From
Dr. Roshni Dasgupta
Evolution of pediatric surgical oncology as a subspecialty
With Dr. Roshni Dasgupta · hosted by Dr. John Vassallo & Dr. Tim Pollock
Chapter 1 of 6
Subspecialty emergence
Introduction and emergence of pediatric surgical oncology as a subspecialty
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
2025 Pediatric Surgery Update Course - Updates in Oncology
21 min · Published Aug 2025
Podcast
Wilms Tumor: Audio Chapter
64 min · Published Jun 2017
Video
Hepatoblastoma with Dr. Greg Tiao
CCHMC Pediatric Surgery · Published Mar 2022
Video
Update Course 2023 - Updates in the use of ICG
19 min · Published Aug 2023
Video
Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma
1 min · Published Jan 2026
Podcast
Wilms Tumor
Todd Ponsky · 64 min · Published Oct 2026
Video
Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater
66 min · Published Sep 2026
Video
Ovarian Torsion with Dr. Dasgupta
Published Sep 2022
Video
Ovarian Tumors with Dr. Roshni Dasgupta
CCHMC Pediatric Surgery · Published Sep 2022
Video
Ovarian Cysts with Dr. Roshni Dasgupta
Published Aug 2022
Podcast
Thoracoscopic lung nodule resection techniques with wire localization and ICG imaging
Roshni Dasgupta · 10 min · Published Jul 2022
Podcast
Hybrid OR workflow for pediatric lung nodule localization and resection
Roshni Dasgupta · 17 min · Published Jun 2022
What the experts said
Changes in molecular and genetic profiling of tumors has caused a paradigm change in surgical oncology, particularly in pediatrics where biological considerations affect treatment pathways and prognostication.
Wilms tumors generally present in children under the age of 4, usually with an asymptomatic palpable mass often found during a well-child check.
Imaging paradigm for suspected Wilms tumor starts with ultrasound, followed by CT or MRI depending on tumor appearance and genetic predispositions.
In Wilms tumor, metastatic disease alone is not a contraindication to primary surgical resection if the local stage appears resectable, unlike in other pediatric cancers.
Loss of heterozygosity at 1P and 16Q are poor prognostic factors in Wilms tumor, occurring in about 5% of patients and requiring more intensive therapy.
Gain of 1Q occurs in about 30% of Wilms tumor patients and requires more intensive therapy.
Patients under age 2 with Wilms tumors under 550g can be treated with surgery alone without chemotherapy, avoiding late effects.
In North America, Wilms tumor patients are typically operated on upfront, whereas in Europe the protocols favor giving chemotherapy first to shrink tumors.
In North America, neoadjuvant chemotherapy for Wilms tumor is given to patients with very high risk of rupture or extensive caval metastasis.
Genetic data (loss of heterozygosity at 1P and 16Q) has led to increased therapy intensity but does not dictate surgical management, which is primarily based on anatomical factors.
Patients with Wilms tumor have over 90% survival when taking all comers, so the focus has shifted to therapy reduction and preventing late effects.
About two-thirds of liver tumors in children are malignant.
Infantile hemangiomas in children are different from adult liver hemangiomas (which are venous malformations); infantile hemangiomas proliferate and then involute.
Hepatoblastoma is the most common liver tumor in children, usually presenting under age 3.
Children with hepatoblastoma generally do not have underlying liver disease, unlike adults with hepatocellular carcinoma who often have cirrhosis or chronic liver conditions.
Most hepatoblastoma patients have elevated AFP, and there is characteristic diagnostic imaging for hepatoblastoma.
Hepatoblastoma is staged using the PRETEXT staging system, done prior to any treatment, with annotation factors for vascular involvement, hepatic vein involvement, metastatic disease, and multifocality.
PRETEXT 1 and 2 hepatoblastoma patients are treated upfront with surgical resection; these have a nice margin around hepatic veins and are easily resectable.
PRETEXT 3 and 4 hepatoblastoma patients with multifocal disease are treated with chemotherapy upfront, then surgical resection after 2-3 cycles.
Hepatoblastoma patients with multifocal disease who have minimal response after two cycles of chemotherapy are referred to transplant centers, as transplant is a viable option.
Pediatric tumors are rare—the most common types have between 700-800 cases per year, orders of magnitude less than adult cancers like breast or lung cancer.
International data sharing through cooperative groups is integral to studying pediatric tumors, understanding outcomes, and developing common treatment paradigms across surgery, chemotherapy, and radiation.
The Pediatric Hepatic International Tumor Trial (PHITT) includes European and Japanese colleagues, does central radiological reviews, and has improved patient care while generating new research questions.
Minimally invasive surgery in pediatric oncology has been primarily diagnostic, including thoracoscopic biopsies of lung nodules and is frequently used for ovarian tumors.
A new study is planned comparing thoracoscopy versus thoracotomy in patients with osteosarcoma.
Robot use in pediatric oncology is limited by patient body size; in patients weighing 4-5 kg, robots are difficult to use due to port size constraints.
Robots have been used for retroperitoneal nodal dissections in patients with paratesticular rhabdomyosarcoma.
The same oncological operation must be achievable minimally invasively as can be done open; if not, the procedure should not be done minimally invasively.
Pediatric cancer now has about 85% overall survival, resulting in many survivors whose biggest concern is ongoing fertility.
Fertility consults should be offered to all patients undergoing any chemotherapy, with risk assessment based on therapy type.
Cyclophosphamide dose greater than 4 g/m² poses significant risk of premature ovarian insufficiency and azoospermia.
Testicular exposure to more than 4 Gy of radiation can cause permanent azoospermia, and this dose can be reached just with scatter radiation.
In females, 10-15 Gy of radiation (achievable with scatter alone) can cause significant ovarian damage.
In prepubertal boys, fertility preservation requires testicular biopsy and tissue preservation, but maturation of that testicular tissue has not yet been achieved.
Prepubertal ovarian preservation is important but maturation has not yet been realized.
In postpubertal patients, ovarian stimulation (requiring about 2 weeks of hormonal stimulation) and sperm banking are used, similar to adults.
In pediatric radiology, ultrasound and MRI are used much more commonly than CT scans to minimize radiation exposure, even for conditions like appendicitis.
Pediatric cancer patients are followed with plain radiographs or MRIs depending on disease process, and sometimes ultrasound is amenable for surveillance.
Pediatric cancer remains one of the top causes of death in children despite advances over the last several decades.
Specific focus on pediatric oncology has only been established over the last 50 years.
Surgical oncology has become a clear subspecialty within pediatric surgery.
Renal tumors are the second most common abdominal tumor in the pediatric population, behind only neuroblastoma.