysgerminomas have a unique laboratory pattern: elevated LDH, but in a pure dysgerminoma AFP and beta-hCG can be normal; hypercalcemia may also be present. — Roshni Dasgupta (clinical) [Ep 384 · 9:48](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=588)
- Germ cell tumor staging requires peritoneal washings, examination of the entire peritoneal cavity, omental resection only if suspicious nodules are present, and unilateral salpingo-oophorectomy (salpingectomy only if fallopian tube is involved). — Roshni Dasgupta (clinical) [Ep 384 · 11:12](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=672)
- For germ cell tumors, lymph nodes should be examined intraoperatively but only removed if enlarged or suspicious; standard lymph node dissection is not required. — Roshni Dasgupta (clinical) [Ep 384 · 11:12](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=672)
- Any portion of the ovary that can be preserved should be considered during germ cell tumor resection. — Roshni Dasgupta (clinical) [Ep 384 · 11:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=710)
- COG staging for germ cell tumors: stage I is limited to the ovary with negative washings; stage II includes capsular rupture with negative washings; stage III is lymph node involvement; stage IV is distant metastasis. — Roshni Dasgupta (guideline) [Ep 384 · 12:42](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=762)
- Stage I germ cell tumors can be managed with surgery alone and observation if the tumor is not ruptured. — Roshni Dasgupta (clinical) [Ep 384 · 13:31](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=811)
- If a germ cell tumor is ruptured during laparoscopic resection and tumor is spilled, the patient is required to receive chemotherapy. — Roshni Dasgupta (clinical) [Ep 384 · 14:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=840)
- For mature teratomas with a cystic component, it is safe to decompress the cyst first to improve access and increase chances of ovarian preservation. — Roshni Dasgupta (clinical) [Ep 384 · 16:30](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=990)
- The ovarian capsule does not need to be closed after shelling out a teratoma; there is no data showing closure is necessary and it will form by itself. — Roshni Dasgupta (clinical) [Ep 384 · 16:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1015)
- A plastic bowel bag can be glued to the ovarian mass and a needle inserted through it to avoid spillage during teratoma resection. — Roshni Dasgupta (clinical) [Ep 384 · 17:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1030)
- Spillage of teratoma contents can cause growing teratoma syndrome, where teratoma grows throughout the abdomen and is not responsive to chemotherapy. — Roshni Dasgupta (clinical) [Ep 384 · 17:23](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1043)
- Staging for epithelial ovarian tumors requires pelvic washings, abdominal examination, omentectomy, primary tumor removal, and lymph node dissection. — Roshni Dasgupta (clinical) [Ep 384 · 18:31](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1111)
- For epithelial tumors, lymph node dissection boundaries are the pelvic iliacs to the renal artery (para-aortic nodes below the renals). — Roshni Dasgupta (clinical) [Ep 384 · 18:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1135)
- About 30% of normal-appearing lymph nodes in epithelial ovarian cancer are positive on pathology, which will upstage the patient. — Roshni Dasgupta (epidemiological) [Ep 384 · 19:23](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1163)
- Borderline epithelial tumors can recur, so patients require close serial follow-up over many years. — Roshni Dasgupta (clinical) [Ep 384 · 20:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1200)
- For borderline epithelial tumors, ovarian-sparing surgery can be performed initially, and if pathology confirms borderline tumor, the ovary can either be removed in a second operation or the patient can be watched with close surveillance. — Roshni Dasgupta (clinical) [Ep 384 · 20:26](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1226)
- There is no perfect tumor marker for ovarian masses; studies from the Midwest Pediatric Surgery Consortium show that a panel of tumor markers is helpful, but no single marker perfectly predicts malignancy. — Roshni Dasgupta (clinical) [Ep 384 · 21:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1260)
- Sickle cell disease is an exception to restrictive transfusion protocols, requiring hematocrit around 30 or HBSS below 50-60% (clinical) [Ep 157 · 2:01](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=121)
- Institutional policy at one center applies VTE prophylaxis with low molecular weight heparin to patients age 12 and over (clinical) [Ep 157 · 5:55](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- High risk criteria for VTE in trauma include femur fractures, cervical spine fracture, and intubation (clinical) [Ep 157 · 5:55](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- Kids with IBD are probably the most at-risk group for deep venous thrombosis — Rae Hanke (clinical) [Ep 157 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- In Wilms tumor with pulmonary metastases, it is still important to take lymph nodes because local disease treatment has an impact on abdominal disease treatment regardless of lung mets (clinical) [Ep 157 · 19:21](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1161)
- In a survey for a Seattle-based multi-institutional study, parents stated they would accept a 50% chance of success as acceptable for enrolling in non-operative appendicitis management study (epidemiological) [Ep 157 · 23:50](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1430)
- The three most frequent extracranial solid tumors in pediatric surgical oncology are neuroblastoma, hepatoblastoma, and Wilms tumor. — Pablo Daval (epidemiological) [Ep 110 · 0:42](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=42)
- For neuroblastoma, hepatoblastoma, and Wilms tumor, the surgeon should know when to perform upfront resection versus delaying until neoadjuvant chemotherapy has reduced tumor size and risks. — Pablo Daval (clinical) [Ep 110 · 1:08](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=68)
- Avoiding vascular lesions is key in all three tumor types (neuroblastoma, hepatoblastoma, and Wilms tumor). — Pablo Daval (clinical) [Ep 110 · 1:28](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=88)
- Implementation of IRDFs (image-defined risk factors) in neuroblastoma can help achieve better resection. — Pablo Daval (clinical) [Ep 110 · 1:34](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=94)
- Exposure should be adequate and dissection thorough in pediatric solid tumor surgery. — Pablo Daval (clinical) [Ep 110 · 1:46](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=106)
- Some pediatric solid tumor cases can be done with minimally invasive surgery, while others require complex approaches. — Pablo Daval (clinical) [Ep 110 · 1:52](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=112)
- The PRETEXT staging system in hepatoblastoma has proven to have prognostic implications. — Pablo Daval (clinical) [Ep 110 · 2:02](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=122)
- The PRETEXT staging system can guide hepatoblastoma surgery while maintaining goals of complete resection without postoperative liver failure. — Pablo Daval (clinical) [Ep 110 · 2:12](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=132)
- In Wilms tumor surgery, the surgeon should avoid intraoperative rupture and vascular lesions. — Pablo Daval (clinical) [Ep 110 · 2:26](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=146)
- Lymph nodes should always be obtained during Wilms tumor surgery. — Pablo Daval (clinical) [Ep 110 · 2:36](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=156)
- In bilateral Wilms tumors, preservation of as much renal parenchyma as possible is the aim. — Pablo Daval (clinical) [Ep 110 · 2:42](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=162)
- Surgical planning for pediatric solid tumors relies on imaging studies. — Pablo Daval (clinical) [Ep 110 · 2:52](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=172)
- The use of 3D printed models, if available, can add to surgical planning for pediatric solid tumors. — Pablo Daval (clinical) [Ep 110 · 2:58](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-pediatric-surgical-oncology-1703?t=178)
- Cyclophosphamide equivalent dose (CED) over 15 grams per meter squared puts pediatric patients at high risk for ovarian failure. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- The patient's CED was 30.8 grams per meter squared, placing her at high risk for primary ovarian insufficiency. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian transposition may not provide adequate distance from scatter radiation in young patients receiving pelvic radiation. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- GnRH agonist therapy has not demonstrated clear fertility preservation benefit in pediatric patients and is not recommended as first-line by ASCO. — Julie Rios (guideline) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- GnRH agonist therapy may have some benefit in older patients with breast cancer, though studies conflict. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue cryopreservation is experimental and followed by future ovarian tissue transplantation, allowing about 30% of patients to have fertility. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Most fertility data from ovarian tissue transplantation comes from post-pubertal patients, but studies show visible follicles in tissue from pediatric patients. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue is typically cryopreserved within the same day of harvest to minimize egg loss from lack of vascular supply. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Orthotopic transplantation involves placing tissue back where the ovary was removed, either sewn to the contralateral ovary or in a peritoneal pocket near the fallopian tube. — Julie Rios (clinical) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Meta-analysis data shows 37-50% of patients with transplants had live births, with 30-40% achieving fertility preservation (some requiring multiple transplants). — Julie Rios (epidemiological) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- 60-90% of patients with ovarian tissue transplants achieve restoration of ovarian endocrine function. — Julie Rios (epidemiological) [Ep 155 · 1:08](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=68)
- Ovarian tissue cryopreservation requires both a surgeon to remove tissue and facilities to freeze it on-site. — Julie Rios (clinical) [Ep 155 · 7:26](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=446)
- Ovarian tissue cryopreservation became standard of care first in the Netherlands. — Julie Rios (clinical) [Ep 155 · 7:26](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=446)
- Sperm banking is only an option for post-pubertal males, typically Tanner stage 3 and above. — Julie Rios (clinical) [Ep 155 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- For prepubertal males receiving high-dose treatment, testicular tissue cryopreservation is available through protocols such as at University of Pittsburgh. — Julie Rios (clinical) [Ep 155 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Testicular tissue preservation typically involves a wedge biopsy rather than full orchiectomy. — Julie Rios (clinical) [Ep 155 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Ovarian tissue transplantation is typically performed only when pregnancy is desired because the graft lasts only 2-5 years. — Julie Rios (clinical) [Ep 155 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Hormone replacement medication is used for pubertal induction and hormone support until pregnancy is desired. — Julie Rios (clinical) [Ep 155 · 8:42](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=522)
- Most centers now use long-term storage facilities with three or four mechanisms for detecting tank dysfunction to prevent tissue loss. — Julie Rios (clinical) [Ep 155 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Hospital fees and anesthesia fees can often be covered by insurance when ovarian tissue harvest is combined with other oncology procedures like bone marrow biopsy or central line placement. — Julie Rios (clinical) [Ep 155 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Tissue storage costs are income-dependent: $75 per year for oncology patients below income threshold, $275 per year above threshold. — Julie Rios (clinical) [Ep 155 · 10:58](https://library.globalcastmd.com/watch/oncofertility-ovarian-salvage-2292?t=658)
- Indocyanine Green was discovered by the post-World War II Kodak company and has been FDA approved since the 1960s. — Seth Goldstein (clinical) [Ep 461 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- ICG is a safe, harmless fluorescent contrast that can be injected subcutaneously or intravenously depending on the use. — Seth Goldstein (clinical) [Ep 461 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- ICG usage has really developed in hepatobiliary surgery. — Seth Goldstein (clinical) [Ep 461 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- Sentinel node biopsy at the time of port placement for alveolar rhabdomyosarcoma is pretty much standard of care. — Seth Goldstein (guideline) [Ep 461 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- Pediatric surgeons can consider use of ICG as an adjunct to sentinel node identification. — Seth Goldstein (opinion) [Ep 461 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- ICG can be used in the operating room with equipment that is either already present or about to be standard in all laparoscopic towers. — Seth Goldstein (clinical) [Ep 461 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- After indocyanine injection into the tumor, ICG travels to the sentinel node over the course of 45, 60, or 75 seconds. — Seth Goldstein (clinical) [Ep 461 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- ICG is exclusively biliary cleared. — Seth Goldstein (clinical) [Ep 461 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- For detecting liver tissue metastases in the chest, ICG should be given the day before surgery so it is the only thing left in the chest by the time of thoracotomy. — Seth Goldstein (clinical) [Ep 461 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- At the time of thoracotomies for lung metastases, if ICG is given the day before, additional metastases can be found beyond what is detected by palpation and visual inspection. — Seth Goldstein (clinical) [Ep 461 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- Spots detected by ICG in the chest after preoperative administration are also positive on histology. — Seth Goldstein (clinical) [Ep 461 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- Fluorescent ureteral stents that emit infrared light can be detected by standard laparoscopic systems and help protect ureters during pelvic tumor resection. — Seth Goldstein (clinical) [Ep 461 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=286)
- Fluorescent ureteral stents can enable minimally invasive approaches to cases that would otherwise require open surgery due to ureteral proximity to tumor. — Seth Goldstein (opinion) [Ep 461 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=286)
- Compressed-interval VDC/IE chemotherapy given every 2 weeks is now well proven to be of benefit over 3-week schedule for Ewing sarcoma — Joseph Pressey (clinical) [Ep 685 · 9:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=563)
- For chest wall sarcomas, the old adage of needing a rib above and a rib below for margins is not the case anymore; the goal is just to get negative margins if possible — Roshni Dasgupta (clinical) [Ep 685 · 11:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=683)
- When tumor is adherent to diaphragm or pericardium, you should not dissect these structures off the tumor because you don't know where the margin is; instead take a portion of the adherent structure with the tumor — Roshni Dasgupta (clinical) [Ep 685 · 12:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=738)
- Titanium rib reconstruction systems may need revision as the child grows, particularly during puberty with significant growth spurts — Roshni Dasgupta (clinical) [Ep 685 · 14:05](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=845)
- For Ewing sarcoma radiotherapy, treatment typically involves two phases: disease presentation volume and then more specific targeting of gross disease or positive margins — Luke Pater (clinical) [Ep 685 · 15:29](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=929)
- Protons are preferred over photons for focused boost volumes because they reduce low-dose exposure to non-target tissue beyond the target, though in lungs the benefit is compromised due to low-density tissue causing scatter — Luke Pater (clinical) [Ep 685 · 20:12](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1212)
- Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) was originally described around 1980 in young adult women presenting with ovarian tumors with nondescript morphology, often associated with hypercalcemia — Joseph Pressey (epidemiological) [Ep 685 · 23:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1403)
- SCCOHT tumors are actually malignant rhabdoid tumors; some have postulated they should be called malignant rhabdoid tumor of the ovary — Joseph Pressey (clinical) [Ep 685 · 23:47](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1427)
- In 2014, three labs simultaneously identified SMARCA4 mutation (usually single nucleotide variant) as the underlying genetic defect in SCCOHT — Joseph Pressey (clinical) [Ep 685 · 24:06](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1446)
- SMARCA4 encodes BRG1 and its loss unifies all SCCOHT tumors; like Ewing sarcoma, these tumors have very low tumor mutational burden with SMARCA4 usually the only mutation found — Joseph Pressey (clinical) [Ep 685 · 24:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1480)
- Many SCCOHT patients enter the OR without this diagnosis in the differential; they are usually thought to be germ cell tumors, resulting in incomplete initial surgery — Joseph Pressey (clinical) [Ep 685 · 26:39](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1599)
- SCCOHT is a chemo-sensitive tumor but only transiently so; it is very important to start intensive systemic chemotherapy quickly rather than sending patients back for immediate second-look operation — Joseph Pressey (clinical) [Ep 685 · 27:00](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1620)
- The VPCBAE regimen (vinorelbine, cisplatin, cyclophosphamide, bleomycin, doxorubicin, etoposide) with all six agents given every 21-day cycle is very intensive toxic therapy requiring meticulous supportive care — Joseph Pressey (clinical) [Ep 685 · 27:20](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1640)
- Four cycles of VPCBAE induction chemotherapy are given prior to second-look operation for SCCOHT; patients with measurable disease after initial surgery often respond well even by RECIST criteria — Joseph Pressey (clinical) [Ep 685 · 27:43](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1663)
- The 12-month-old SCCOHT patient is the youngest ever described with this tumor; the average age for diagnosis is 24 years — Joseph Pressey (epidemiological) [Ep 685 · 28:25](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1705)
- MRIs and PET scans are not great for detecting peritoneal disease and very small nodules (1mm); second-look surgery is necessary to identify disease that imaging cannot detect — Roshni Dasgupta (clinical) [Ep 685 · 29:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1758)
- For SCCOHT second-look surgery, laparoscopy is used initially to understand extent of disease and determine size of laparotomy incision needed; the operation is never done with laparoscopy alone — Roshni Dasgupta (clinical) [Ep 685 · 29:44](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1784)
- Complete cytoreduction for SCCOHT includes removing all visible disease, with particular attention to peritoneal reflection in pouch of Douglas and surface of rectum where tumor can hide after spill — Roshni Dasgupta (clinical) [Ep 685 · 30:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1840)
- HIPEC in pediatric patients requires a multidisciplinary team experienced in this procedure; it is not the same as adult HIPEC — Roshni Dasgupta (clinical) [Ep 685 · 32:25](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1945)
- HIPEC protocol includes preoperative hyperhydration (1-2x maintenance fluids), warming abdomen to 42°C, cisplatin given in 2/3 dose initially and 1/3 at 45 minutes, continuous shaking for 90-minute dwell time, sodium thiosulfate infusion at 30 minutes to scavenge cisplatin, and 4-5L washout — Roshni Dasgupta (clinical) [Ep 685 · 32:59](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1979)
- Post-HIPEC patients receive 24 hours of hyperhydration in ICU; main counseled toxicities are ileus and kidney function issues, though the Cincinnati protocol has not seen significant renal toxicity — Roshni Dasgupta (clinical) [Ep 685 · 34:49](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2089)
