Welcome back. It's the JPS Article Review podcast. We got a big team today. I'm Brittany Levy. I'm I'm Tom Bash, and I'm Rod Gerardo from Cincinnati Children's. And this month, we have 3 articles selected by Doctor Paul Tam, who is an editor for the Journal of Pediatric Surgery and the chair of Pediatric Surgery at the University of Hong Kong. The first is about Wilm's tumor, while the second two review recent article updates and fetal surgery procedures and practice patterns. OK, let's get into it. Our first article coming from London, it's surgical Management, staging and outcomes of W's tumors. With intravascular extension, results of the import study. That's the International Society of Pediatric Oncology Renal Tumor Study. If you want to read more about this, we have the links of the articles in the description below the video for you. Follow the links and read along with us. So we weren't able to discuss with the original authors, but basically their study was looking at children with Wilms tumor, where tumor thrombus extended into the renal vein. And they provided the outcomes for when complete resection of tumor thrombus was successful or it wasn't. Worm's tumor has been a great success story for pediatric surgery and pediatric oncology. That's Dr. Paul Tam, the JPS editor we told you about. So how do you improve a great success? What are we doing as far as surgical management? How is that? Having an effect on the stage of their Wilms tumor and this can probably then be used to figure out where we want to go next with the care for these patients. The obvious thing to do is to identify areas, uh, subgroups of patients who are not, still not doing so well and try to improve in this. Particular area. Is there an outcome benefit? You know, if, if you had all these kids and you removed their, you didn't remove their tumor, you did remove the tumor, and it didn't matter, then why are we trying so hard to remove all the tumor? You know, there's no outcome benefit. But here, if half of them get removed and half of them don't, and there is an outcome difference, then we should still try really hard to remove all of it. Next article. This article is entitled Efficacy of Clinical grade Human P placental Mesenchymal stromal Cells and fetal ovine myelomeningocele repair. And you may remember this topic from a few months back when we discussed the safety of this approach. And we are discussing the efficacy this time with the first author out of UC Davis. My name is Christina Theodoro, and I am a PGI 6 general surgery resident at UC Davis Medical Center in Sacramento. Article discussed the use of mesenchy. stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs that were given the intervention. This study, a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myeloma meningocele repair. We can see that we are one step closer. To first in human clinical trial. So the premise is basically, they had a lamb model that would have a myelo meningocele. They would then do fetal surgery on that test subject. Here's Dr. Theodoro explains their technique and how repairs are performed. We expose the fetal back, we re-expose the spinal cord, we identify the MMC defect, and then we take our extracellular matrix patch that has the placental. Stem cells on it, it is, uh, placed with the cells facing the spinal cord in direct contact, and then the skin is closed and the baby is returned to the uterus to continue gestation until term. And then when it's full term, then the lamb is born, and then they evaluate the motor skills of those lambs. And we found that lambs were paired with these clinical grade subfrontal stem cells have significantly improved motor function compared to lambs that did not receive the stem cells. I mean, that's pretty groundbreaking. This was Doctor Todd Ponsky. He's a pediatric surgeon at Cincinnati Children's Hospital. So, we already have shown a benefit of repairing these in utero, and now to take it a step further, if you impregnate it with mesenchymal stromal cells, you actually have even a larger benefit in the chance of ambulation. I've said this before and I'll say it again. If left to our own devices, we would probably just choose clinical research articles because that's kind of where our head's at. I am not smart enough to select an article like this, and I'm absolutely astounded by it. So, to continue the theme of fetal surgery, the next article is titled Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery, and we were lucky enough to talk to the first author. I'm Natalie Lopian. I'm a clinical lecturer at the Department of Pediatric Surgery at Mott Children's Hospital in the University of Michigan. This study was a survey of non-traineee surgeons within the American Pediatric Surgical Association. And they wanted to gauge some idea of practice patterns in fetal surgery across the country. These were self-identified specialists within the field of fetal surgery, um, and yet only 4% of those people, uh, reported receiving formal training in fetal. Surgery. So shocking to me that only 4% had formal training in this like very specialized, like intricate anatomy and physiology operations. In the survey, a lot of respondents reported that they received their fetal training during their pediatric surgery fellowship training. And yet when the question was posed in a different way, a lot of them responded that they didn't have exposure to fetal surgery during their fellowship training. Fetal surgery is a frontier for pediatric surgery. That's Doctor Paul Tam again. It is thought provoking. I felt that this survey gives us a reality check on how we should develop a front. treatment which up to this stage remains rare and often experimental. So it will be interesting to see as this sort of field expands, um, whether we start to make it be a requirement that there's at least some exposure to fetal surgery during training or if we really do hone in on those fetal centers and make those be the sort of feeding ground. For fetal surgeons. I think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening. We're seeing the value of fetal surgery and fetal intervention, and so it's reasonable to expect that there are different levels of what different hospitals do, but it, I think it's great that there are some centers that don't necessarily do interventions, but are having a dedicated team focusing on fetal care. It's kind of interesting as we talked to a lot of authors over multiple months about subspecialization and how that's working all around the world, it seems like this was kind of a pilot, you know, feel out the waters and see would people be interested in doing that for fetal surgery in America. And really from these results, it seems like no for a variety of reasons. This study was not designed to link subspecialization of fetal surgery to outcomes, and it also wasn't really designed to provide a clear definition of a fetal surgery center. Um, and so certainly that work, I think it Forthcoming from NAFNET, um, and that'll be interesting to see. And here's a couple more questions for the future. Have we defined on paper what constitutes a fetal care center? What services they should provide? Who constitutes the complement of the fetal surgery team? I think finding these answers would be advantageous for patient care, both for moms and for babies. Yeah, very interesting to see, you know, the future of fetal surgery and Sub-specialization within pediatric surgery as a whole, curious what's gonna happen to it. So there you have it, the April Journal of Pediatric Surgery article Review podcast, articles handpicked by Doctor Paul Tam, given to you in this podcast format. If you want to read more about them, scroll down under the media player, click on the links and open them. But until next time, I'm Rod Gerardo. I'm I'm Tom Bash, and I'm Brittany Levy. And remember, knowledge should be free.
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