# Pediatric Surgical Oncology — GCMD Library living collection

Updated: n/a · 27 episodes · 138 cited statements

## Episodes
### Neuroblastoma
- [Neuroblastoma](https://library.globalcastmd.com/article/neuroblastoma-16551) — article · [machine version](https://library.globalcastmd.com/article/neuroblastoma-16551.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)
- [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-14018) — video · 1:07:10 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018.md)
- [Neuroblastoma: Optimal Surgery Timing After Cycle Four of Chemotherapy w/ Dr. Katherine Somers & Dr. Meera Kotagal](https://library.globalcastmd.com/watch/neuroblastoma-optimal-surgery-timing-after-cycle-four-of-chemotherapy-w-dr-kathe-15893) — video · 0:24 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-optimal-surgery-timing-after-cycle-four-of-chemotherapy-w-dr-kathe-15893.md)
- [Neuroblastoma Surgery: How ERAS Protocol Improved Pediatric Outcomes w/ Dr. Meera Kotagal](https://library.globalcastmd.com/watch/neuroblastoma-surgery-how-eras-protocol-improved-pediatric-outcomes-w-dr-meera-k-15966) — video · 0:19 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-surgery-how-eras-protocol-improved-pediatric-outcomes-w-dr-meera-k-15966.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-fo-11866) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866.md)

### Renal Tumors
- [Nephron sparing surgery and surgical management of intravascular extension of Wilms tumor](https://library.globalcastmd.com/article/nephron-sparing-surgery-and-surgical-management-of-intravascular-extension-of-wi-16574) — article · [machine version](https://library.globalcastmd.com/article/nephron-sparing-surgery-and-surgical-management-of-intravascular-extension-of-wi-16574.md)
- [IVC Thrombus in Wilms Tumor: Resection First or Chemo First? w/ Dr. Meera Kotagal](https://library.globalcastmd.com/watch/ivc-thrombus-in-wilms-tumor-resection-first-or-chemo-first-w-dr-meera-kotagal-15895) — video · 0:19 · [machine version](https://library.globalcastmd.com/watch/ivc-thrombus-in-wilms-tumor-resection-first-or-chemo-first-w-dr-meera-kotagal-15895.md)
- [Association of Systemic Inflammatory Markers and Clinical Outcomes Among Children With Wilms Tumor](https://library.globalcastmd.com/article/association-of-systemic-inflammatory-markers-and-clinical-outcomes-among-childre-16588) — article · [machine version](https://library.globalcastmd.com/article/association-of-systemic-inflammatory-markers-and-clinical-outcomes-among-childre-16588.md)
- [Race and Ethnic Group Enrollment and Outcomes for Wilms Tumor: Analysis of the Current Era Children's Oncology Group Study, AREN03B2](https://library.globalcastmd.com/article/race-and-ethnic-group-enrollment-and-outcomes-for-wilms-tumor-analysis-of-the-cu-16590) — article · [machine version](https://library.globalcastmd.com/article/race-and-ethnic-group-enrollment-and-outcomes-for-wilms-tumor-analysis-of-the-cu-16590.md)
- [Current surgical approaches to pediatric renal tumors](https://library.globalcastmd.com/article/current-surgical-approaches-to-pediatric-renal-tumors-16562) — article · [machine version](https://library.globalcastmd.com/article/current-surgical-approaches-to-pediatric-renal-tumors-16562.md)
- [Renal Tumors](https://library.globalcastmd.com/article/renal-tumors-16597) — article · [machine version](https://library.globalcastmd.com/article/renal-tumors-16597.md)
- [Aggressive pediatric renal tumors](https://library.globalcastmd.com/article/aggressive-pediatric-renal-tumors-16608) — article · [machine version](https://library.globalcastmd.com/article/aggressive-pediatric-renal-tumors-16608.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-micha-14740) — video · 1:11:52 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740.md)
- [Pediatric Renal Mass: Lymph Node Sampling & Nodal Positivity Insights](https://library.globalcastmd.com/watch/pediatric-renal-mass-lymph-node-sampling-nodal-positivity-insights-15964) — video · 0:21 · [machine version](https://library.globalcastmd.com/watch/pediatric-renal-mass-lymph-node-sampling-nodal-positivity-insights-15964.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/article/what-every-pediatric-surgeon-should-know-about-common-systemic-therapies-for-the-16555) — article · [machine version](https://library.globalcastmd.com/article/what-every-pediatric-surgeon-should-know-about-common-systemic-therapies-for-the-16555.md)

### Hepatoblastoma
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/article/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-16558) — article · [machine version](https://library.globalcastmd.com/article/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-16558.md)

### Enhanced Recovery (ERAS)
- [Development of an enhanced recovery after surgery program for pediatric solid tumors](https://library.globalcastmd.com/article/development-of-an-enhanced-recovery-after-surgery-program-for-pediatric-solid-tu-16566) — article · [machine version](https://library.globalcastmd.com/article/development-of-an-enhanced-recovery-after-surgery-program-for-pediatric-solid-tu-16566.md)
- [Frontiers | Development of an enhanced recovery after surgery program for pediatric solid tumors](https://library.globalcastmd.com/article/frontiers-development-of-an-enhanced-recovery-after-surgery-program-for-pediatri-16601) — article · [machine version](https://library.globalcastmd.com/article/frontiers-development-of-an-enhanced-recovery-after-surgery-program-for-pediatri-16601.md)
