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Pediatric Surgery International

Published in:

01-12-2023 | Heart Surgery | Original Article

Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned from a 20-year experience

Authors: Benjamin A. Keller, Nicholas C. Saenz

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Purpose

Complex pediatric surgery patients with thoracic tumors invading the mediastinum and infradiaphragmatic tumors extending into the chest are at risk for surgical morbidity and mortality if the patient’s care is not coordinated. We sought to identify areas of focus when managing these patients to improve care.

Methods

A 20-year, retrospective study of pediatric patients with complex surgical pathology was performed. Demographic data, pre-operative characteristics, intraoperative data, complications, and outcomes data were collected. Three index cases were highlighted to provide granularity in patient management.

Results

Twenty-six patients were identified. Common pathology included mediastinal teratomas, foregut duplications, advanced Wilms tumors, hepatoblastoma, and lung masses. All cases were performed in a multidisciplinary fashion. All cases were done with pediatric cardiothoracic surgery and three cases (11.5%) required pediatric otolaryngology. Eight patients (30.7%) required cardiopulmonary bypass. Operative and 30-day mortality was zero.

Conclusions

Management of complex pediatric surgical patients requires a multidisciplinary approach throughout the patient’s hospital course. This multidisciplinary team should meet in advance of a patient’s procedure to create a customized care plan that may include pre-operative optimization. At the time of their procedure, all necessary and emergency equipment should available. This approach improves patient safety and has resulted in excellent outcomes.

Level of evidence

IV.

Aldrink JH, Heaton TE, Dasgupta R, Lautz TB, Malek MM, Abdessalam SF et al (2019) Update on Wilms tumor. J Pediatr Surg 54:390–397. https://doi.org/10.1016/j.jpedsurg.2018.09.005CrossRefPubMed

Rc S, Ml R, Gm H, Tl B, T L-Y, Ne B et al (2001) Intravascular extension of Wilms tumor. Ann Surg. https://doi.org/10.1097/00000658-200107000-00017CrossRef

Perger L, Lee EY, Shamberger RC (2008) Management of children and adolescents with a critical airway due to compression by an anterior mediastinal mass. J Pediatr Surg 43:1990–1997. https://doi.org/10.1016/j.jpedsurg.2008.02.083CrossRefPubMed

Blank RS, de Souza DG (2011) Anesthetic management of patients with an anterior mediastinal mass: continuing professional development. Can J Anaesth 58(853–9):860–867. https://doi.org/10.1007/s12630-011-9539-xCrossRef

Acker SN, Linton J, Tan GM, Garrington TP, Bruny J, Hilden JM et al (2015) A multidisciplinary approach to the management of anterior mediastinal masses in children. J Pediatr Surg 50:875–878. https://doi.org/10.1016/j.jpedsurg.2014.09.054CrossRefPubMed

Krauel L, Albert A, Mora J, Sola T, Cruz O, Mortera C et al (2009) Use of angioembolization as an effective technique for the management of pediatric solid tumors. J Pediatr Surg 44:1848–1855. https://doi.org/10.1016/j.jpedsurg.2009.04.037CrossRefPubMed

Fraser GC, Blair GK, LeBlanc JG, Scott LA (1988) The use of cardiopulmonary bypass and circulatory arrest in the resection of massive tumors. J Pediatr Surg 23:777–778. https://doi.org/10.1016/s0022-3468(88)80426-3CrossRefPubMed

Densmore JC, Lim HJ, Oldham KT, Guice KS (2006) Outcomes and delivery of care in pediatric injury. J Pediatr Surg 41:92–98. https://doi.org/10.1016/j.jpedsurg.2005.10.013CrossRefPubMed

Pearson G, Shann F, Barry P, Vyas J, Thomas D, Powell C et al (1997) Should paediatric intensive care be centralised? Trent versus Vic Lancet 349:1213–1217. https://doi.org/10.1016/S0140-6736(96)12396-5CrossRef

10.

Oldham KT (2014) Optimal resources for children’s surgical care. J Pediatr Surg 49:667–677. https://doi.org/10.1016/j.jpedsurg.2014.02.046CrossRefPubMed

11.

Murphy AJ, Ayers GD, Hilmes MA, Mukherjee K, Wilson KJ, Allen WM et al (2013) Imaging analysis of hepatoblastoma resectability across neoadjuvant chemotherapy. J Pediatr Surg 48:1239–1248. https://doi.org/10.1016/j.jpedsurg.2013.03.019CrossRefPubMedPubMedCentral

12.

Rojas Y, Jaramillo S, Lyons K, Mahmood N, Wu M-F, Liu H et al (2016) The optimal timing of surgical resection in high-risk neuroblastoma. J Pediatr Surg 51:1665–1669. https://doi.org/10.1016/j.jpedsurg.2016.05.021CrossRefPubMed

13.

Galevska A, Mishas K, Lord DJE, Chennapragada M, Alexander A (2020) The utility of angioembolisation prior to surgery in a highly vascular renal tumour. J Pediatr Urol 16:S16. https://doi.org/10.1016/j.jpurol.2020.05.046CrossRef

14.

Anand S, Sandlas G, Sangani G, Roy D, Darji D, Joshi P (2021) Role of interventional radiology in the management of complex pediatric surgical cases. Int J Surg Case Rep. https://doi.org/10.1016/j.ijscr.2021.105886CrossRefPubMedPubMedCentral

15.

Krishna SG, Bryant JF, Tobias JD (2018) Management of the difficult airway in the pediatric patient. J Pediatr Intensive Care 7:115–125. https://doi.org/10.1055/s-0038-1624576CrossRefPubMedPubMedCentral

Title: Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned from a 20-year experience
Authors: Benjamin A. Keller
Nicholas C. Saenz
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Heart Surgery
Nephroblastoma
Care
Heart Surgery
Sternotomy
Pathology
Thoracotomy
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05456-4

At a glance: The STEP trials

Springer Medicine

Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned from a 20-year experience

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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