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Madadi-Sanjani O, Kuebler JF, Brendel J, Costanzo S, Granström AL, Aydin E, Loukogeorgakis S, Lacher M, Wiesner S, Domenghino A, Clavien PA, Mutanen A, Eaton S, Ure BM. Validation of the Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery: A Collaborative ERNICA Project. J Pediatr Surg 2024; 59:1672-1679. [PMID: 38582705 DOI: 10.1016/j.jpedsurg.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The Clavien-Madadi classification is a novel instrument for the assessment and grading of unexpected events in pediatric surgery, based on the Clavien-Dindo classification. The system has been adjusted to better fit the pediatric population in a prospective single-center study. There is a need now to validate the Clavien-Madadi classification within an international expert network. METHODS A pediatric surgical working group created 19 case scenarios with unexpected events in a multi-staged process. Those were circulated within the European Reference Network of Inherited and Congenital Anomalies (ERNICA) and surgeons were instructed to rate the scenarios according to the Clavien-Madadi vs. Clavien-Dindo classification. RESULTS 59 surgeons from 12 European countries completed the questionnaire. Based on ratings of the case scenarios, the Clavien-Madadi classification showed significantly superior agreement rates of the respondents (85.9% vs 76.2%; p < 0.05) and was less frequently considered inaccurate for rating the pediatric population compared to Clavien-Dindo (2.1% vs 11.1%; p = 0.05). Fleiss' kappa analysis showed slightly higher strength of agreement using the Clavien-Madadi classification (0.74 vs 0.69). Additionally, intraclass correlation coefficient was slightly higher for the Clavien-Madadi compared to the Clavien-Dindo classification (ICCjust 0.93 vs 0.89; ICCunjust 0.93 vs 0.89). More pediatric surgeons preferred the Clavien-Madadi classification for the case scenarios (43.0% vs 11.8%; p = 0.002) and advantages of the Clavien-Madadi were confirmed by 81.4% of the surgeons. CONCLUSION The Clavien-Madadi classification is an accurate and reliable instrument for the grading of unexpected events in pediatric surgery. We therefore recommend its application in clinical and academic pediatric surgical practice. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Omid Madadi-Sanjani
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands.
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
| | - Sara Costanzo
- Pediatric Surgery Department, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Anna L Granström
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Division of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Emrah Aydin
- Department of Pediatric Surgery, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Stavros Loukogeorgakis
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Soeren Wiesner
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Anja Domenghino
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Annika Mutanen
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Simon Eaton
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
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Knatten CK, Dahlseng MO, Perminow G, Skari H, Austrheim AI, Nyenget T, Aabakken L, Schistad O, Stensrud KJ, Bjørnland K. Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement. J Pediatr Surg 2024; 59:1879-1885. [PMID: 38604831 DOI: 10.1016/j.jpedsurg.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Push-PEG (percutaneous endoscopic gastrostomy) with T-fastener fixation (PEG-T) allows one-step insertion of a balloon tube or button, and avoids contamination of the stoma by oral bacteria. However, PEG-T is a technically more demanding procedure with a significant learning curve. The aim of the present study was to compare outcomes after PEG-T and pull-PEG in a setting where both procedures were well established. MATERIALS AND METHODS The study is a prospective cohort study including all patients between 0 and 18 year undergoing PEG-T and pull-PEG between 2017 and 2020 at a combined local and tertiary referral center. Complications and parent reported outcomes were recorded during hospital stay, after 14 days and 3 months postoperatively. RESULTS 82 (93%) of eligible PEG-T and 37 (86%) pull-PEG patients were included. The groups were not significantly different with regard to age or weight. Malignant disorders and heart conditions were more frequent in the pull-PEG group, whilst neurodevelopmental disorders were more frequent in the PEG-T group (p < 0.001). 54% in both groups had a complication within 2 weeks. Late complications (between 2 weeks and 3 months postoperatively) occurred in 63% PEG-T vs 62% pull-PEG patients (p = 0.896). More parents in the pull-PEG group (49%) reported that the gastrostomy tube restricted their child's activity, compared to PEG-T (24%) (p = 0.01). At 3 months follow-up, more pull-PEG patients (43%) reported discomfort from the gastrostomy compared to PEG-T (21%) (p = 0.03). CONCLUSION Overall complication rates were approximately similar, but pull-PEG was associated with more discomfort and restriction of activity. LEVELS OF EVIDENCE Treatment study level II.