- [Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study.](https://library.globalcastmd.com/article/enhanced-recovery-after-surgery-for-pediatric-abdominal-tumor-resections-a-prosp-16559) — article · [machine version](https://library.globalcastmd.com/article/enhanced-recovery-after-surgery-for-pediatric-abdominal-tumor-resections-a-prosp-16559.md)
- [Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma](https://library.globalcastmd.com/article/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-16554) — article · [machine version](https://library.globalcastmd.com/article/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-16554.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-complicati-11522) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522.md)
- [Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma](https://library.globalcastmd.com/infographic/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11632) — article · [machine version](https://library.globalcastmd.com/infographic/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11632.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-10886) — video · 32:14 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886.md)

### Perioperative Management
- [Early postoperative fever in pediatric oncology patients undergoing solid tumor resection](https://library.globalcastmd.com/infographic/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11245) — article · [machine version](https://library.globalcastmd.com/infographic/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-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-11354) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354.md)

### Breast Masses
- [Management of Pediatric Breast Masses for the Pediatric Surgeon: Expert Consensus Recommendations From the APSA Cancer Committee](https://library.globalcastmd.com/article/management-of-pediatric-breast-masses-for-the-pediatric-surgeon-expert-consensus-16560) — article · [machine version](https://library.globalcastmd.com/article/management-of-pediatric-breast-masses-for-the-pediatric-surgeon-expert-consensus-16560.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=0) Introduction and Neuroblastoma Epidemiology (Ep 2)
- [1:43](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=103) Case 1: Diagnosis and Initial Workup (Ep 2)
- [3:58](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=238) Staging Systems: INSS vs INRG (Ep 2)
- [7:12](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=432) Case 1: Surgical Management (Ep 2)
- [8:32](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=512) Case 2: Mediastinal Neuroblastoma (Ep 2)
- [11:38](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=698) Case 3: Observation Strategy for Infants (Ep 2)
- [13:02](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=782) Summary and Conclusion (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=0) Introduction and ERAS Principles Overview (Ep 24)
- [4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246) ERAS for Neonates (Ep 24)
- [12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748) ERAS for Colorectal and GI Surgery (Ep 24)
- [21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302) ERAS for Thyroid Surgery (Ep 24)
- [27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661) ERAS for Oncology Surgery and Closing Remarks (Ep 24)
- [0:00](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=0) Early Postoperative Fever in Pediatric Oncology: Study Findings and Clinical Implications (Ep 26)
- [0:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=0) ERAS Protocol for Neuroblastoma Resection (Ep 22)
- [0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=0) Introduction and Study Context (Ep 6)
- [0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=13) Study Design and Pancreatic Findings (Ep 6)
- [0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=43) Body Composition Changes and Clinical Implications (Ep 6)
- [2:08](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=128) Case 1 Introduction and Initial Imaging Findings (Ep 3)
- [7:50](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=470) Case 1 Diagnosis and Risk Stratification (Ep 3)
- [15:17](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=917) High-Risk Neuroblastoma Treatment Pathway (Ep 3)
- [24:32](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=1472) Case 1 Post-Chemotherapy Imaging and Robotic Surgery (Ep 3)
- [31:00](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=1860) Robotic Surgery Patient Selection and Technique (Ep 3)
- [40:22](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=2422) Case 2 Introduction and Complex Imaging (Ep 3)
- [45:54](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=2754) Case 2 Diagnosis and Surgical Planning (Ep 3)
- [50:27](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=3027) Case 2 Open Surgical Technique (Ep 3)
- [55:03](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=3303) Enhanced Recovery After Surgery Protocol (Ep 3)
- [61:49](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=3709) Multidisciplinary Coordination and Future Directions (Ep 3)
- [3:39](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=219) Case 1: 15-month-old with large left renal mass — upfront nephrectomy decision (Ep 14)
- [10:40](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=640) Enhanced recovery after surgery (ERAS) protocol for abdominal tumors (Ep 14)