- SCCOHT patients can resume next cycle of chemotherapy 4-7 days postoperatively after HIPEC once bowel function recovers — Roshni Dasgupta (clinical) [Ep 685 · 35:50](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2150)
- Maintaining interval compression as dense as possible (7-8 days to resume chemotherapy post-HIPEC) is very important to continue killing residual tumor cells — Joseph Pressey (clinical) [Ep 685 · 36:06](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2166)
- SCCOHT treatment uses 6 cycles of VPCBAE (usually 4 induction, 2 adjuvant); some stage 1 patients or those with considerable toxicity (especially renal) have stopped after 5 cycles to get to transplant in good health — Joseph Pressey (clinical) [Ep 685 · 36:39](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2199)
- Cincinnati uses busulfan-thiotepa conditioning for autologous stem cell transplant in SCCOHT, which is more toxic than the carboplatin-based regimen used by the French consortium but complements VPCBAE better with heavy alkylator exposure — Joseph Pressey (clinical) [Ep 685 · 37:08](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2228)
- Approximately 43% of SCCOHT patients carry germline SMARCA4 mutations; in Cincinnati's last 20 patients, 8 had germline SMARCA4 (40%) — Joseph Pressey (epidemiological) [Ep 685 · 37:56](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2276)
- For SCCOHT patients with germline SMARCA4, contralateral salpingo-oophorectomy should be performed at second-look operation because it would be nearly impossible to treat a metachronous SCCOHT tumor a second time with intensive therapy — Joseph Pressey (clinical) [Ep 685 · 38:21](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2301)
- Germline SMARCA4 mutations have been found in older SCCOHT patients in their late 30s with no prior personal or family history of cancer; all patients should be tested regardless of family history — Joseph Pressey (clinical) [Ep 685 · 38:55](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2335)
- Hysterectomy should be considered for germline SMARCA4 carriers due to risk of SMARCA4-deficient uterine sarcoma, which peaks around age 50 (later than SCCOHT which peaks at 23-24 years) — Joseph Pressey (clinical) [Ep 685 · 39:16](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2356)
- Two patients who survived SCCOHT developed metachronous SCCOHT tumors in the contralateral ovary and subsequently died, demonstrating this is a real risk not worth taking — Joseph Pressey (clinical) [Ep 685 · 39:37](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2377)
- Penetrance of germline SMARCA4 is estimated at 62% based on UK Biobank study comparing males vs females over age 40, assuming the deficit of females was explained by SCCOHT deaths — Joseph Pressey (epidemiological) [Ep 685 · 40:10](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2410)
- Cincinnati's methodology estimates SMARCA4 penetrance closer to 20% studying family members of SCCOHT patients; even at 20% this is considered considerable risk for otherwise healthy female carriers — Joseph Pressey (epidemiological) [Ep 685 · 41:08](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2468)
- About 20% of SCCOHT patients have de novo SMARCA4 mutations with neither parent carrying the mutation — Joseph Pressey (epidemiological) [Ep 685 · 41:35](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2495)
- Major long-term toxicity from SCCOHT treatment is ototoxicity requiring hearing aids; otherwise patients grow and develop well — Joseph Pressey (clinical) [Ep 685 · 42:11](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2531)
- Whole abdomen radiation for SCCOHT was used historically but is excessively toxic in patients who receive autologous stem cell transplant and HIPEC; Cincinnati has walked away from this approach — Luke Pater (clinical) [Ep 685 · 43:16](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2596)
- Whole abdomen radiation could still be considered for SCCOHT patients who do not get HIPEC or autologous bone marrow transplant — Luke Pater (opinion) [Ep 685 · 43:46](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2626)
- Protons are ideal for SCCOHT lymph node radiation to minimize bowel, liver, kidney exposure and in similar scenarios to minimize dose to uterus, ovaries, pancreas, and spleen (low-dose pancreatic/splenic exposure is problematic long-term for metabolic syndrome and immune function) — Luke Pater (clinical) [Ep 685 · 44:30](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2670)
- Cincinnati's SCCOHT series of 20 consecutive patients (2018-2024) with median follow-up of 58 months shows 60% overall survival, about 20 percentage points higher than the French study published in 2020 — Joseph Pressey (epidemiological) [Ep 685 · 50:21](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3021)
- For rhabdomyosarcoma, surgery should only be attempted if negative margins are achievable; if only debulking is possible, local control should be done with radiation only — Roshni Dasgupta (clinical) [Ep 685 · 55:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3318)
- The goal of delayed primary excision (DPE) for rhabdomyosarcoma is to achieve at least R1 disease (microscopic residual only) — Roshni Dasgupta (clinical) [Ep 685 · 55:41](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3341)
- Scapular disarticulation provides excellent access for high chest wall tumors, allowing the chest to be opened like a book — Roshni Dasgupta (clinical) [Ep 685 · 56:33](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3393)
- For tumors near subclavian vessels and brachial plexus, a neck incision (similar to first rib operation for thoracic outlet syndrome) allows isolation of these structures from above before thoracotomy — Roshni Dasgupta (clinical) [Ep 685 · 56:47](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3407)
- For high chest wall defects covered by scapula, bony reconstruction is not needed; Gore-Tex mesh with trapezius flap rotation provides adequate coverage — Roshni Dasgupta (clinical) [Ep 685 · 57:34](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3454)
- After delayed primary excision for presenting R3/group 3 rhabdomyosarcoma, radiotherapy is typically recommended — Luke Pater (clinical) [Ep 685 · 59:48](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3588)
- In the rhabdomyosarcoma case with germline TP53 mutation, radiation was deferred due to the mutation combined with excellent chemotherapy response and complete surgical resection, despite this being non-standard for group 3 disease — Luke Pater (clinical) [Ep 685 · 60:13](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3613)
- Radiation-induced sarcomas in Li-Fraumeni patients are typically more aggressive and less chemosensitive than primary sarcomas — Joseph Pressey (clinical) [Ep 685 · 60:53](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3653)
- The incidence of secondary malignancy from radiation is assumed to be higher the younger the patient, both because of more years to develop it and an inherent increased risk with young age — Luke Pater (clinical) [Ep 685 · 61:31](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3691)
- Radiation decisions in young children involve nuanced discussions of toxicities including pulmonary function, cardiac exposure, wound healing, and chest wall development, individualized case by case — Luke Pater (opinion) [Ep 685 · 61:48](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3708)
- The risk of hereditary predisposition among all sarcoma patients may be as high as 15% — Joseph Pressey (epidemiological) [Ep 685 · 64:17](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3857)
- Cincinnati now performs universal germline testing for all newly diagnosed solid tumor patients and many benign tumors like desmoid tumors (with FAP testing) — Joseph Pressey (clinical) [Ep 685 · 64:27](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3867)
- For neuroblastoma patients with L2 tumors (local regional tumor with positive image-defined risk factors), those with MYCN amplification did extremely poorly when treated as intermediate risk compared to their MYCN non-amplified cohorts. (clinical) [Ep 686 · 12:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=778)
- Percutaneous core biopsy can provide adequate tissue for genetic analysis needed to risk-stratify neuroblastoma patients; open biopsy is not required for every patient if adequate cores are obtained in collaboration with pathology. (clinical) [Ep 686 · 13:54](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=834)
- The optimal timing for surgical resection of neuroblastoma is after cycle 4 of chemotherapy, when the biggest tumor response has occurred but before significant fibrosis develops that would make surgery more challenging. (clinical) [Ep 686 · 21:08](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1268)
- The addition of tandem stem cell transplants into the standard of care for high-risk neuroblastoma is associated with significant improvement in progression-free and overall survival. (clinical) [Ep 686 · 16:36](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=996)
- The robotic platform provides 7 degrees of freedom in motion compared to 6 with the human hand, allowing better access to tight spaces. (clinical) [Ep 686 · 28:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1703)
- Robotic surgery should not be pursued for neuroblastoma with image-defined risk factors involving major vessels (aorta, SMA, celiac, renal pedicles) post-therapy, just as laparoscopy would not be pursued in these cases. (clinical) [Ep 686 · 29:33](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1773)
- Robotic surgery for neuroblastoma has been performed safely in patients as small as 5 kg, with port spacing of 3 cm sufficient in smaller babies compared to 5 cm in larger patients. (clinical) [Ep 686 · 30:17](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1817)
- For thoracic neuroblastomas extending beyond the diaphragm, robotic approach provides excellent visualization and access, avoiding the need for two large incisions. (clinical) [Ep 686 · 31:54](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1914)
- MRI is superior to CT for identifying image-defined risk factors in neuroblastoma, particularly for visualizing lymph nodes separate from the mass, neural foraminal involvement, and bony disease, though it requires sedation and takes up to 60 minutes. (clinical) [Ep 686 · 8:46](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=526)
- On T2-weighted MRI, neuroblastoma that has responded well to chemotherapy appears extremely dark due to calcification. (clinical) [Ep 686 · 24:43](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1483)
- Diffusion-weighted imaging (DWI) with high B-value makes retroperitoneal adenopathy from neuroblastoma very obvious and easy to identify. (clinical) [Ep 686 · 6:59](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=419)
- For open neuroblastoma resection, medial visceral rotation mobilizing the spleen and pancreatic tail is critical for safe visualization of vessels, particularly when working near the SMA and celiac artery. (clinical) [Ep 686 · 50:50](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3050)
- The key surgical principle for neuroblastoma resection is to start from known anatomy (aorta, bifurcation) and work toward unknown, staying on vessels as a safe plane. (clinical) [Ep 686 · 52:00](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3120)
- Post-operative ileus was the most common complication in neuroblastoma surgery prior to implementation of ERAS protocols. (clinical) [Ep 686 · 56:55](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3415)
- ERAS protocols for neuroblastoma include turning off IV maintenance fluids on post-operative day 1 even if patients aren't drinking well, monitoring urine output and giving boluses as needed. (clinical) [Ep 686 · 58:30](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3510)
- With ERAS protocols, neuroblastoma patients can be cleared for chemotherapy by 7 days after surgery, with typical hospital stays of 3 days even for complex open resections. (clinical) [Ep 686 · 59:09](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3549)
- For intermediate-risk neuroblastoma, a reduction of 50% of the original tumor volume may be acceptable rather than gross total resection if needed to preserve function of important organs and vessels. (clinical) [Ep 686 · 34:26](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=2066)
- Neuroblastoma is a systemic disease at its core; local primary control is essential but systemic therapy cannot be forgotten even for localized tumors. (clinical) [Ep 686 · 60:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3623)
- Osseous metastatic lesions from neuroblastoma can be extraordinarily painful, and starting chemotherapy is one of the best ways to treat the pain. (clinical) [Ep 686 · 46:52](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=2812)
- For neuroblastoma with widespread high CURIE score disease, the primary tumor tends to respond better to chemotherapy than bony metastases. (clinical) [Ep 686 · 48:20](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=2900)
- Allowing pediatric oncology patients to lose weight on therapy, particularly toddlers, is not acceptable and nutritional support is essential for surgical outcomes and overall tolerance of therapy. (clinical) [Ep 686 · 59:56](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3596)
- With new targeted therapies, molecular therapy, cellular therapy, anti-GD2, and anti-MYCN treatments, surgeons should not be required to dissect in the subadventitial plane of the aorta to achieve local control of neuroblastoma. (opinion) [Ep 686 · 62:55](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3775)
- For neuroblastoma resection, dividing the tumor into pieces does not change outcomes and allows safer dissection when working along major vessels like the renal artery or SMA. (clinical) [Ep 686 · 54:41](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3281)
- Using surgical ties rather than clips in proximity to vessels during neuroblastoma resection prevents imaging artifact on post-operative CTA. (clinical) [Ep 686 · 54:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3263)
- For neuroblastoma surgery, ligature or harmonic devices should be used laterally and away from primary vessels; direct dissection with right angle and cautery is safer near the aorta and major vessels. (clinical) [Ep 686 · 52:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3178)
- Indocyanine green (ICG) for neuroblastoma surgery is given intraoperatively rather than days in advance, and is used primarily for vascular identification and delineation of tumor edge; the tumor itself often does not take up ICG but surrounding structures do. (clinical) [Ep 686 · 65:29](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3929)
- ICG can be given multiple times during a neuroblastoma operation as it gets metabolized quickly, allowing repeated assessment of vascular relationships during dissection. (clinical) [Ep 686 · 66:13](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3973)
- The da Vinci robotic system is the commercially available platform used for pediatric neuroblastoma surgery in the United States, though it is not FDA approved for pediatrics. (clinical) [Ep 686 · 35:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=2158)
- The pathway to cure for relapsed or refractory neuroblastoma is dismal, making upfront intensification of therapy essential to avoid relapse. (clinical) [Ep 686 · 63:36](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3816)
- Neuroblastoma falls into the category of pediatric oncology diagnoses where event-free survival, progression-free survival, and overall survival are not yet acceptable. (epidemiological) [Ep 686 · 63:24](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3804)
- Tumors larger than 12 centimeters have an increased risk of intraoperative spill. — Meera Kotagal (clinical) [Ep 687 · 8:27](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=507)
- Biopsy can upstage the patient and change treatment down the line, including radiation that may otherwise not have been necessary. — Lindsay Hacker (clinical) [Ep 687 · 7:31](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=451)
- At least one lymph node must be sampled to be eligible for the current COG trial (AREN 2231). — Meera Kotagal (guideline) [Ep 687 · 10:18](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=618)
- The lymph node stations important for Wilms tumor include left renal hilar, periaortic, and aortic cable window. — Meera Kotagal (clinical) [Ep 687 · 9:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=595)
- AREN 2231 expands very low risk criteria to include any child less than 4 years old and eliminates the tumor weight threshold. — Lindsay Hacker (guideline) [Ep 687 · 16:12](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=972)
- Patients with one copy number gain (1q gain) are considered to have adverse biology on AREN 2231 and require chemotherapy. — Lindsay Hacker (guideline) [Ep 687 · 17:50](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1070)
- Enhanced recovery protocol includes preoperative carbohydrate load, regional anesthesia, no drains, early feeding (clears on post-op day 0, regular diet on post-op day 1), and IV fluids off on post-op day 1. — Meera Kotagal (clinical) [Ep 687 · 12:22](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=742)
- Length of stay with ERAS protocol is 3 to 4 days shorter than historical practice. — Meera Kotagal (epidemiological) [Ep 687 · 13:20](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=800)
- NG tube placement post-operatively is rare with ERAS; only one or two patients required it over 4-5 years. — Meera Kotagal (epidemiological) [Ep 687 · 13:40](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=820)
- Standard neoadjuvant chemotherapy for bilateral renal tumors is vincristine, dactinomycin, and doxorubicin (3-drug induction). — Lindsay Hacker (guideline) [Ep 687 · 26:19](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1579)
- Patients with bilateral disease need definitive surgery by week 12 because no ongoing tumor shrinkage is expected from chemotherapy alone beyond that point. — Lindsay Hacker (clinical) [Ep 687 · 27:21](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1641)
- In bilateral Wilms tumor, each side gets its own local stage, which impacts long-term management. — Meera Kotagal (clinical) [Ep 687 · 31:39](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1899)
- Preoperative ureteral stenting is done for all partial nephrectomies to optimize drainage and reduce urine leak risk, which can delay chemotherapy. — Michael Docherty (clinical) [Ep 687 · 29:50](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1790)
- Partial nephrectomy for Wilms tumor often requires entering the collecting system because tumors sit deeper than typical RCC. — Michael Docherty (clinical) [Ep 687 · 30:23](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1823)
- Cold (sharp) dissection without cautery around the renal pelvis and calyces reduces post-operative urine leak risk. — Michael Docherty (clinical) [Ep 687 · 36:48](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2208)
- Partial nephrectomy is performed without vascular clamping; kidney compression provides adequate hemostasis and avoids ischemia. — Michael Docherty (clinical) [Ep 687 · 37:25](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2245)
- Foley catheter is left in place for 3 to 4 days post-partial nephrectomy to allow mucosal healing. — Michael Docherty (clinical) [Ep 687 · 39:22](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2362)
- Drains are not routinely used after partial nephrectomy; active suction can induce urine leak. — Michael Docherty (clinical) [Ep 687 · 39:07](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2347)
- Focal anaplasia must be a clearly defined focus within the renal parenchyma, not in vascular spaces, with only one or two foci and none greater than 15 millimeters. — Lindsay Hacker (clinical) [Ep 687 · 32:48](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1968)
- Bilateral focal anaplasia Wilms tumor (stage 5, local stage 2 and 1) is treated with bilateral flank radiation and regimen DD4A (vincristine, dactinomycin, doxorubicin over 24-25 weeks). — Lindsay Hacker (guideline) [Ep 687 · 41:29](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2489)
- Renal transplant candidacy requires a two-year cancer-free interval. — Lindsay Hacker (guideline) [Ep 687 · 43:52](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=2632)
- Imaging is not sensitive or specific for lymph node involvement when nodes are in the intermediate size range. — Ethan Smith (clinical) [Ep 687 · 19:16](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=1156)
- TFE3-rearranged RCC shows widely disproportionate metastatic lymph nodes compared to primary tumor size; lymph nodes can be bigger than the tumor itself. — Ethan Smith (clinical) [Ep 687 · 56:01](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=3361)
- In TFE3 RCC, node-positive patients who undergo resection may still be considered cured or have active disease treated. — Michael Docherty (clinical) [Ep 687 · 56:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=3415)
- RCCs are resistant to conventional chemotherapy; backbone of therapy is immune checkpoint inhibition, often combined with VEGF TKI. — Lindsay Hacker (clinical) [Ep 687 · 58:45](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=3525)