- [20:46](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1246) Case 2: 4-year-old with bilateral Wilms tumor — nephron-sparing approach (Ep 14)
- [36:30](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2190) Surgical technique for bilateral disease: incision choice, fluorescence guidance, leak prevention (Ep 14)
- [44:34](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2674) Case 3: 13-year-old with incidental renal lesion pre-BMT — robotic partial nephrectomy (Ep 14)
- [51:15](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3075) Case 4: 22-year-old with RCC and bone metastases — SDH-deficient subtype (Ep 14)
- [59:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3595) Case 5: 3-year-old with Wilms tumor and IVC thrombus — thrombectomy in continuity (Ep 14)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- A multi-center prospective study evaluated a structured ERAS pathway for children undergoing abdominal neuroblastoma resection — Sophia Schermerhorn (clinical) [Ep 22 · 0:03](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=3)
- The ERAS protocol included 20 evidence-based elements spanning the entire perioperative process — Sophia Schermerhorn (clinical) [Ep 22 · 0:13](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=13)
- ERAS protocol elements included preoperative counseling, hydrate loading, standardized multimodal analgesia, early feeding, and early mobilization — Sophia Schermerhorn (clinical) [Ep 22 · 0:13](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=13)
- Length of stay decreased from about 7 days to 3.7 days — Sophia Schermerhorn (clinical) [Ep 22 · 0:28](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=28)
- Post-operative opioid use dropped by over half — Sophia Schermerhorn (clinical) [Ep 22 · 0:32](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=32)
- Patients resumed regular diets and ambulated about 3 days earlier — Sophia Schermerhorn (clinical) [Ep 22 · 0:32](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=32)
- The proportion of patients experiencing any postoperative complication decreased by over 50% — Sophia Schermerhorn (clinical) [Ep 22 · 0:39](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=39)
- Patients were cleared to resume adjuvant chemotherapy earlier at around 8 days as opposed to 10 days — Sophia Schermerhorn (clinical) [Ep 22 · 0:46](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=46)
- A structured ERAS pathway meaningfully improves recovery even after complex neuroblastoma resections — Sophia Schermerhorn (opinion) [Ep 22 · 0:51](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=51)
- ERAS represents a tangible opportunity to standardize perioperative care for neuroblastoma resection — Sophia Schermerhorn (opinion) [Ep 22 · 0:51](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complicati-11522?t=51)
- Radiation improves survival in high-risk neuroblastoma — Sophia Schermerhorn (clinical) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=0)
- This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy — Sophia Schermerhorn (clinical) [Ep 6 · 0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-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 6 · 0:19](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=19)
- There was a significant decrease in pancreatic volume after radiation — Sophia Schermerhorn (clinical) [Ep 6 · 0:27](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=27)
- Very few patients developed clinically apparent pancreatic insufficiency — Sophia Schermerhorn (clinical) [Ep 6 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=31)
- Pancreatic insufficiency wasn't systematically screened for in this study — Sophia Schermerhorn (clinical) [Ep 6 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-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 6 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=31)
- Pancreatic dysfunction could be an under-recognized late effect — Sophia Schermerhorn (opinion) [Ep 6 · 0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=43)
- Patients had a significant drop in weight percentile with smaller decreases in fat and muscle — Sophia Schermerhorn (clinical) [Ep 6 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=48)
- Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone — Sophia Schermerhorn (opinion) [Ep 6 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=48)
- These findings highlight the importance of nutritional screening during cancer treatments — Sophia Schermerhorn (opinion) [Ep 6 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-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 6 · 1:03](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-fo-11866?t=63)
- 42% of 220 oncology patients had a fever in the 48 hours following tumor resection — Sophia Schermerhorn (epidemiological) [Ep 26 · 0:12](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=12)
- Only 2 of the febrile patients (2.8%) had an actual infection — Sophia Schermerhorn (epidemiological) [Ep 26 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=19)
- The two patients with actual infection were hemodynamically unstable with positive blood cultures — Sophia Schermerhorn (clinical) [Ep 26 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=19)
- Most fevers triggered a workup that costs on average about $500 per patient — Sophia Schermerhorn (epidemiological) [Ep 26 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=30)
- About a third of patients received empiric antibiotics that they did not need — Sophia Schermerhorn (epidemiological) [Ep 26 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=30)
- In the 48 hours following tumor resection, fever alone may not be a reason to panic — Sophia Schermerhorn (opinion) [Ep 26 · 0:40](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-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 26 · 0:45](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-11354?t=45)
- Neuroblastoma makes up about 8 to 10% of all pediatric cancers and about 15% of cancer-related deaths. — Meera Kotagal (epidemiological) [Ep 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 12:48](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=768)
- 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 24 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=36)
- Successful ERAS implementation requires significant system design, education, and reinforcement of that education. — Ben Hamm (clinical) [Ep 24 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 0:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=36)
- The World Journal of Surgery published consensus guidelines around 2020 for ERAS in neonatal intestinal surgery. — Cassie Hoffman (guideline) [Ep 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Broader ERAS guidelines were developed for essentially all neonatal surgery following the initial intestinal surgery guidelines. — Cassie Hoffman (guideline) [Ep 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Most institutions now run preservative infusions in the NICU, reducing hesitancy to use preservatives in regional blocks. — Cassie Hoffman (clinical) [Ep 24 · 4:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Neonatology colleagues do not know what ERAS stands for or what enhanced recovery means, making implementation challenging. (opinion) [Ep 24 · 11:02](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=662)
- The concepts that underpin enhanced recovery protocols are challenging in a complex environment like a NICU. (opinion) [Ep 24 · 11:02](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 12:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 19:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 19:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1188)
- Surgical volume impacts outcomes for thyroidectomy, as shown in the literature. (epidemiological) [Ep 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- At the speaker's institution, one ENT surgeon and the speaker collaborate on thyroid cases as a subspecialist program. (clinical) [Ep 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 21:42](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- The oncology ERAS study showed significantly improved pain scores, particularly in the neuroblastoma subset. (epidemiological) [Ep 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- ERAS is feasible for large abdominal operations including large retroperitoneal dissections and big tumors. (clinical) [Ep 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- Using regional anesthesia and minimizing opioids is key to successful ERAS in oncology cases. (clinical) [Ep 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-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 24 · 27:41](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- 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 3 · 12:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 13:54](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 21:08](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 16:36](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 28:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 29:33](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 30:17](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 31:54](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 8:46](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=526)
- On T2-weighted MRI, neuroblastoma that has responded well to chemotherapy appears extremely dark due to calcification. (clinical) [Ep 3 · 24:43](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=1483)
- Diffusion-weighted imaging (DWI) with high B-value makes retroperitoneal adenopathy from neuroblastoma very obvious and easy to identify. (clinical) [Ep 3 · 6:59](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 50:50](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 52:00](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=3120)
- Post-operative ileus was the most common complication in neuroblastoma surgery prior to implementation of ERAS protocols. (clinical) [Ep 3 · 56:55](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 58:30](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 59:09](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 34:26](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 60:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 46:52](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 48:20](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 59:56](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 62:55](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 54:41](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 54:23](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 52:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 65:29](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 66:13](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 35:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 63:36](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 63:24](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=3804)