- Pembrolizumab and axitinib (based on Keynote 426 study) showed superiority over sunitinib for RCC. — Lindsay Hacker (epidemiological) [Ep 687 · 58:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=3535)
- Surgery is a mainstay of management for TFE RCC and provides meaningful survival benefit even in metastatic disease. — Meera Kotagal (clinical) [Ep 687 · 55:20](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=3320)
- Patients with slow pulmonary response (persistent nodules at week 6) require intensification to regimen M (cyclophosphamide and etoposide added to vincristine, dactinomycin, doxorubicin) due to worse outcomes without intensification. — Lindsay Hacker (guideline) [Ep 687 · 68:57](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=4137)
- IVC thrombus below the level of the hepatic veins should be resected upfront; intrahepatic extension warrants neoadjuvant chemotherapy. — Meera Kotagal (clinical) [Ep 687 · 66:58](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=4018)
- Thrombectomy must be performed in continuity with the nephrectomy specimen; transecting the thrombus upstages the patient to stage 3. — Meera Kotagal (clinical) [Ep 687 · 67:14](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=4034)
- Tumor thrombus is more adherent to the vessel wall after chemotherapy than in upfront resection. — Meera Kotagal (clinical) [Ep 687 · 70:01](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=4201)
- For IVC thrombus extending above the diaphragm, a thoracoabdominal approach with cardiac surgery support and potential bypass is used. — Meera Kotagal (clinical) [Ep 687 · 70:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-michael-daugherty-and-meera-kotagal-14740?t=4255)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025 — Jill Knepprath summarizing a resource [Ep 655 · 0:14](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=14)
- The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes — Jill Knepprath summarizing a resource [Ep 655 · 0:19](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=19)
- Factors studied included the number of metastases, the size of the metastases, and different biological markers — Jill Knepprath summarizing a resource [Ep 655 · 0:30](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=30)
- There was no difference in survival based on the number of metastases — Jill Knepprath summarizing a resource [Ep 655 · 0:36](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=36)
- Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival — Jill Knepprath summarizing a resource [Ep 655 · 0:41](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=41)
- Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival — Jill Knepprath summarizing a resource [Ep 655 · 0:41](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=41)
- In multivariable models, neither the size nor the number of nodules had any effect on survival — Jill Knepprath summarizing a resource [Ep 655 · 0:49](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=49)
- 1q gain was associated with worse event-free survival — Jill Knepprath summarizing a resource [Ep 655 · 0:55](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=55)
- 1q gain was associated with worse overall survival — Jill Knepprath summarizing a resource [Ep 655 · 0:55](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=55)
- 1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases — Jill Knepprath summarizing a resource [Ep 655 · 1:04](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=64)
- It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection — Jill Knepprath summarizing a resource [Ep 664 · 0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0)
- The study was multi-institutional and published in Pediatric Blood and Cancer in 2025 — Jill Knepprath summarizing a resource [Ep 664 · 0:13](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=13)
- The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients — Jill Knepprath summarizing a resource [Ep 664 · 0:19](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=19)
- Of those transfused, the majority received red blood cells — Jill Knepprath summarizing a resource [Ep 664 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- Only 11% of transfused patients received platelets — Jill Knepprath summarizing a resource [Ep 664 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- Intraoperative blood transfusions had no effect on recurrence — Jill Knepprath summarizing a resource [Ep 664 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- Intraoperative blood transfusions were associated with increased death — Jill Knepprath summarizing a resource [Ep 664 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- There were instances of unnecessary blood transfusions — Jill Knepprath summarizing a resource [Ep 664 · 0:39](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=39)
- Patients who were transfused had higher post-op hemoglobin — Jill Knepprath summarizing a resource [Ep 664 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- Transfused patients still required more plasma and platelets postoperatively — Jill Knepprath summarizing a resource [Ep 664 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy — Jill Knepprath summarizing a resource [Ep 664 · 0:52](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=52)
- The authors recommend more careful patient selection for intraoperative transfusions — Jill Knepprath summarizing a resource [Ep 664 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- The authors recommend a balanced transfusion approach — Jill Knepprath summarizing a resource [Ep 664 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- Solid pseudopapillary neoplasms are one of the most frequent pancreatic tumors in pediatric patients — Lizzie Lee summarizing a resource [Ep 665 · 0:09](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=9)
- Surgery for solid pseudopapillary neoplasms is usually curative and outcomes are excellent — Lizzie Lee summarizing a resource [Ep 665 · 0:15](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=15)
- In a single center study, 10 adolescent girls underwent surgical resection for solid pseudopapillary neoplasms — Lizzie Lee summarizing a resource [Ep 665 · 0:22](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=22)
- 3 out of 10 patients developed acute recurrent or chronic pancreatitis after resection — Lizzie Lee summarizing a resource [Ep 665 · 0:25](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=25)
- Every patient who developed ongoing pancreatitis had genetic risk factors like CFTR gene variants or pancreas divisum — Lizzie Lee summarizing a resource [Ep 665 · 0:32](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=32)
- Some patients with post-resection pancreatitis ultimately required completion pancreatectomy — Lizzie Lee summarizing a resource [Ep 665 · 0:40](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=40)
- Identifying genetic and anatomic risk factors before surgery may change management of patients with solid pseudopapillary neoplasms — Lizzie Lee summarizing a resource [Ep 665 · 0:48](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=48)
- Risk stratification for Wilms tumor has evolved many times over the years. — Jill Knepprath summarizing a resource [Ep 667 · 0:00](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=0)
- The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025. — Jill Knepprath summarizing a resource [Ep 667 · 0:09](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=9)
- The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification. — Jill Knepprath summarizing a resource [Ep 667 · 0:19](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=19)
- The new model changes some of the older features or gets rid of them altogether. — Jill Knepprath summarizing a resource [Ep 667 · 0:27](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=27)
- Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement. — Jill Knepprath summarizing a resource [Ep 667 · 0:32](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=32)
- Tumor nephrectomy weight is no longer included in the risk stratification. — Jill Knepprath summarizing a resource [Ep 667 · 0:41](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=41)
- The model modified how histology and age are used to stratify certain patients. — Jill Knepprath summarizing a resource [Ep 667 · 0:43](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=43)
- More changes are expected in the future as ongoing COG trials produce more results. — Jill Knepprath summarizing a resource [Ep 667 · 0:48](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=48)
- Memorial Sloan Kettering data suggests biggest volume response of neuroblastoma tumor occurs with first two cycles of chemotherapy, with very little response after that — Daniel von Allmen summarizing the discussion [Ep 50 · 10:00](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=600)
- Sloan Kettering study suggests stage 4 neuroblastoma patients do better with primary tumor resection — The host summarizing the discussion [Ep 50 · 14:27](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=867)
- Kylie's study showed no difference in survival based on completeness of neuroblastoma resection — The host summarizing the discussion [Ep 50 · 14:33](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=873)
- European studies show no difference in survival based on completeness of neuroblastoma resection — The host summarizing the discussion [Ep 50 · 14:35](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=875)
- Most recent COG study shows probably no difference in survival based on completeness of neuroblastoma resection — The host summarizing the discussion [Ep 50 · 14:35](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=875)
- Georgia study showed 46% survival in high-risk neuroblastoma with transplantation plus immunotherapy plus differentiating agents — The host summarizing the discussion [Ep 50 · 16:22](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=982)
- Many deaths in intensified high-risk neuroblastoma treatment were due to the treatment itself rather than cancer — The host summarizing the discussion [Ep 50 · 16:22](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=982)
- German study of 278 stage 4 high-risk neuroblastoma patients achieved complete resection in almost half and >90% resection in another quarter (75% total with >90% resection) — Daniel von Allmen summarizing the discussion [Ep 50 · 16:48](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1008)
- German study showed overall survival 45%, event-free survival 33%, and local progression-free survival 58% in stage 4 neuroblastoma — Daniel von Allmen summarizing the discussion [Ep 50 · 17:13](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1033)
- German study showed no difference in overall survival, event-free survival, or local progression-free survival based on completeness of resection in stage 4 neuroblastoma — Daniel von Allmen summarizing the discussion [Ep 50 · 17:32](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1052)
- German study concluded aggressive surgery is not justified in stage 4 neuroblastoma, that limited operations decrease complications, and there is limited impact on patient outcome — Daniel von Allmen summarizing the discussion [Ep 50 · 17:51](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1071)
- European study included 1,324 high-risk neuroblastoma patients (stages 2, 3, and 4) and achieved 76% with >95% resection — Daniel von Allmen summarizing the discussion [Ep 50 · 18:14](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1094)
- European neuroblastoma study showed 0.5% mortality and 10% morbidity (30% including lesser complications) — Daniel von Allmen summarizing the discussion [Ep 50 · 19:02](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1142)
- European study showed significant improvement in event-free survival and overall survival with aggressive resection in high-risk neuroblastoma - first study to show overall survival benefit — Daniel von Allmen summarizing the discussion [Ep 50 · 19:17](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1157)
- European study concluded >95% resection results in improvement in event-free survival in high-risk neuroblastoma — Daniel von Allmen summarizing the discussion [Ep 50 · 20:17](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1217)
- COG 3973 study of approximately 230 high-risk neuroblastoma patients showed significant improvement in local relapse-free survival and event-free survival but not overall survival — Daniel von Allmen summarizing the discussion [Ep 50 · 21:24](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1284)
- European neuroblastoma procedures are performed in more than 200 hospitals yet still demonstrated survival improvements — Daniel von Allmen summarizing the discussion [Ep 50 · 23:33](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1413)
- Older data shows worse survival in neuroblastoma when kidney is removed, likely because single kidney limits chemotherapy dosing — Daniel von Allmen summarizing the discussion [Ep 50 · 24:03](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1443)
- A multicenter review examined over 200 sacrococcygeal teratoma cases comparing children with Currarino syndrome to those without it. — Lizzie Lee summarizing a resource [Ep 615 · 0:10](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=10)
- Currarino patients were almost always diagnosed after birth. — Lizzie Lee summarizing a resource [Ep 615 · 0:19](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=19)
- Tumors in Currarino patients are almost exclusively Altman type 4, buried deep in the pelvis. — Lizzie Lee summarizing a resource [Ep 615 · 0:19](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=19)
- Every tumor in the Currarino group was a mature one with no immature or malignant components at all. — Lizzie Lee summarizing a resource [Ep 615 · 0:27](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=27)
- Currarino-associated tumors were much smaller, around 3 centimeters instead of 8 centimeters. — Lizzie Lee summarizing a resource [Ep 615 · 0:33](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=33)
- Recurrence was almost nonexistent in Currarino cases and not significantly different from non-Currarino cases. — Lizzie Lee summarizing a resource [Ep 615 · 0:36](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=36)
- Currarino-associated sacrococcygeal teratomas behave incredibly well oncologically, suggesting potential for less aggressive long-term follow-up. — Lizzie Lee summarizing a resource [Ep 615 · 0:41](https://library.globalcastmd.com/watch/sacrococcygeal-teratomas-in-currarino-syndrome-a-multicenter-review-of-tumor-characteristics-surgical-outcomes-and-recurrence-11278?t=41)
- In a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence — Fred Rescorla summarizing a resource [Ep 253 · 8:10](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=490)
- Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents — Fred Rescorla summarizing a resource [Ep 253 · 26:57](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1617)
- Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary — Fred Rescorla summarizing a resource [Ep 253 · 27:12](https://library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1632)
- The systematic review and meta-analysis was conducted by IPSO — Cecilia Gigena summarizing a resource [Ep 458 · 0:09](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=9)
- The review analyzed the accuracy and safety of image-guided core needle biopsy for neuroblastoma — Cecilia Gigena summarizing a resource [Ep 458 · 0:09](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=9)
- The review included 8 retrospective studies with 490 patients — Cecilia Gigena summarizing a resource [Ep 458 · 0:23](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23)
- Tissue adequacy was not significantly different between image-guided core needle biopsy and surgical biopsy groups — Cecilia Gigena summarizing a resource [Ep 458 · 0:23](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23)
- Biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups — Cecilia Gigena summarizing a resource [Ep 458 · 0:23](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23)
- Intraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy — Cecilia Gigena summarizing a resource [Ep 458 · 0:23](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23)
- Complications were higher in the surgical biopsy group compared to image-guided core needle biopsy — Cecilia Gigena summarizing a resource [Ep 458 · 0:23](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23)
- Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma — Cecilia Gigena summarizing a resource [Ep 458 · 0:43](https://library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=43)
- Dr. Bailey Roberts from IPSO presented on extracellular vesicles for metastatic osteosarcoma contributing to the creation of pre-metastatic niche — Cecilia summarizing a resource [Ep 464 · 0:08](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=8)
- Dr. Dominic Simons from IPSO presented on multimodal 3D visualization of pediatric neuroblastoma aiding surgical planning beyond anatomical information — Cecilia summarizing a resource [Ep 464 · 0:19](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=19)
- Dr. Miyake from CAPS presented on using microinjection for drug delivery with nanoparticles in lung explants to study prenatal treatment of CDH — Cecilia summarizing a resource [Ep 464 · 0:31](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=31)
- Dr. Urichuk from CAPS presented that individuals with thoracoabdominal congenital surgical anomalies are at increased risk of adverse mental health outcomes — Cecilia summarizing a resource [Ep 464 · 0:47](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=47)
- Dr. Matthew Urichuk won Heat 2 of the Best of the Best in Pediatric Surgery 2024 competition — Cecilia summarizing a resource [Ep 464 · 1:27](https://library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=87)
- The systematic review and meta-analysis was conducted in Chongqing, China — Cecilia Gigena summarizing a resource [Ep 469 · 0:12](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=12)
- The study aimed to evaluate efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor — Cecilia Gigena summarizing a resource [Ep 469 · 0:12](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=12)
- The analysis included 26 studies — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- Nephron-sparing surgery increased glomerular filtration rate after surgery — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- There were no significant differences in overall survival between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- There were no significant differences in recurrence rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- There were no significant differences in hypertension rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- There were no significant differences in renal dysfunction rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 469 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- The speaker is affiliated with Cincinnati Children's Hospital — Lizzie Lee summarizing a resource [Ep 596 · 0:06](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=6)
- Traditionally, children with neuroendocrine appendix tumors have been treated the same way as adults with right hemicolectomy — Lizzie Lee summarizing a resource [Ep 596 · 0:10](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=10)
- A new national study examined over 1,300 children with neuroendocrine appendix tumors — Lizzie Lee summarizing a resource [Ep 596 · 0:19](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=19)
- Survival rates were approximately 99% whether patients had appendectomy or right hemicolectomy, even with larger tumors or positive margins — Lizzie Lee summarizing a resource [Ep 596 · 0:24](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=24)
- For pediatric patients, appendectomy alone is safe and effective for neuroendocrine tumors of the appendix — Lizzie Lee summarizing a resource [Ep 596 · 0:35](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=35)
- Appendectomy avoids putting pediatric patients through a much bigger operation with no added survival benefit compared to right hemicolectomy — Lizzie Lee summarizing a resource [Ep 596 · 0:35](https://library.globalcastmd.com/watch/appendectomy-vs-right-hemicolectomy-for-pediatric-neuroendocrine-tumor-of-the-appendix-10941?t=35)
- The study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021 — Cecilia Gigena summarizing a resource [Ep 443 · 0:00](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=0)
- The study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status — Cecilia Gigena summarizing a resource [Ep 443 · 0:20](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=20)
- The study included 50 patients with hepatoblastoma — Cecilia Gigena summarizing a resource [Ep 443 · 0:35](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=35)
- 41 patients were rendered to no evidence of disease status — Cecilia Gigena summarizing a resource [Ep 443 · 0:42](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=42)
- Overall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status — Cecilia Gigena summarizing a resource [Ep 443 · 0:48](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=48)
- Pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients — Cecilia Gigena summarizing a resource [Ep 443 · 0:58](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=58)
- STEP procedure in the perinatal period has poor outcomes according to the STEP registry and should be discouraged; outcomes are particularly difficult in gastroschisis patients due to motility disorders. — Greg summarizing the discussion [Ep 52 · 26:24](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1584)
- The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=135)
- The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 3:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=222)
- Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 386 · 4:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=256)
- Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 386 · 4:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=271)
- CDC Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=312)
- One has to be careful not to make too strong of conclusions based on any data when it's related to simply ICD 10 codes, regardless of how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 6:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=367)
- There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=407)
- The new hepatoblastoma cell line was created by injecting labeled cells into mouse tail vein, harvesting lung metastases, culturing surviving cells, and repeating the process until establishing a reliably metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 386 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=444)
- Compared to the original human cell line, the new cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy — Nicole Chandler summarizing the discussion [Ep 386 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=494)
- The most common localization techniques for small pulmonary nodules were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 386 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=649)
- There was no difference in successful IR localization or successful resection of pulmonary nodules when comparing different localization techniques — Nicole Chandler summarizing the discussion [Ep 386 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=656)
- Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 386 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 386 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=135)
- The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 3:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=222)
- Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 388 · 4:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=256)
- Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 388 · 4:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=271)
- CDC's Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=312)
- One has to be careful not to make too strong of conclusions based on ICD 10 codes, no matter how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 6:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=367)
- There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=407)
- The researchers labeled hepatoblastoma cells with luciferase, injected them into mouse tail veins where they preferentially went to lungs, harvested and cultured surviving cells, and repeated this process until establishing a reliable metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 388 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=444)
- The new metastatic hepatoblastoma cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line — Nicole Chandler summarizing the discussion [Ep 388 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=494)
- The most common localization techniques were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 388 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=649)
- There was no difference in successful IR localization or successful resection of pulmonary nodules among the different localization techniques — Nicole Chandler summarizing the discussion [Ep 388 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=656)
- Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 388 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 388 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- The curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons. — Todd Ponsky summarizing the discussion [Ep 357 · 1:53](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113)
- In the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions. — Todd Ponsky summarizing the discussion [Ep 357 · 11:52](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=712)
- Half of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up. — Todd Ponsky summarizing the discussion [Ep 357 · 12:08](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=728)
- In the Journal of Clinical Oncology study of 1,531 patients with stage 4 high-risk neuroblastoma, 5-year event-free survival and overall survival were significantly higher with complete resection compared to incomplete microscopic resection. — The host summarizing the discussion [Ep 357 · 14:20](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=860)
- Local progression in stage 4 neuroblastoma was lower with complete resection when compared with incomplete resection. — The host summarizing the discussion [Ep 357 · 14:36](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=876)
- In the New England Journal of Medicine randomized controlled trial of 80 women carrying fetuses with severe isolated left-sided congenital diaphragmatic hernia, fetal endoscopic tracheal occlusion (FETO) at 27-29 weeks resulted in 40% survival to discharge versus 15% with expectant care. — The host summarizing the discussion [Ep 357 · 16:30](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=990)
- At 6 months of age, survival was the same between FETO and expectant care groups in severe CDH. — The host summarizing the discussion [Ep 357 · 16:44](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1004)
- FETO was associated with an increased risk of pre-labor rupture of membranes and preterm labor. — The host summarizing the discussion [Ep 357 · 16:47](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1007)
- In the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same. — Todd Ponsky summarizing the discussion [Ep 357 · 18:16](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1096)
- The study compared outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus patients who had planned workup and excision. — Todd Ponsky summarizing a resource [Ep 20 · 0:16](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=16)
- 40 patients were referred after having an innocuous lesion removed that came back as non-rhabdomyosarcoma. — Todd Ponsky summarizing a resource [Ep 20 · 0:49](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=49)
- 5 of the 40 referred patients were deemed impossible to re-excise based on location or other reasons, leaving 35 patients for re-excision. — Todd Ponsky summarizing a resource [Ep 20 · 1:00](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=60)
- 44 patients had planned excision at the study institution after workup with MRI or incisional biopsy or core biopsy. — Todd Ponsky summarizing a resource [Ep 20 · 1:10](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=70)
- 23 of the 44 planned excision patients received neoadjuvant therapy, leaving 21 for comparison. — Todd Ponsky summarizing a resource [Ep 20 · 1:33](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=93)
- 45.7% of patients who underwent re-excision had residual tumor found in the specimen. — Todd Ponsky summarizing a resource [Ep 20 · 1:56](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=116)
- There was no difference in disease relapse between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 20 · 2:13](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=133)
- There was no difference in 5-year overall survival between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 20 · 2:21](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=141)
- There was no difference in disease-free survival between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 20 · 2:26](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146)
- There was no difference in local control rates or local recurrence between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 20 · 2:26](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146)
- The study authors concluded that patients should have a higher index of suspicion and should be worked up more thoroughly. — Todd Ponsky summarizing a resource [Ep 20 · 2:56](https://library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=176)
- When performing nephrectomy for Wilms tumor, lymph node sampling is mandatory according to protocols. — The host summarizing the discussion [Ep 21 · 1:54](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=114)
- If histologically negative lymph nodes are not documented during Wilms tumor nephrectomy, they are assumed to be positive, which increases the stage and requires increased chemotherapy. — The host summarizing the discussion [Ep 21 · 2:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=121)
- Failure to sample lymph nodes during Wilms tumor nephrectomy is an identified practice gap by the Cancer Committee and COG publications. — The host summarizing the discussion [Ep 21 · 2:19](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=139)
- The presence of metastatic disease in the lung does not preclude treating the primary tumor with nephrectomy, because this affects whether radiation therapy is required. — The host summarizing the discussion [Ep 21 · 4:07](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=247)
- There is both a local stage and a patient stage for Wilms tumor. — The host summarizing the discussion [Ep 21 · 4:25](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=265)
- On the ACS pediatric surgery blog, a similar question showed that overwhelmingly the presence of lymph node metastases led people to choose biopsy and chemotherapy, which is incorrect. — The host summarizing the discussion [Ep 21 · 4:33](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=273)
- Regardless of pulmonary metastatic disease, if the primary tumor can be removed without removing other organs, nephrectomy should be performed because it decreases radiation therapy requirements. — The host summarizing the discussion [Ep 21 · 4:44](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=284)
- The child will receive stage 4 metastatic chemotherapy regardless, but performing biopsy counts as local spillage and requires radiation therapy to the flank or abdomen. — The host summarizing the discussion [Ep 21 · 5:04](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=304)
- Local disease should be treated differently than systemic disease in Wilms tumor. — The host summarizing the discussion [Ep 21 · 5:17](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=317)
- Oncologists want measurable disease to assess response to chemotherapy. — The host summarizing the discussion [Ep 21 · 5:45](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=345)
- According to Dr. Shamberger, there are radiographic criteria for single lung nodules; if it looks like a metastasis you proceed, but if it does not look like a metastasis you can biopsy it to prove it is not a met and avoid chemotherapy. — The host summarizing the discussion [Ep 21 · 6:54](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=414)
- In SIOP protocols, they perform percutaneous biopsy of the primary tumor and treat with chemotherapy. — Todd Ponsky summarizing the discussion [Ep 21 · 8:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481)
- The American College of Surgeons registry data shows improvement with fewer patients receiving nephrectomies without lymph node sampling since educational efforts began. — The host summarizing the discussion [Ep 21 · 9:29](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- German study concluded aggressive surgery is not justified in stage 4 disease, limited operations decrease complications, and there is limited impact on patient outcome — Dan summarizing the discussion [Ep 28 · 17:34](https://library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1054)
- Blood flow on ultrasound does not exclude torsion because the ovary may be twisted but not completely occluded at that moment in time — Todd Ponsky summarizing the discussion [Ep 53 · 22:35](https://library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1355)
- An Italian study showed that a 5 centimeter tumor in a child less than 3 years old is equivalent to a 3 centimeter tumor in larger patients, suggesting 3 centimeters as the cutoff for excision versus biopsy in toddlers. — Andrea summarizing the discussion [Ep 68 · 6:54](https://library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414)
- Bob Shamberger has made the point that if a Wilms tumor is not responding to chemotherapy, tissue is needed to check for anaplasia. — Dan summarizing the discussion [Ep 71 · 6:56](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=416)
- Most pathologists think anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy. — The host summarizing the discussion [Ep 71 · 7:24](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=444)
- The STEP registry discourages performing STEP procedures in the perinatal period due to difficult outcomes at best — Greg summarizing the discussion [Ep 70 · 26:24](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1584)
- STEP procedures in patients with gastroschisis are not particularly beneficial due to underlying motility disorders — Greg summarizing the discussion [Ep 70 · 26:33](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- Good blood flow on ultrasound does not rule out torsion because the ovary may be intermittently twisted — Todd Ponsky summarizing the discussion [Ep 69 · 21:50](https://library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1310)
- Wilms tumor is the second most common intra-abdominal tumor in children and fifth most common tumor in children overall. — The host summarizes what Dr. Andrew Davidoff said [Ep 252 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0)
- Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old. — Rae Hanke summarizes what Dr. Daniel von Allmen said [Ep 250 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality — Alex Gibbons summarizing the discussion [Ep 210 · 0:26](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=26)
- Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality — The host summarizing the discussion [Ep 210 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and is equally tolerated — The host summarizing the discussion [Ep 210 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still have recovery afterwards and it helps preserve fertility — The host summarizing the discussion [Ep 210 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- Ultrasound is not a great tool for diagnosis of ovarian torsion; clinical judgment should not be based primarily on ultrasound findings — The host summarizing the discussion [Ep 210 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin — The host summarizing the discussion [Ep 210 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7 — The host summarizing the discussion [Ep 210 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- Burnout directly impacts patient care and outcomes — The host summarizing the discussion [Ep 210 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- Support systems for physician wellness need to be established proactively during education and practice because burnt out surgeons are not likely to seek help — The host summarizing the discussion [Ep 210 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- Physicians should talk to patients about whether there's a firearm in the home and if there is, whether it's safely stored — The host summarizing the discussion [Ep 210 · 8:23](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=503)
- Isotonic fluids should be continued throughout hospitalization instead of switching to hypotonic fluids for maintenance, which decreases the risk of hyponatremia with similar morbidity and mortality — The host summarizing the discussion [Ep 210 · 11:27](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=687)
- In Wilms tumor operations, failure to remove lymph nodes automatically upstages the patient — Liz Byerly summarizing the discussion [Ep 210 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- Pulmonary metastasis in Wilms tumor doesn't preclude doing a primary nephrectomy — Liz Byerly summarizing the discussion [Ep 210 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures — The host summarizing the discussion [Ep 210 · 16:41](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1001)
- The important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction — Todd Ponsky summarizing the discussion [Ep 210 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- In the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy — Todd Ponsky summarizing the discussion [Ep 210 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- Parents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study — Todd Ponsky summarizing the discussion [Ep 210 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- Recommendations for opioid crisis management include reducing total amount of opioids prescribed, using non-opioid analgesia and non-pharmacological approaches, and educating on disposal of unused opioids — The host summarizing the discussion [Ep 210 · 23:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- Enhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge — Todd Ponsky summarizing the discussion [Ep 210 · 23:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- For well-appearing neonates with intact omphalocele and no maternal fever or chorioamnionitis, preoperative antibiotic given one hour before incision and discontinued within 72 hours is most appropriate — The host summarizing the discussion [Ep 210 · 26:19](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1579)
- Based on AAP and neonatology recommendations, as long as the baby is well and mother has no signs of sepsis or chorioamnionitis, you don't need to give antibiotics for children that don't have an open abdomen — The host summarizing the discussion [Ep 210 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- According to Surviving Sepsis Campaign guidelines, give 20 cc per kilo boluses of isotonic fluid up to 60 ml per kilo total, with goal of perfusion improvement — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- Stop fluid boluses if you see over-perfusion such as rales on auscultation or enlarged liver — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- Must start broad-spectrum antibiotics in sepsis; data shows in adults that if you wait over three hours to start antibiotics in a septic patient, survival goes down — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- If hematocrit or hemoglobin is less than 10 in septic patient, transfusion may be indicated — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- For pediatric sepsis, epinephrine is the vasopressor of choice; two randomized trials showed mortality was better with epi in one study and epi had better improvement in systolic blood pressure in the other compared to dopamine — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- Hydrocortisone has a role in sepsis for patients who are vasopressor refractory, meaning vasopressors were started and systolic blood pressure remains low — Stephen Lee summarizing the discussion [Ep 210 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- Draw blood for lactate level and cultures just prior to starting antibiotics in sepsis, but don't delay starting antibiotics while waiting — Stephen Lee summarizing the discussion [Ep 210 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- Antibiotic stewardship in sepsis means following cultures and titrating antibiotics down or stopping them altogether if in three or four days patients have improved and it's no longer an infectious issue — Stephen Lee summarizing the discussion [Ep 210 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- The odds ratio for not starting antibiotics within three hours in children with sepsis was 3.92 for mortality - almost four times more likely to die — Salim Islam summarizing the discussion [Ep 210 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- Updated APSA blunt liver-spleen injury guidelines recommend treating based on patients' hemodynamic status, not injury grade — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- Modified shock index for pediatrics (heart rate over systolic blood pressure) can determine if patient is still bleeding; if so, recommend ICU admission — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- If patient with solid organ injury has responded to normal saline bolus and remains hemodynamically stable, they just need to be observed on the ward — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- For ward admission with solid organ injury, patient needs only another hemoglobin check in six hours, can have regular diet, and no activity restrictions needed — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- After first 20 ml per kilo normal saline bolus in trauma, if patient still requires additional fluids, give blood (10 cc per kilo) — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- Angioembolization in stable patients with solid organ injury does not need to be done even with contrast blush, particularly in splenic injuries which have been shown not to continue bleeding — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- If there's evidence of ongoing bleeding in solid organ injury, then angioembolization should be performed — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- Based on ATOMIC protocol, 40 mLs per kilogram of packed red blood cells is the threshold; when you need more than 40 cc per kilo, you should go to the operating room — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- ATOMIC was started in 2010 as a group of level one pediatric trauma centers (Arkansas, Texas, Oklahoma, Memphis, Arizona) coming together to study vital trauma questions prospectively — The host summarizing the discussion [Ep 210 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- Cervical spine injury is about 1 to 2% of all pediatric traumas — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- In older children, 70 to 80% of cervical spine injuries are bony injuries following adult patterns — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- In younger children less than or equal to 8 years, about 50% have isolated fractures and 50% have ligamentous injury, dislocations, or SCIWORA — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- 60 to 80% of vertebral injuries in kids are in the cervical spine compared to 30 to 40% in adults — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- AAST study of over 12,000 children with blunt trauma found 0.6% had cervical spine injury; four independent predictors were GCS less than 14, involved in motor vehicle crash, age greater than or equal to 2 years — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- Patients with cervical spine injury score of 0-1 points had negative predictive value over 99% and did not need imaging — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- For cervical spine clearance imaging in children, use AP and lateral x-rays; if cross-sectional imaging needed, use MRI not CT because most injuries are ligamentous not bony — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- 46% of institutions don't have a protocol for cervical spine clearance in children — Meera Kotagal summarizing the discussion [Ep 210 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- Hepatoblastoma is the most common malignant liver tumor in the pediatric population. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=0)