- Tumors larger than 12 centimeters have an increased risk of intraoperative spill. — Meera Kotagal (clinical) [Ep 14 · 8:27](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=507)
- Biopsy can upstage the patient and change treatment down the line, including radiation that may otherwise not have been necessary. — Lindsay Haacker (clinical) [Ep 14 · 7:31](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 10:18](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=618)
- The lymph node stations important for Wilms tumor include left renal hilar, periaortic, and aortic cable window. — Meera Kotagal (clinical) [Ep 14 · 9:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Haacker (guideline) [Ep 14 · 16:12](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=972)
- Patients with one copy number gain (1q gain) are considered to have adverse biology on AREN 2231 and require chemotherapy. — Lindsay Haacker (guideline) [Ep 14 · 17:50](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 12:22](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=742)
- Length of stay with ERAS protocol is 3 to 4 days shorter than historical practice. — Meera Kotagal (epidemiological) [Ep 14 · 13:20](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 13:40](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=820)
- Standard neoadjuvant chemotherapy for bilateral renal tumors is vincristine, dactinomycin, and doxorubicin (3-drug induction). — Lindsay Haacker (guideline) [Ep 14 · 26:19](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Haacker (clinical) [Ep 14 · 27:21](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1641)
- In bilateral Wilms tumor, each side gets its own local stage, which impacts long-term management. — Meera Kotagal (clinical) [Ep 14 · 31:39](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Daugherty (clinical) [Ep 14 · 29:50](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1790)
- Partial nephrectomy for Wilms tumor often requires entering the collecting system because tumors sit deeper than typical RCC. — Michael Daugherty (clinical) [Ep 14 · 30:23](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1823)
- Cold (sharp) dissection without cautery around the renal pelvis and calyces reduces post-operative urine leak risk. — Michael Daugherty (clinical) [Ep 14 · 36:48](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2208)
- Partial nephrectomy is performed without vascular clamping; kidney compression provides adequate hemostasis and avoids ischemia. — Michael Daugherty (clinical) [Ep 14 · 37:25](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2245)
- Foley catheter is left in place for 3 to 4 days post-partial nephrectomy to allow mucosal healing. — Michael Daugherty (clinical) [Ep 14 · 39:22](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2362)
- Drains are not routinely used after partial nephrectomy; active suction can induce urine leak. — Michael Daugherty (clinical) [Ep 14 · 39:07](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Haacker (clinical) [Ep 14 · 32:48](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Haacker (guideline) [Ep 14 · 41:29](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2489)
- Renal transplant candidacy requires a two-year cancer-free interval. — Lindsay Haacker (guideline) [Ep 14 · 43:52](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 19:16](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 56:01](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3361)
- In TFE3 RCC, node-positive patients who undergo resection may still be considered cured or have active disease treated. — Michael Daugherty (clinical) [Ep 14 · 56:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3415)
- RCCs are resistant to conventional chemotherapy; backbone of therapy is immune checkpoint inhibition, often combined with VEGF TKI. — Lindsay Haacker (clinical) [Ep 14 · 58:45](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3525)
- Pembrolizumab and axitinib (based on Keynote 426 study) showed superiority over sunitinib for RCC. — Lindsay Haacker (epidemiological) [Ep 14 · 58:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 55:20](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 Haacker (guideline) [Ep 14 · 68:57](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 66:58](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 67:14](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4034)
- Tumor thrombus is more adherent to the vessel wall after chemotherapy than in upfront resection. — Meera Kotagal (clinical) [Ep 14 · 70:01](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-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 14 · 70:55](https://library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4255)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 12:21](https://library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=741)
- 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 3 · 27:25](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 28:47](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 55:58](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-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 3 · 38:11](https://library.globalcastmd.com/watch/clinical-research-update-neuroblastoma-with-drs-katherine-somers-cara-morin-juan-14018?t=2291)

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