- Neuroblastoma is the most common solid malignancy in the pediatric population. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 1:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=73)
- The differential diagnosis for a liver mass should include hepatoblastoma, hemangioma, hematomas, focal nodular hyperplasia, and hepatocellular carcinoma. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 1:28](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=88)
- Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, respiratory distress due to tumor size, or as a paraneoplastic syndrome like precocious puberty. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- An elevated alpha-fetoprotein (AFP) is a key component in the workup of hepatoblastoma and is critical for the diagnostic algorithm and as a guide for treatment response. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- MRI is relied upon by most experts to delineate the anatomy and evaluate the extent of liver involvement in hepatoblastoma. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 2:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=159)
- To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- The most important intervention for survival in hepatoblastoma is to achieve complete resection. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- Aggressive resections for hepatoblastoma include trisectionectomy, mesohepatectomy, resection with an additional procedure in the remnant liver, and liver transplantation. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- In the PRETEXT staging system, PRETEXT 1 has 3 contiguous sections free of disease, PRETEXT 2 has 2 contiguous sections free, PRETEXT 3 has 1 free section, and PRETEXT 4 has no free sections or diffuse tumor burden in all sections. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 5:53](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=353)
- PRETEXT 1 and 2 tumors with greater than a centimeter margin from the middle hepatic vein and the portal bifurcation should be considered for resection at diagnosis. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 6:34](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=394)
- It is important to consult a transplant center early for PRETEXT 3 and 4 tumors. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 8:11](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=491)
- The Pediatric Hepatic International Tumor Trial (FIT) is an ongoing multinational trial aimed at identifying high and low risk features for each of the PRETEXT stages of hepatoblastoma. — The host summarizes what Dr. Greg Tiao said [Ep 336 · 8:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=526)
- The first article examines surgical management, staging and outcomes of Wilms tumors with intravascular extension, using results from the SIOP (International Society of Pediatric Oncology) Renal Tumor Study. — Brittany Levy summarizing the discussion [Ep 370 · 0:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=34)
- The study looked at children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection of tumor thrombus was successful versus when it was not. — Brittany Levy summarizing the discussion [Ep 370 · 0:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58)
- Dr. Paul Tam states that Wilms tumor has been a great success story for pediatric surgery and pediatric oncology. — Brittany Levy summarizing the discussion [Ep 370 · 1:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74)
- Dr. Paul Tam suggests improving outcomes by identifying subgroups of patients who are still not doing well and trying to improve care in those particular areas. — Brittany Levy summarizing the discussion [Ep 370 · 1:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=99)
- If half of Wilms tumor patients have complete tumor removal and half do not, and there is an outcome difference, then surgeons should still try hard to remove all of the tumor. — Brittany Levy summarizing the discussion [Ep 370 · 1:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114)
- The second article examines efficacy of clinical grade human placental mesenchymal stromal cells in fetal ovine myelomeningocele repair. — Brittany Levy summarizing the discussion [Ep 370 · 2:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=133)
- The article discussed use of mesenchymal stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs given the intervention. — Brittany Levy summarizing the discussion [Ep 370 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=160)
- The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country. — Rod Gerardo summarizing the discussion [Ep 370 · 4:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277)
- Many survey respondents reported receiving fetal training during their pediatric surgery fellowship training, yet when the question was posed differently, many responded that they did not have exposure to fetal surgery during fellowship training. — Brittany Levy summarizing the discussion [Ep 370 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337)
- Dr. Paul Tam states that fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental. — Brittany Levy summarizing the discussion [Ep 370 · 5:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354)
- About 20% of osteosarcoma patients already have lung metastases by the time of diagnosis, usually picked up on staging chest CT. — Rod Gerardo summarizing the discussion [Ep 376 · 1:29](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=89)
- With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited. — Rod Gerardo summarizing the discussion [Ep 376 · 5:03](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=303)
- A multi-institution study of 200 patients with metastatic osteosarcoma—the largest study ever done—compared outcomes between open resection and thoracoscopy. — Rod Gerardo summarizing the discussion [Ep 376 · 5:23](https://library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=323)
- In the TOTAL trial for severe CDH, FETO significantly improved survival — Craig Lillehei summarizing the discussion [Ep 383 · 10:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600)
- In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance — Craig Lillehei summarizing the discussion [Ep 383 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=630)
- The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols — Craig Lillehei summarizing the discussion [Ep 383 · 11:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=660)
- Studies suggest clear liquids containing carbohydrates empty the stomach very quickly regardless of age — The host summarizing the discussion [Ep 383 · 16:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=960)
- British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17 — The host summarizing the discussion [Ep 383 · 16:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=990)
- ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals — The host summarizing the discussion [Ep 383 · 17:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1020)
- European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else — The host summarizing the discussion [Ep 383 · 17:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1050)
- In a study of 521 primary lung lesions from 11 children's hospitals, none of the prenatally diagnosed lesions were malignant — The host summarizing the discussion [Ep 383 · 40:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2400)
- Approximately 10% of postnatally diagnosed lung lesions were malignant in the Midwest consortium study — The host summarizing the discussion [Ep 383 · 40:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2430)
- About half of malignant lung lesions were associated with DICER1 mutation — The host summarizing the discussion [Ep 383 · 41:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2460)
- No malignant lung lesion had a systemic feeding vessel in the consortium study — The host summarizing the discussion [Ep 383 · 41:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2490)
- CT scan sensitivity and specificity for detecting pleuropulmonary blastoma was poor, with poor inter-rater reliability among nine radiologists — The host summarizing the discussion [Ep 383 · 42:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2520)
- In a series of approximately 600 patients with prenatal lung lesion diagnosis, the chance of pleuropulmonary blastoma is close to zero — The host summarizing the discussion [Ep 383 · 44:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640)
- In the IMPACT study, piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and postoperative CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis — The host summarizing the discussion [Ep 383 · 48:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2880)
- A NSQIP study by Sean Rangel of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole were preferred over piperacillin-tazobactam — The host summarizing the discussion [Ep 383 · 48:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2910)
- The IMPACT study was multi-institutional but 75% of patients were at one institution and 25% at another — The host summarizing the discussion [Ep 383 · 49:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2940)
- Mechanical bowel preparation has no effect on surgical site infection rates — Paul Yzotrak summarizing the discussion [Ep 383 · 51:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3060)
- Some data suggests mechanical bowel preparation actually increases surgical site infections — Paul Yzotrak summarizing the discussion [Ep 383 · 51:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3090)
- The NEST trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage for NEC — Paul Yzotrak summarizing the discussion [Ep 383 · 55:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3300)
- The NEST trial used approximately one kilogram as the cutoff weight for laparotomy — Paul Yzotrak summarizing the discussion [Ep 383 · 54:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3240)
- Proximal small bowel resection results in greater oxidative stress in the liver, evidenced by elevated mRNA transcripts for tumor necrosis factor alpha, NADPH oxidase, and glutathione synthase with greater compensatory antioxidant response — Colin Martin summarizing the discussion [Ep 446 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=182)
- 46 of 50 hepatoblastoma patients underwent resection using adjuvant techniques including total hepatic vascular exclusion, vascular reconstruction, biliary reconstruction, or en-bloc resection and total hepatectomy with transplantation — Colin Martin summarizing the discussion [Ep 446 · 6:14](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=374)
- 82% (41 of 50) of hepatoblastoma patients were able to achieve no-evidence-of-disease (NED) status — Colin Martin summarizing the discussion [Ep 446 · 6:23](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=383)
- 14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies (7 for unilateral disease, 7 for bilateral disease) with a median of 4.5 nodules resected — Em Tombash summarizing the discussion [Ep 446 · 6:40](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=400)
- 5 high-risk hepatoblastoma patients relapsed and 3 of them were saved; NED status was inversely correlated with 5-year mortality — Em Tombash summarizing the discussion [Ep 446 · 6:50](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=410)
- The esophageal atresia surveillance survey had a 77% response rate from 181 physicians at 19 institutions — Colin Martin summarizing the discussion [Ep 446 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=596)
- Only 36% of institutions perform routine upper GI endoscopy in esophageal atresia patients regardless of symptoms, despite evidence showing these patients should be surveilled — Colin Martin summarizing the discussion [Ep 446 · 10:03](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=603)
- Without proper surveillance, esophageal atresia patients could be at risk for esophageal cancer and chronic dysmotility as they survive into adulthood — Colin Martin summarizing the discussion [Ep 446 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=643)
- The Curie score is used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0-3, for a maximum score of 30. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 3:03](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=183)
- The International Neuroblastoma Staging System (INSS) takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 4:04](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=244)
- The International Neuroblastoma Risk Group (INRG) is a preoperative staging system designed to assess how difficult patients may be to resect and allow comparison of patients preoperatively. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 4:26](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=266)
- NMYC amplification status, ploidy, and 11Q aberrations are factors considered for neuroblastoma staging. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 5:44](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=344)
- For low stage neuroblastoma with good survival rates, the goal is to reduce therapy and avoid late effects, as 2/3 of cancer patients will have some long-term morbidity from chemotherapy. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 6:11](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=371)
- Neuroblastoma resections differ from other tumors because the tumor is divided into tiny pieces during removal. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 7:29](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=449)
- A Children's Oncology Group study of 87 patients less than 6 months of age with small adrenal masses and no metastatic disease showed 97% four-year event-free survival with observation. — Em Gootee summarizes what Dr. Meera Kotagal said [Ep 525 · 12:21](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=741)
- Opening the uterus for fetal surgery produces a scar and can activate uterine contractions; preterm delivery can occur days after surgery despite tocolysis. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 2:39](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=159)
- CVR (CPAM volume ratio) is calculated as (width × height × length × 0.523) divided by head circumference, with a cutoff of 1.6. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 4:11](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=251)
- First-line therapy for high-risk CPAM is maternal intramuscular betamethasone, which can be given in 1, 2, or 3 weekly rounds to decrease CVR. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 4:36](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=276)
- Postnatal spina bifida repair is required on the first day of life to avoid infections and protect the spinal cord. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 5:57](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=357)
- Neonatal spina bifida surgery results in sequelae including fecal incontinence, urinary incontinence, sexual dysfunction, orthopedic abnormalities, motor impairments (potentially requiring wheelchair), and hydrocephalus from brainstem compression. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 6:51](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=411)
- At 24 weeks gestation, half of fetuses with spina bifida already have hydrocephalus; 95% will develop it later in pregnancy. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 7:20](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440)
- The MOMS trial compared prenatal versus postnatal spina bifida surgery using the same closure technique (dura, layers, skin, sometimes patches). — The host summarizes what Dr. Jose Peiro said [Ep 532 · 8:04](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=484)
- MOMS trial results showed prenatal spina bifida surgery reduced shunting need by at least half, improved mental and motor scores, and completely reversed hindbrain herniation in most cases. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 8:17](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=497)
- Dr. Peiro's fetoscopic approach creates less maternal morbidity and allows vaginal delivery. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 8:48](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=528)
- EXIT procedure requires fetal paralysis and anesthesia, maternal monitoring and stability, and inhalational anesthetics for uterine relaxation. — The host summarizes what Dr. Jose Peiro said [Ep 532 · 9:37](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=577)
- Kewarm stated in a 2020 GCO paper that complete macroscopic excision of the primary tumor improved both overall and event-free survival in a cohort of 1,531 patients with stage 4 neuroblastoma. — Sabine Irtan summarizing the discussion [Ep 557 · 0:52](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=52)
- In Kewarm's study, the success of the intervention and judgment on the post-operative residue was based on the operative report with no systematic radiological assessment of residue performed. — Sabine Irtan summarizing the discussion [Ep 557 · 1:08](https://library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=68)
- APSA created a peer support program for pediatric surgeons in 2020. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=60)
- The goal of the APSA peer support program was to support surgeons after traumatic events. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=72)
- The most common referral reasons for the peer support program were toxic work environments and adverse events. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=76)
- 50 surgeons total agreed to receive training on how to be a supporter in the APSA program. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=80)
- Over 80% of trained peer supporters were able to use these peer support skills informally with colleagues, partners, and trainees. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=85)
- The peer support program shows that this type of support system can work really well to help surgeons heal from traumatic experiences and toxic work environments. — Lizzie Lee summarizes what Dr. Carlos Colunga said [Ep 565 · 1:31](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=91)
- Tracheomalacia was 5% more common in tracheal occluded infants with CDH, with 4% more cases. — Carlos Colunga summarizing a resource [Ep 565 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145)
- Tracheomalacia symptoms in FETO-treated CDH infants typically receded within 55 months. — Carlos Colunga summarizing a resource [Ep 565 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145)
- FETO-treated CDH infants typically showed a larger trachea, which was around 31% wider. — Carlos Colunga summarizing a resource [Ep 565 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154)
- 37% of tracheal occluded CDH cases retained metallic balloon components, although no significant complications were reported. — Carlos Colunga summarizing a resource [Ep 565 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154)
- While tracheal occlusion is effective in promoting lung growth, it is associated with a higher risk of tracheomalacia, although most cases resolve and do not appear to have long-term effects. — Carlos Colunga summarizing a resource [Ep 565 · 2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167)
- The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma. — Cecilia Gigena summarizes what Dr. Carlos Colunga said [Ep 565 · 3:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=207)
- Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma. — Cecilia Gigena summarizes what Dr. Carlos Colunga said [Ep 565 · 3:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220)
- Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma. — Cecilia Gigena summarizes what Dr. Carlos Colunga said [Ep 565 · 3:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234)
- Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma. — Cecilia Gigena summarizes what Dr. Carlos Colunga said [Ep 565 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=240)
- The histopathology report confirmed an aggressive osteosarcoma. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 0:51](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=51)
- There is a lack of clear evidence-based guidelines for reconstructive materials, but the priority is long-term durability, aesthetics, function, and accommodating future growth. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 1:45](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=105)
- Instead of using screws that came packaged with the plates, they used a K-wire drill to drill through the remaining ribs and then used Prolene sutures to secure the implant. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=185)
- Permacol is a surgical implant made of a porcine dermal collagen matrix that allows device placement. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 3:29](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=209)
- Doctor Mutch performed a further chest wall reconstruction where they excised the entire sternum, costochondral cartilages, and anterior ribs and replaced it with a cement mesh. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 4:12](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=252)
- There was one case of minor scoliosis on follow-up, which is being followed by the spinal team and so far has not needed intervention. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 4:45](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=285)
- Bioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 588 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=317)
- Pediatric trauma patients are at high risk for developing venous thromboembolism (VTE). — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 601 · 1:02](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=62)
- The Wita et al. cohort study was conducted from 2019 to 2022 in eight pediatric trauma centers and included patients younger than 18 years old. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 601 · 1:09](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=69)
- Among 460 high-risk pediatric trauma patients, more than half received chemical VTE prophylaxis. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 601 · 1:18](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=78)
- Delaying blood thinners beyond 24 hours of hospital arrival increases the risk of blood clots in pediatric trauma patients. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 601 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=85)
- VTE prophylaxis is safe and effective for pediatric trauma patients and needs to be started within 24 hours of admission. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 601 · 1:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=92)
- Gillielli et al. reviewed 104 abstracts and 34 full text articles, ultimately including 12 studies in their systematic review of female fertility cryopreservation in childhood cancer. — Alex Halpern summarizing a resource [Ep 601 · 2:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=124)
- Ovarian tissue cryopreservation was performed in 501 pediatric cancer patients, with 5.9% undergoing ovarian tissue transplantation. — Alex Halpern summarizing a resource [Ep 601 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=136)
- After ovarian tissue transplantation, 33% of pediatric cancer patients were able to become pregnant. — Alex Halpern summarizing a resource [Ep 601 · 2:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=147)
- Ovarian tissue cryopreservation has great advantages for pediatric cancer patients but needs to be studied further. — Alex Halpern summarizing a resource [Ep 601 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=153)
- The Lee et al. systematic review and meta-analysis from Chongqing, China evaluated efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 601 · 3:09](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=189)
- The meta-analysis gathered 26 studies on nephron-sparing surgery for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 601 · 3:23](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=203)
- Nephron-sparing surgery increased glomerular filtration rate after surgery for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 601 · 3:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- Nephron-sparing surgery showed no significant differences in overall survival, recurrences, hypertension, or renal dysfunction compared to radical nephrectomy for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 601 · 3:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- The North American COG approach often involves immediate surgery, while the European SIOP approach typically starts with chemotherapy before surgery. — Lizzie Lee summarizing the discussion [Ep 595 · 3:30](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=210)
- Loss of heterozygosity is the loss of genetic diversity in tumor cells and can indicate more aggressive disease in Wilms tumor. — Lizzie Lee summarizing the discussion [Ep 595 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=114)
- Gain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers. — Lizzie Lee summarizing the discussion [Ep 595 · 2:02](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=122)
- According to Children's Oncology Group updates, adverse biologic factors are associated with worse prognosis in stage 2 patients, but not in stage 1 favorable histology Wilms tumor patients. — Lizzie Lee summarizing the discussion [Ep 595 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=195)
- Genetic markers like loss of heterozygosity at specific chromosomes can indicate a higher risk of cancer recurrence and guide decisions about adding chemotherapy treatments. — Lizzie Lee summarizing the discussion [Ep 595 · 3:49](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=229)
- In a study of stage 3 ovarian tumors with 20 patients, 5 were stage 3 only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage 1 with likely higher recurrence — Fred Rescorla summarizing a resource [Ep 22 · 8:10](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=490)
- A recent study in Fertility and Sterility Journal demonstrated that premenarchal girls have higher risk of ovarian torsion — Fred Rescorla summarizing a resource [Ep 22 · 26:50](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1610)
- The recommendation from the Fertility and Sterility study is to perform oophoropexy in premenarchal girls or if the same ovary has torsed before — Fred Rescorla summarizing a resource [Ep 22 · 27:10](https://library.globalcastmd.com/watch/pediatric-ovarian-tumors-video-podcast-362?t=1630)
- Application-specific equipment and scope technology for endoscopic neurosurgery has evolved to meet demands, with the armamentarium for skull base work being distinctly different from that used for intraventricular work. — The host summarizing a resource [Ep 24 · 20:01](https://library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1201)
- Chemotherapy and/or hormone therapy for breast cancer significantly lower the age of menopause compared to untreated controls (median ~51.5 years); combination therapy produces the earliest menopause. — Teresa Woodruff summarizing a resource [Ep 27 · 4:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=240)
- Since 2010, ASCO, ASRM, and the Pediatric Hematology/Oncology Nursing Society have published practice guidelines mandating that providers discuss fertility impairment at the earliest possible moment, refer to a qualified oncofertility specialist, and promote ongoing research. — Teresa Woodruff summarizing a resource [Ep 27 · 15:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=920)
- The American Academy of Pediatrics has provided guidance that parents may act to preserve the fertility of pediatric cancer patients, an important ethical advance because fertility is not impaired at the time of diagnosis. — Teresa Woodruff summarizing a resource [Ep 27 · 16:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1000)
- The Shehata technique for intraabdominal testes achieves 88% success rate with 7% slip traction requiring redo, 12% atrophy rate, and no reported cases of internal hernia in over 430 cases over 15 years — Todd Ponsky summarizing a resource [Ep 396 · 51:49](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=3109)
- Ligation of testicular vessels during orchiopexy leads to significant reduction of spermatogonia despite preserved testicular volume, meaning you bring down a good-sized testis of poor quality — Todd Ponsky summarizing a resource [Ep 396 · 49:39](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=2979)
- 18% of lateral cutaneous nerve branches are posterior to the mid-axillary line, requiring posterior cryoprobe placement to avoid ineffective blocks — Todd Ponsky summarizing a resource [Ep 396 · 89:09](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=5349)
- Thoracic aortic injury in children managed with endovascular repair shows better outcomes than non-operative management, with decreased mortality and reduced spinal cord injury risk compared to open repair — Todd Ponsky summarizing a resource [Ep 396 · 66:52](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=4012)
- DVT prophylaxis started within 24 hours of injury in trauma patients significantly reduces DVT incidence compared to delayed initiation, based on Midwest Consortium data — Todd Ponsky summarizing a resource [Ep 396 · 71:01](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=4261)
- Adult randomized controlled trial of 6000 patients showed aspirin was non-inferior to Lovenox for DVT prophylaxis in orthopedic trauma patients — Todd Ponsky summarizing a resource [Ep 396 · 76:24](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=4584)
- Dr. Kim's double-freeze technique targeting both the main intercostal nerve and the collateral branch on the rib above resulted in 9 of 22 patients reporting pain scores of zero — Todd Ponsky summarizing a resource [Ep 396 · 92:20](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=5540)
- Kasai portoenterostomy performed before 45 days of age reduces the incidence of liver transplant need in biliary atresia patients — Todd Ponsky summarizing a resource [Ep 396 · 117:30](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=7050)
- Every 10 days of delay in Kasai procedure translates to 20% worse outcomes in biliary atresia patients — Todd Ponsky summarizing a resource [Ep 396 · 112:26](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=6746)
- Conversion rate to open thoracotomy due to failure to localize subcentimeter pulmonary nodules during thoracoscopy is 47% — Todd Ponsky summarizing a resource [Ep 396 · 121:32](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=7292)
- In national survey of thoracic aortic injury management, 67% were managed non-operatively, 27% endovascularly, and 6% with open repair — Todd Ponsky summarizing a resource [Ep 396 · 63:56](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6043?t=3836)
- Animal studies show that ligation of testicular vessels during orchiopexy leads to significant reduction of spermatogonia, though volumetric characteristics remain unchanged—meaning a good-sized testis of poor quality — The host summarizing the discussion [Ep 395 · 49:39](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=2979)
- Endovascular repair of thoracic aortic injury in children shows better outcomes than non-operative management, with decreased mortality, lower spinal cord injury risk, and shorter hospital stays — Todd Ponsky summarizing the discussion [Ep 395 · 66:52](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=4012)
- A randomized controlled trial in 12,000 adults showed aspirin was non-inferior to Lovenox for DVT prophylaxis in orthopedic trauma patients — Todd Ponsky summarizing the discussion [Ep 395 · 76:24](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=4584)
- DVT prophylaxis should be started within 24 hours of injury in adolescent trauma patients; the Midwest Consortium study showed patients receiving prophylaxis within 24 hours were much less likely to develop DVT — Todd Ponsky summarizing the discussion [Ep 395 · 71:01](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=4261)
- MMP-7 is a validated diagnostic biomarker for biliary atresia with sensitivity ranging from 88-100% across multiple international studies, though cutoff values vary by assay (2.5 ng/mL in Far East studies, 18-50 ng/mL in North American assays) — Todd Ponsky summarizing the discussion [Ep 395 · 115:48](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=6948)
- Kasai portoenterostomy performed before 45 days of age reduces the incidence of transplant need in biliary atresia patients; every 10-day delay translates to 20% worse outcomes — Todd Ponsky summarizing the discussion [Ep 395 · 117:16](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=7036)
- The average age at Kasai in North America through 2010 was around 75 days, but programs are now targeting 40 days or earlier when diagnosis can be established — Todd Ponsky summarizing the discussion [Ep 395 · 117:02](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=7022)
- Wire dislodgement rates for pulmonary nodule localization range from 2.4% to 22%, with higher rates when patients must be transported from CT to OR and when pneumothorax is created — Todd Ponsky summarizing the discussion [Ep 395 · 123:41](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=7421)
- Conversion rate to thoracotomy due to failure to localize subcentimeter pulmonary nodules during thoracoscopy is 47% — Todd Ponsky summarizing the discussion [Ep 395 · 121:32](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=7292)
- In a Phoenix study, combining rib tip removal or stabilization surgery with intraoperative cryoablation for slipping rib syndrome resulted in shorter length of stay and less narcotic use — Todd Ponsky summarizing the discussion [Ep 395 · 102:19](https://library.globalcastmd.com/watch/8th-annual-pediatric-surgery-update-course-6042?t=6139)
- Testing for malignancy in ovarian tissue can be assessed prior to transplant rather than at the time of tissue acquisition, and future technologies may allow delivery of safe follicles in an artificial ovary without contaminated cells. — The host summarizing a resource [Ep 60 · 0:50](https://library.globalcastmd.com/watch/options-for-female-fertility-preservation-pediatric-oncofertility-2017-899?t=50)
- The American Society of Clinical Oncology recommends that sperm cryopreservation should be offered to all peri and postpubertal adolescents who are able to provide a semen specimen. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- In a Philadelphia cohort, azoospermia was present in only 16.9% of untreated patients versus 84% of patients who were treated and then subsequently tried to perform sperm cryopreservation. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Several centers have demonstrated successful sperm banking in greater than 80% of patients, with a median of 1.5 attempts and 7 samples per patient. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Studies have shown that adequate semen specimens can be obtained in adolescents as young as 11 years of age. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- In the Philadelphia study, semen volume, total motile count, and rate of azoospermia improved with increasing age on both univariate and multivariate analysis. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- In the youngest age group (11-14 years), 65% of patients were able to successfully sperm bank. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- The mean and median semen volume, concentration, and motility in the adolescent cohort were greater than WHO criteria derived from fertile adult males. — Shrine summarizing the discussion [Ep 63 · 3:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=180)
- Successful sperm retrieval with TESE has been reported in 47% of patients prior to chemotherapy and 37-65% after chemotherapy. — Shrine summarizing the discussion [Ep 63 · 6:20](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=380)
- In a study subset of adolescents and young adults aged 11-19 years, 33% sperm retrieval rate was reported prior to treatment. — Shrine summarizing the discussion [Ep 63 · 6:20](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=380)
- Sperm was successfully extracted from an adolescent as young as 11 years of age, but not from any child below Tanner stage 3 development. — Shrine summarizing the discussion [Ep 63 · 6:20](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=380)
- Studies have demonstrated high satisfaction and acceptance of risk for testicular tissue cryopreservation among patients and families. — Shrine summarizing the discussion [Ep 63 · 9:00](https://library.globalcastmd.com/watch/options-for-male-fertility-preservation-pediatric-oncofertility-2017-900?t=540)
- Some experts think peritoneal pocket placement may provide better blood supply and functionality compared to ovarian placement — The host summarizing the discussion [Ep 61 · 6:00](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=360)
- Some reports suggest removing transplanted tissue immediately after successful pregnancy to minimize malignancy risk — The host summarizing the discussion [Ep 61 · 26:20](https://library.globalcastmd.com/watch/ovarian-tissue-transplantation-pediatric-oncofertility-2017-902?t=1580)
- In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed initial aspiration (pneumothorax recurred within 6 hours) eventually required VATS procedure. — Todd Ponsky summarizing the discussion [Ep 237 · 3:52](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=232)
- Patients with spontaneous pneumothorax who were sent home after successful aspiration had a 44% recurrence rate with no episodes of tension pneumothorax. — Todd Ponsky summarizing the discussion [Ep 237 · 4:28](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=268)
- In a 12-center UK retrospective review, the recurrence rate of benign ovarian tumors (mature and immature teratomas and serous cystadenomas) in children was 8%. — Todd Ponsky summarizing the discussion [Ep 237 · 10:00](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=600)
- The UK study authors recommend every 6-month ultrasounds for benign ovarian tumor follow-up but do not conclude on duration of surveillance. — Todd Ponsky summarizing the discussion [Ep 237 · 10:25](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=625)
- After uncomplicated appendectomy, 84% of patients require no opioids on post-operative day 1, 95% by post-op day 2, and 100% by post-op day 3. — Todd Ponsky summarizing the discussion [Ep 237 · 12:10](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=730)
- In the Riley Hospital RCT comparing pyloric stenosis feeding strategies, a relaxed ad-lib feeding protocol decreased time to goal feeds and overall length of stay without significant differences in post-operative vomiting or readmissions compared to incremental scheduled feeds. — Todd Ponsky summarizing the discussion [Ep 237 · 17:30](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1050)
- Pyloric stenosis patients with serum chloride less than 100 on admission took significantly longer to reach their feeding goal. — Todd Ponsky summarizing the discussion [Ep 237 · 18:15](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1095)
- Nationwide Children's Hospital reduced stoma takedown wound infection rate from 21% to 8% by implementing a perioperative bundle, then further reduced it to 2% by changing antibiotics from cefoxitin to Unasyn. — Todd Ponsky summarizing the discussion [Ep 237 · 21:20](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1280)
- The reason for switching to Unasyn for stoma takedown was that infections after stoma closure were predominantly enterococcus, and Unasyn provides better enterococcus coverage than cefoxitin. — Todd Ponsky summarizing the discussion [Ep 237 · 24:10](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1450)
- Dr. Levitt identified changing gloves and changing instruments when doing fascial and skin closures as the bundle element that probably made the biggest difference in reducing stoma takedown infections. — Todd Ponsky summarizing the discussion [Ep 237 · 22:40](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1360)
- In a multi-state retrospective cohort study, umbilical hernia repair before age 4 had double the recurrence rate and double the readmission rate compared to repair at age 4 or later. — Todd Ponsky summarizing the discussion [Ep 237 · 19:00](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1140)
- A 1960s study of African-American children in the United States found that very large umbilical hernia defects had a lower chance of spontaneous closure. — Todd Ponsky summarizing the discussion [Ep 237 · 23:50](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1430)
- In a prospective multicenter study published in Journal of Crohn's and Colitis, appendectomy in patients with refractory ulcerative colitis resulted in sustained symptomatic improvement in 30%, pathologic improvement in 50%, and complete endoscopic remission in 17%. — Todd Ponsky summarizing the discussion [Ep 237 · 22:10](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1330)
- In a retrospective study of 24 patients with penile necrosis after circumcision, five predictive factors were identified: monopolar cautery use, post-circumcision infection, compartment syndrome, local anesthetic agent use, and methemoglobinemia. — Todd Ponsky summarizing the discussion [Ep 237 · 29:00](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1740)
- The Gips procedure for pilonidal disease involves coring out pits with a trephine or punch biopsy, extracting granulation tissue and hair with a mosquito, curettage with a smaller trephine, flushing with saline then hydrogen peroxide, leaving punch openings unpacked and unsutured with no drains, and takes 3-5 minutes. — Todd Ponsky summarizing the discussion [Ep 237 · 35:00](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2100)
- In a 133-patient series using chest CT for suspected airway foreign body, CT excluded foreign body in 30% of patients who would have otherwise undergone bronchoscopy. — Todd Ponsky summarizing the discussion [Ep 237 · 43:20](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2600)
- When chest CT showed findings of airway foreign body, bronchoscopy confirmed the findings 94% of the time, compared to only 61% positive yield when bronchoscopy was performed based on clinical suspicion alone. — Todd Ponsky summarizing the discussion [Ep 237 · 43:45](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2625)
- Modern pediatric chest CT delivers 1 to 10 millisieverts of radiation, equivalent to living on Earth for 1 year, with chest CTs often in the 1-3 millisievert range. — Todd Ponsky summarizing the discussion [Ep 237 · 46:40](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2800)
- For intussusception that reaches the cecum on contrast enema but cannot be fully reduced, a second enema attempt has a 50-64% success rate in stable patients without peritoneal signs. — Todd Ponsky summarizing the discussion [Ep 237 · 48:00](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2880)
- The ATOMAC multi-center prospective data showed that pediatric trauma patients do better with earlier blood administration: only one 20 cc/kg bolus of saline should be given, and if the patient does not respond, blood should be given rather than a second crystalloid bolus. — Todd Ponsky summarizing the discussion [Ep 237 · 49:10](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2950)
- In pediatric trauma, the magic number for operative intervention is 40 cc/kg of blood or 4 units: patients transfused with this amount probably cannot be managed non-operatively and should go to the operating room. — Todd Ponsky summarizing the discussion [Ep 237 · 50:20](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3020)
- For stable pediatric solid organ injury patients who never required blood transfusion, they can be discharged home the next day if hemoglobin remains stable. — Todd Ponsky summarizing the discussion [Ep 237 · 51:20](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3080)
- Kansas City data on 622 central line placements showed that obtaining chest X-rays only for symptomatic patients (rather than routine post-procedure imaging) resulted in no critically ill patients, with only one patient requiring intervention. — Todd Ponsky summarizing the discussion [Ep 237 · 52:40](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3160)
- In an RCT of glycopyrrolate for anastomotic leak after esophageal atresia repair, the treatment group had chest tube output of 124 mL versus 370 mL in placebo, leak resolution in 76% versus 29%, and oral feeding achieved in 71% versus 14%. — Todd Ponsky summarizing the discussion [Ep 237 · 53:50](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3230)
- In the Riley Hospital study of operating room headgear, cloth skull caps had the lowest permeability and lowest particle/microbial shedding on the surgical field, while disposable bouffant caps had the highest shedding. — Todd Ponsky summarizing the discussion [Ep 237 · 56:20](https://library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3380)
- The surgical approach uses three ports total: one camera port and two working ports. — Rod Gerardo summarizing the discussion [Ep 367 · 8:34](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=514)
- The surgeon does not initially insufflate the chest, finding and retrieving the wire while the lung is inflated before working with anesthesiology to deflate the lung. — Rod Gerardo summarizing the discussion [Ep 367 · 8:34](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=514)
- Wedge resection is performed using a thoracoscopic stapler, and tissue sealant is applied over staple lines to prevent bleeding. — Rod Gerardo summarizing the discussion [Ep 367 · 8:34](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=514)
- The specimen is radiographed after removal to verify complete removal of wire or coil. — Rod Gerardo summarizing the discussion [Ep 367 · 8:34](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5537?t=514)
- Radiographs are a shot in time, fluoroscopy gives real-time 2D images, and latest fluoroscopic machines can do cone beam CT which performs 360-degree scan of designated 3D volume, giving cross-section images. — Rod Gerardo summarizing the discussion [Ep 366 · 5:44](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=344)
- Localization on CT is simple: draw line between skin surface and target on CT images; beauty of cross-sectional CT images is you can account for z-axis, giving 3D rendition or 3D space. — Rod Gerardo summarizing the discussion [Ep 366 · 5:44](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=344)
- To ensure same respiratory effort, ask anesthesia colleagues to fully paralyze patient and disconnect tubes from ventilator so patient can exhale naturally and stop at very natural stopping point—most reproducible rather than having CPAP of 20 or 25. — Rod Gerardo summarizing the discussion [Ep 366 · 8:43](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=523)
- Having no positive pressure reduces chance of pneumothorax. — Rod Gerardo summarizing the discussion [Ep 366 · 8:43](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=523)
- If lesion is peripheral, high risk of pneumothorax; if lesion is more central, higher risk of pulmonary hemorrhage. — Anton Bash summarizing the discussion [Ep 366 · 10:03](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=603)
- Under plain fluoroscopy, nodule that small can't be seen, so would be pushing blind without CT and planned graphics. — Anton Bash summarizing the discussion [Ep 366 · 11:47](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=707)
- Display monitor shows live X-ray image with graphics and pre-op CT so can compare all images while doing procedure. — Rod Gerardo summarizing the discussion [Ep 366 · 12:27](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=747)
- 3D rendering takes time; it's a tool in the armamentarium but may not be needed for every case. — Rod Gerardo summarizing the discussion [Ep 366 · 14:23](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=863)
- Added benefit from technologist perspective: having surgeon and interventional radiologist in room helping staff physician so everyone's happy when they get in there. — Rod Gerardo summarizing the discussion [Ep 366 · 15:26](https://library.globalcastmd.com/watch/image-guided-surgery-video-series-episode-2-lung-nodule-localization-5526?t=926)
- TIRRADS (Thyroid Imaging Reporting and Data System) is a scoring system developed for adults to stratify the risk of thyroid nodules based on ultrasound findings — Jill Knepprath summarizing the discussion [Ep 684 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=39)
- Thyroid nodules are more common in adults than in children, so there are not many centers that have a pediatric surgeon with high volume of these cases — Jill Knepprath summarizing the discussion [Ep 684 · 1:35](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=95)
- In thyroid surgery, intraoperative nerve monitoring is a technique to localize the recurrent laryngeal nerves which control the vocal cords using an electric probe to stimulate the nerve and EMG electrodes to monitor vocal cord movement — Jill Knepprath summarizing the discussion [Ep 684 · 2:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=134)
- In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring — Jill Knepprath summarizing the discussion [Ep 684 · 2:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=156)
- Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy — Jill Knepprath summarizing the discussion [Ep 684 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=208)
- Nerve monitoring devices were often too big for pediatric patients — Jill Knepprath summarizing the discussion [Ep 684 · 3:58](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=238)
- Nerve monitoring can be considered in all pediatric thyroid surgeries because adhesive electrodes can be applied to even a 3.0 endotracheal tube — Jill Knepprath summarizing the discussion [Ep 684 · 4:18](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=258)
- Radiologists say that TIRRADS is not really reliable for pediatrics since it was originally developed for adults — Jill Knepprath summarizing the discussion [Ep 684 · 4:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=290)
- When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed — Jill Knepprath summarizing the discussion [Ep 684 · 5:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=327)
- Dr. Aldrin's 2025 study showed that the PES-TIRRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines — Jill Knepprath summarizing the discussion [Ep 684 · 5:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=333)
- Proximal small bowel resection results in greater oxidative stress in the liver compared to distal resection, as evidenced by elevated messenger RNA transcripts for tumor necrosis factor alpha, NADPH oxidase, and glutathione synthase. — Colin Martin summarizing the discussion [Ep 683 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=182)
- 82% of hepatoblastoma patients (41 out of 50) achieved no-evidence-of-disease status through aggressive surgical management. — Colin Martin summarizing the discussion [Ep 683 · 6:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=383)
- 46 of 50 hepatoblastoma patients underwent resection using adjuvant techniques including total hepatic vascular exclusion, vascular reconstruction, biliary reconstruction, or en-bloc resection and total hepatectomy with transplantation. — Colin Martin summarizing the discussion [Ep 683 · 6:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=374)
- 14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies (7 for unilateral disease, 7 for bilateral disease) with a median of 4.5 nodules resected. — Em Tombash summarizing the discussion [Ep 683 · 6:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=400)
- 5 high-risk hepatoblastoma patients relapsed and 3 of them were saved. — Em Tombash summarizing the discussion [Ep 683 · 6:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=410)
- The esophageal atresia surveillance survey had a 77% response rate from 181 physicians at 19 institutions. — Colin Martin summarizing the discussion [Ep 683 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=596)
- Only 36% of institutions perform routine upper GI endoscopy in esophageal atresia patients regardless of symptoms, despite evidence showing these patients should be surveilled. — Colin Martin summarizing the discussion [Ep 683 · 10:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=603)
- Without proper surveillance, esophageal atresia patients are at risk for esophageal cancer and chronic dysmotility as they survive into adulthood. — Colin Martin summarizing the discussion [Ep 683 · 10:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2023-aap-issue-13353?t=652)
- Patient was a 3½-year-old female who presented with chronic cough and chest pain, with CT scan showing right perirenal mass — The host summarizing a resource [Ep 675 · 0:00](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=0)
- The Cool Trinity 5 mm device has very low energy profile and heat spread, allowing dissection without worry of injury to the colon — The host summarizing a resource [Ep 675 · 0:30](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=30)
- The fine tips of the 5 mm jaw allow for both grasping and fine dissection between tissue planes — The host summarizing a resource [Ep 675 · 1:00](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=60)
- The tumor was directly on the inferior vena cava and densely adherent, as represented in the CT scan — The host summarizing a resource [Ep 675 · 2:30](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=150)
- The visualization afforded by the dual action and fine tips is better than all other tissue sealing devices and is equivalent to that of a 5 mm Maryland — The host summarizing a resource [Ep 675 · 3:30](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=210)
- At no time during this procedure was it necessary to remove the Trinity and insert a different grasping or dissecting device because of its ability to perform both functions — The host summarizing a resource [Ep 675 · 4:00](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=240)
- The device allows sealing and dividing tissues with separate actions, which is critically important for ensuring adequate hemostasis before division — The host summarizing a resource [Ep 675 · 5:00](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=300)
- The tissue between tumor and IVC was quite thick and inflamed, making the plane difficult to identify — The host summarizing a resource [Ep 675 · 5:30](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=330)
- The minimal heat spread ensures no damage to adjacent structures such as kidney, liver, bowel, or vena cava — The host summarizing a resource [Ep 675 · 6:30](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=390)
- There is minimal sticking following the sealing of tissues with the device — The host summarizing a resource [Ep 675 · 7:00](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=420)
- The device is taken out periodically to clean the jaws to remove any small amount of char — The host summarizing a resource [Ep 675 · 7:15](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=435)
- This procedure took under 2 hours — The host summarizing a resource [Ep 675 · 7:45](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=465)
- The tumor was placed in an endoscopic bag and brought out through an elongated umbilical incision, saving the child significant morbidity from a large open procedure — The host summarizing a resource [Ep 675 · 7:50](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=470)
- The child was discharged on the 2nd postoperative day — The host summarizing a resource [Ep 675 · 8:15](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=495)
- The pathology came back consistent with a neuroblastoma arising from the right adrenal gland — The host summarizing a resource [Ep 675 · 8:20](https://library.globalcastmd.com/watch/narrated-r-adrenal-coolseal-11947?t=500)
- The patient was a 20-year-old who had previously been treated for osteosarcoma in the limb with a limb preservation and had been disease-free for 4 years when she developed shortness of breath and eventually hemoptysis. — The host summarizing a resource [Ep 674 · 0:00](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=0)
- CT scan showed a large mass in the left lower lobe. — The host summarizing a resource [Ep 674 · 0:30](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=30)
- Three ports were used for the procedure initially 3 5-millimeter ports, with 1 port being increased to a 12 for the stapler. — The host summarizing a resource [Ep 674 · 0:40](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=40)
- The 5 millimeter Trinity was the main instrument used for the entire procedure. — The host summarizing a resource [Ep 674 · 1:00](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=60)
- The major fissure was relatively complete, however there was still lung tissue overlying the pulmonary artery. — The host summarizing a resource [Ep 674 · 1:10](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=70)
- The inferior pulmonary vein was divided a good 1 centimeter away from the pericardium to allow for safe division. — The host summarizing a resource [Ep 674 · 5:00](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=300)
- The entire procedure was done in 90 minutes through 2 5-millimeter and 1 12-millimeter trochar. — The host summarizing a resource [Ep 674 · 5:40](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=340)
- The patient recovered well and was discharged on the second postoperative day. — The host summarizing a resource [Ep 674 · 5:55](https://library.globalcastmd.com/watch/lll-for-metastatic-osteosacoma-11927?t=355)
- Many patients cannot undergo autotransplantation due to the risk of reintroducing cancer cells into their bodies. — The host summarizes what Dr. Monica Laronda said [Ep 657 · 8:53](https://library.globalcastmd.com/watch/pediatric-oncofertility-from-cryopreservation-to-future-fertility-solutions-11683?t=533)
- Pafolacianine is expensive and requires purchasing multiple vials for off-label use in pediatric patients. — Gloria Gonzalez summarizing a resource [Ep 593 · 8:05](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-oncology-10901?t=485)
- The APPY trial is an international multicenter study comparing appendectomy versus antibiotics for acute uncomplicated appendicitis in children, with 936 patients aged 5-16 years randomized across 11 hospitals — Jose Campos summarizing the discussion [Ep 592 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273)
- In the APPY trial, treatment failure was defined differently in each arm: in the antibiotic group as appendectomy needed within one year, and in the surgical group as negative appendectomy or any procedure under general anesthesia related to appendicitis within one year — Jose Campos summarizing the discussion [Ep 592 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273)
- At one year in the APPY trial, 31% of children in the antibiotic group failed treatment compared with 7% in the appendectomy group, with the 26.7% difference exceeding the pre-specified 20% non-inferiority margin — Jose Campos summarizing the discussion [Ep 592 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273)
- Children in the antibiotic group of the APPY trial returned to school earlier and needed almost no pain medication — Jose Campos summarizing the discussion [Ep 592 · 6:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=370)
- The APPY trial had 10% of patients with incomplete data and consent refusal reasons were not collected — Jose Campos summarizing the discussion [Ep 592 · 6:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=370)
- Some guidelines recommend against DVT prophylaxis in pediatric trauma, and in the study only 50% of doctors caring for these children gave DVT prophylaxis — Jose Campos summarizing the discussion [Ep 592 · 7:25](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=445)
- A JAMA Surgery 2024 study prospectively evaluated 462 pediatric trauma patients with high risk for deep vein thrombosis across level one trauma centers, comparing outcomes based on whether prophylaxis was given and when it was initiated — Johan Karameez summarizing the discussion [Ep 592 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568)
- No major bleeding event occurred in any patient who received anticoagulation in the DVT prophylaxis study — Johan Karameez summarizing the discussion [Ep 592 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568)
- Patients who received DVT prophylaxis within 24 hours had a venous thromboembolism rate of 1.6%, while those who received it after 24 hours had a rate of 6.9%, nearly identical to the 5.3% in patients who never received prophylaxis — Johan Karameez summarizing the discussion [Ep 592 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568)
- The DVT prophylaxis study had low adherence to VTE guidelines with almost half of patients never receiving prophylaxis and relatively low absolute numbers of VTE events restricting statistical power — Johan Karameez summarizing the discussion [Ep 592 · 10:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=636)
- The DVT prophylaxis study was powered to detect any adverse event and there was no adverse event whatsoever from prophylaxis — Jose Campos summarizing the discussion [Ep 592 · 13:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=786)
- A Journal of American College of Surgeons 2025 study using the National Cancer Database between 2004 and 2022 identified 1339 patients under 18 years with appendiceal neuroendocrine tumors, comparing appendectomy versus right hemicolectomy — Jose Campos summarizing the discussion [Ep 592 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912)
- In the neuroendocrine tumor study, survival was excellent and equivalent between appendectomy and hemicolectomy groups: 99.9% at 5 years and 99.4% at 10 years without chemotherapy or additional treatment — Jose Campos summarizing the discussion [Ep 592 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912)
- No forced disease progression occurred in children treated with appendectomy alone, even when high-risk features like tumor larger than 2 centimeters, positive margins, or positive lymph nodes were present — Jose Campos summarizing the discussion [Ep 592 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912)
- The TOUCH trial was the first multicenter randomized control trial comparing stoma versus anastomosis in necrotizing enterocolitis, randomizing patients during laparotomy when both options were deemed feasible — Jose Campos summarizing the discussion [Ep 592 · 20:31](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1231)
- The TOUCH trial found no difference in mortality or complications in general between stoma and anastomosis groups, but the stoma group had up to 19% of intestinal and stoma complications — Jose Campos summarizing the discussion [Ep 592 · 21:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1290)
- In the TOUCH trial, the likelihood of being weaned from parenteral nutrition was much higher in the anastomosis group, and children were weaned 20 days earlier compared to the stoma group — Jose Campos summarizing the discussion [Ep 592 · 21:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1290)
- Yuri Kuzlov in Russia has performed over 300 robotic cases — Todd Ponsky summarizing the discussion [Ep 591 · 11:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=702)
- General surgery residents report doing 75-80% of minimally invasive surgery robotically — Todd Ponsky summarizing the discussion [Ep 591 · 11:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=702)
- Robotic surgery shows equivalent oncologic outcomes in certain tumor surgeries — Todd Ponsky summarizing the discussion [Ep 591 · 15:34](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-robotics-in-pediatric-surgery-which-indications-benefit-the-most-10896?t=934)
- The histological integration of the bioprosthesis with surrounding tissue does not prevent growth or movement of the tissue. — Laura Galganski summarizes what Dr. Chiara Oreglio said [Ep 556 · 8:23](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=503)
- Lipiodol is being adapted from adult procedures to pediatric practice — M Godoy summarizes what Dr. Gloria Gonzalez said [Ep 537 · 4:24](https://library.globalcastmd.com/watch/update-course-rewind-lipiodol-for-lung-metastases-2024-9484?t=264)
- Up until the 1980s, the vast majority of children on the transplant wait lists passed away due to the lack of available organs. — Cecilia Gigena summarizing a resource [Ep 506 · 0:04](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=4)
- In the 1990s, techniques that took advantage of the liver's segmental anatomy and ability to regenerate greatly increased organ availability, with segmental transplants (Baron graphs or segmental grafts) decreasing waitlist mortality from 80% to just 10%. — Cecilia Gigena summarizing a resource [Ep 506 · 1:00](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=60)
- For children under 1 year of age, mortality remains at about 30% due to size constraints. — Cecilia Gigena summarizing a resource [Ep 506 · 2:00](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=120)
- The most common indication for pediatric liver transplant is biliary atresia. — Cecilia Gigena summarizing a resource [Ep 506 · 2:20](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=140)
- Native liver survival after a Kasai procedure can be as high as 80%, with keys being early diagnosis and selective use of antibiotics and steroids. — Cecilia Gigena summarizing a resource [Ep 506 · 2:35](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=155)
- In adults, organ allocation is based on the MELD score, which estimates a patient's chances of survival in the next 3 months, ranging from 6 to 40 (higher is worse), based on creatinine, bilirubin, serum sodium, and INR. — Cecilia Gigena summarizing a resource [Ep 506 · 2:55](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=175)
- In children, the PELD score is used for those under 12 years of age, calculated using albumin, bilirubin, INR, and degree of growth failure without creatinine, with special designations of 1A for acute liver failure and 1B for hepatoblastoma. — Cecilia Gigena summarizing a resource [Ep 506 · 3:40](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=220)
- Only about 25% of kids with acute liver failure survive their condition without a transplant or death. — Cecilia Gigena summarizing a resource [Ep 506 · 4:20](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=260)
- A study from a major liver center in Denmark used high volume plasmapheresis for 16 children when bilirubin exceeded 20 or if they had a toxic ingestion as a cause. — Cecilia Gigena summarizing a resource [Ep 506 · 4:40](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=280)
- A native liver with over 90% necrosis will eventually recover, taking advantage of the liver's regenerative capacity. — Cecilia Gigena summarizing a resource [Ep 506 · 5:09](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=309)
- In auxiliary liver transplant, the native left liver can be resected leaving the right lobe behind, then transplanted with a new left lobe maintained with immunosuppression for 6 months while the native liver recovers. — Cecilia Gigena summarizing a resource [Ep 506 · 5:27](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=327)
- Hepatoblastoma is the most common liver tumor for kids under 5, and for tumors too extensive to be resected, transplant is the only treatment of choice. — Cecilia Gigena summarizing a resource [Ep 506 · 5:46](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=346)
- About 60% of hepatoblastomas are unresectable at the time of diagnosis, and about 20% of patients remain unresectable after chemotherapy. — Cecilia Gigena summarizing a resource [Ep 506 · 6:12](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=372)
- The second most common indication for pediatric liver transplant is metabolic liver disease, most caused by single gene mutations affecting enzymes principally harbored in the liver. — Cecilia Gigena summarizing a resource [Ep 506 · 6:32](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=392)
- Dr. Merola explained that in the future, many metabolic liver diseases may be cured with cellular therapies using isolated pluripotent stem cells with corrected deficient genes, expanded as liver organoids and infused back into the patient. — Cecilia Gigena summarizing a resource [Ep 506 · 7:00](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=420)
- Living donor liver transplant offers the advantage of hastening organ access and a faster recipient recovery, with recipients having much shorter length of stay and requiring fewer transfusions because they don't have to wait until extremely sick. — Cecilia Gigena summarizing a resource [Ep 506 · 7:46](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=466)
- At Cincinnati Children's Hospital, they make liberal use of infrarenal aortic conduits where a piece of donor iliac artery is placed end to side on the aorta and the other end anastomosed end to end to the recipient hepatic artery, giving excellent arterial flow when the small native hepatic artery is inadequate. — Cecilia Gigena summarizing a resource [Ep 506 · 8:40](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=520)
- Graft survival after pediatric liver transplant routinely exceeds 30 to 40 years, especially for living and partial donor grafts. — Cecilia Gigena summarizing a resource [Ep 506 · 9:15](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=555)
- Primary nonfunction results from severe ischemic injury and possibly preformed antibodies, but fortunately happens in less than 1% of transplants. — Cecilia Gigena summarizing a resource [Ep 506 · 9:34](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=574)
- Vascular complications are much more common in pediatric transplant and usually occur within the first 30 days. — Cecilia Gigena summarizing a resource [Ep 506 · 10:00](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=600)
- Hepatic artery thrombosis is the most common vascular complication, and when it happens within the first week and revascularization is not possible, it receives a special designation since urgent retransplant is the only treatment. — Cecilia Gigena summarizing a resource [Ep 506 · 10:20](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=620)
- Biliary strictures are the Achilles' heel of liver transplant, but thankfully most can be managed with endoscopic dilation. — Cecilia Gigena summarizing a resource [Ep 506 · 10:50](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=650)
- Acute rejection in children is about 20% in the first year, but does not affect survival of the liver transplant if treated early with steroids. — Cecilia Gigena summarizing a resource [Ep 506 · 11:10](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=670)
- Untreated rejection can lead to chronic injury, which is the most common cause for late graft loss. — Cecilia Gigena summarizing a resource [Ep 506 · 11:30](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=690)
- There are two types of ex vivo perfusion platforms available: normothermic platform and cold perfusion pulsatile platform, both shown to help livers recover when they're high risk grafts. — Cecilia Gigena summarizing a resource [Ep 506 · 11:36](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=696)
- Many transplant centers, particularly in the adult population, are using the pump, putting high risk livers on pump to assess if they perform adequately before transplant. — Cecilia Gigena summarizing a resource [Ep 506 · 12:10](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=730)
- The next step in ex vivo organ perfusion technology is treatment of livers: making fatty livers less fatty, enhancing immune compatibility, and changing blood group antigens. — Cecilia Gigena summarizing a resource [Ep 506 · 12:32](https://library.globalcastmd.com/watch/liver-transplant-with-dr-jonathan-merola-8832?t=752)
- A fertility navigator role, often filled by a nurse, integrates between oncology, surgery, urology, and gynecology and has been strongly advocated in the literature. — Todd Ponsky summarizing the discussion [Ep 454 · 6:29](https://library.globalcastmd.com/watch/update-course-rewind-fertility-preservation-2023-7867?t=389)
- MRI disadvantages include longer acquisition time (sometimes requiring anesthesia), reduced availability, and higher cost. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 4:34](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=274)
- AFP is the primary tumor marker for germ cell disease. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 9:28](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=568)
- PEB chemotherapy (platinum, etoposide, bleomycin) is the standard approach for germ cell tumors requiring adjuvant treatment and is very effective. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 14:42](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=882)
- Six-year overall survival with PEB chemotherapy is excellent even in stage IV germ cell tumor patients. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 15:05](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=905)
- Teratomas consist of all three primordial tissue types (ectoderm, mesoderm, endoderm) and can contain brain, bone, and teeth. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 15:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=920)
- Cystic teratomas are the most common type and can be bilateral in about 10% of patients. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 15:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=940)
- Calcifications are often visible in teratomas, making CT scan useful for detection. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 15:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=950)
- Immature teratomas have neuroepithelial components graded 0-3; higher grades are more likely to have yolk sac foci and malignant behavior. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 15:58](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=958)
- Most immature teratomas do not need chemotherapy after resection. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 16:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=980)
- Epithelial ovarian tumors account for about 20% of pediatric ovarian tumors, which is relatively rare compared to adults. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 18:06](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1086)
- Epithelial tumors are mucinous and serous; serous lesions are more commonly bilateral than mucinous. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 18:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1100)
- Borderline epithelial tumors are more common in children and have a better prognosis than invasive ovarian cancer. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 384 · 19:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1180)
- Restrictive transfusion protocols using target hemoglobin of 7 instead of 8, 9, or 10 show no difference in mortality — Alex Gibbons summarizing the discussion [Ep 157 · 0:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=27)
- Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality — Alex Gibbons summarizing the discussion [Ep 157 · 2:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and equally tolerated — Alex Gibbons summarizing the discussion [Ep 157 · 2:27](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- Ultrasound is not a great tool for diagnosis of ovarian torsion — Rae Hanke summarizing the discussion [Ep 157 · 4:11](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=251)
- In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still recover and this helps preserve fertility — Alejandro Cassar summarizing the discussion [Ep 157 · 4:39](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=279)
- For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin — Rae Hanke summarizing the discussion [Ep 157 · 4:59](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7 — Rae Hanke summarizing the discussion [Ep 157 · 4:59](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- Burnout directly impacts patient care and outcomes — Rae Hanke summarizing the discussion [Ep 157 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- Support systems for physician wellness need to be proactive because when burnt out, surgeons are not likely to seek help — Rae Hanke summarizing the discussion [Ep 157 · 6:52](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- Physicians should ask parents if there is a firearm in the home, how it is stored, whether it is locked and loaded, whether ammunition is kept separate, and who has access — The host summarizing the discussion [Ep 157 · 12:19](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=739)
- Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic maintenance fluids — Alex Gibbons summarizing the discussion [Ep 157 · 13:13](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- Continuing isotonic fluids decreases the risk of hyponatremia and had similar mortality otherwise — Alex Gibbons summarizing the discussion [Ep 157 · 13:13](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- In Wilms tumor surgery, failing to take lymph nodes automatically upstages the patient — Alex Gibbons summarizing the discussion [Ep 157 · 17:10](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- Pulmonary metastasis in Wilms tumor does not preclude doing a primary nephrectomy — Alex Gibbons summarizing the discussion [Ep 157 · 17:10](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures otherwise — Rae Hanke summarizing the discussion [Ep 157 · 19:49](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1189)
- In the adult IMPACT trial from Finland at 5 years, 41% of the non-operative appendicitis management group underwent appendectomy — Alex Gibbons summarizing the discussion [Ep 157 · 22:45](https://library.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1365)
- Brongard et al. published a study in the August 2019 issue of JPS examining recurrence rates of benign ovarian tumors in children. — The host summarizing a resource [Ep 144 · 0:00](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093?t=0)
- The study was a retrospective review of 12 pediatric centers in the UK. — The host summarizing a resource [Ep 144 · 0:00](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093?t=0)
- Among mature teratomas, immature teratomas, and serous cystadenomas, the recurrence rate was 8%. — The host summarizing a resource [Ep 144 · 0:00](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093?t=0)
- Brongard et al. conclude that patients with benign ovarian tumors need robust follow-up. — The host summarizing a resource [Ep 144 · 0:00](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093?t=0)
- Brongard et al. recommend every six month ultrasounds for surveillance of benign ovarian tumors in children. — The host summarizing a resource [Ep 144 · 0:00](https://library.globalcastmd.com/watch/ovarian-tumors-in-children-continued-monitoring-is-necessary-2093?t=0)
- Technetium-99 radio tracer is normally used for sentinel node location and can be detected with a special detector. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=91)
- Using radio tracer requires coordination between oncologists and surgeons to purchase machines and coordinate tracer injection with same-day operations. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=91)
- Most new laparoscopic towers have an integrated system with a specific mode that can detect ICG. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 2:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=173)
- ICG is being used as the primary localizer of the sentinel node while still confirming with Technetium. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 2:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=173)
- For liver transplant due to hepatic carcinomas, zero metastasis is required, which often necessitates bilateral lung metastasectomies. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 3:20](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=200)
- ICG is excreted by the biliary tract. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 5:38](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)
- ICG can be used to detect sentinel nodes in many types of cancer using either laparoscopic or open instruments. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 5:38](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)
- Given 24 hours in advance, ICG can be useful to detect hepatocarcinoma lung metastasis because it is primarily excreted through hepatic cells. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 461 · 5:38](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)
- Robotic surgery for neuroblastoma, with experience, has better outcomes, shorter length of stay, and less chance of conversion to open compared to laparoscopic approach. — The host summarizing the discussion [Ep 686 · 27:25](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1645)
- Robotic approach to neuroblastoma is safe and efficient with no increase in morbidity or mortality and no decrease in event-free survival, based on review of over 100 procedures. — The host summarizing the discussion [Ep 686 · 28:47](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=1727)
- Enhanced recovery after surgery (ERAS) protocols for neuroblastoma reduced nasogastric tube use from over 90% to 16%, enabled ambulation 3 days earlier, cut opioid consumption in half, reduced complications, and nearly halved length of stay. — The host summarizing the discussion [Ep 686 · 55:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=3358)
- Cases needed for proficiency in robotic surgery have been cut in half compared to transitioning from open to laparoscopic surgery, and surgical times have also been cut in half while maintaining safety and efficiency. — The host summarizing the discussion [Ep 686 · 38:11](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-gurria-and-meera-kotagal-14018?t=2291)

## Changelog
- Oct 3: Pediatric Oncology published — 692 items
- Oct 3: Collection generated from campaign corpus: 692 items, 120 dossiers, summaries for 4 audience(s)

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