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Affiliation(s)
| | | | - Gøri Perminow
- Department of Pediatrics, Oslo University Hospital, Norway
| | - Hans Skari
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | | | - Tove Nyenget
- Department of Pediatrics, Oslo University Hospital, Norway
| | - Lars Aabakken
- Department of Gastroenterology, Oslo University Hospital, Norway; University of Oslo, Norway
| | - Ole Schistad
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | - Kjetil Juul Stensrud
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | - Kristin Bjørnland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; University of Oslo, Norway
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Langreen S, Ludwikowski B, Dingemann J, Ure BM, Hofmann AD, Kuebler JF. Laparoscopic pyeloplasty in neonates and infants is safe and efficient. Front Pediatr 2024; 12:1397614. [PMID: 39132308 PMCID: PMC11310035 DOI: 10.3389/fped.2024.1397614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Dismembered laparoscopic pyeloplasty (LP) is a well-accepted treatment modality for ureteropelvic junction obstruction (UPJO) in children. However, its efficacy and safety in infants, particularly neonates, remain uncertain. To address this significant knowledge gap, we aimed to compare outcomes between a cohort of neonates and infants undergoing LP vs. open pyeloplasty (OP) at less than 6 months and 6 weeks of age. Material and methods We conducted a retrospective analysis of data from patients who underwent primary pyeloplasty at our institution between 2000 and 2022. Only patients aged 6 months or less at the time of surgery were included, excluding redo-procedures or conversions. Ethical approval was obtained, and data were assessed for redo-pyeloplasty and postoperative complications, classified according to the Clavien-Madadi classification. A standard postoperative assessment was performed 6 weeks postoperatively. This included an isotope scan and a routine ultrasound up to the year 2020. Results A total of 91 eligible patients were identified, of which 49 underwent LP and 42 underwent OP. Patients receiving LP had a median age of 11.4 (1-25.4) weeks, compared to 13.8 (0.5-25.9) weeks for those receiving OP (p > 0.31). Both groups in our main cohort had an age range of 0-6 months at the time of surgery. Nineteen patients were younger than 6 weeks at the time of surgery. The mean operating time was longer for LP (161 ± 43 min) than that for OP (109 ± 32 min, p < 0.001). However, the mean operating time was not longer in the patient group receiving LP at ≤6 weeks (145 ± 21.6) compared to that in our main cohort receiving LP. There was no significant difference in the length of stay between the groups. Four patients after LP required emergency nephrostomy compared to one patient after OP. The rate of revision pyeloplasty in our main cohort aged 0-6 months at surgery was 8% in the patient group receiving LP and 14% in the patient group receiving OP (not significant). Three revisions after LP were due to persistent UPJO, and one was due to stent migration. Only one patient requiring revision pyeloplasty was less than 6 weeks old. Conclusion To our knowledge, this is one of the largest collectives of laparoscopic pyeloplasty performed in infants, and it is the youngest cohort published to date. Based on our experience, LP in neonates and infants under 6 months appears to be as effective as open surgery.
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Affiliation(s)
- S. Langreen
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - B. Ludwikowski
- Department of Pediatric Surgery, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - J. Dingemann
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - B. M. Ure
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - A. D. Hofmann
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - J. F. Kuebler
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
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Pakarinen MP, Luoto T, Nuutinen S, Raitio A, Tahkola E, Koivusalo A. Finnish Pediatric Surgery Hub - From Centralization to Collective Learning and Sharing of Expertise. J Pediatr Surg 2024:161642. [PMID: 39142954 DOI: 10.1016/j.jpedsurg.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/26/2024] [Accepted: 07/20/2024] [Indexed: 08/16/2024]
Abstract
AIM OF THE STUDY Continuous surgical developments, growing awareness of patient representatives and limited health-care resources are pushing for innovative approaches to ensure equal high-quality pediatric surgical care. We aimed to describe early experiences and assess surgical safety of a novel nationwide pediatric surgery collaborative initiative. METHODS In 2021, general pediatric surgeons representing all five independent university hospitals performing neonatal surgery in Finland initiated national collaboration, the Finnish pediatric surgery hub (FPSH), for sharing of surgical expertise and collective learning. For each case addressed by FPSH, place of care and surgical team were decided individually, and when deemed necessary, operations were performed in cooperation. Operations performed during 2021-2023 and associated early (<30 days) postoperative complications were analyzed according to Clavien-Madadi classification. RESULTS Of the total 40 surgeries managed co-operatively by FPSH, 30 (75%) took place in local university hospitals and 10 in Helsinki University Hospital. There were 34 (85%) elective and 6 urgent cases, which were operated within median 1 (range, 1-3) days. Most frequent underlying diagnoses included anorectal malformations, esophageal atresia and Hirschsprung disease. Overall, 12 (30%) had any early postoperative complications, all Clavien-Madadi grade IIIB or lower, and five patients (13%) were reoperated. Rate or grade of complications was not associated with place of care. In addition to regular virtual case meetings, national care protocols and research projects were introduced. CONCLUSION These preliminary findings suggest that our national collaborative initiative, FPSH, not only provided practical and safe framework for sharing of surgical expertise but also for collective learning. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mikko P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Topi Luoto
- Department of Pediatric Surgery, Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Susanna Nuutinen
- Department of Pediatric Surgery, Oulu University Hospital, Oulu, Finland
| | - Arimatias Raitio
- Department of Pediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Esko Tahkola
- Department of Pediatric Surgery, Kuopio University Hospital, Finland and University of Helsinki, Finland
| | - Antti Koivusalo
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Teunissen NM, Daniels H, Schnater JM, de Blaauw I, Wijnen RMH. Prevalence and early surgical outcome of congenital diaphragmatic hernia in the Netherlands: a population-based cohort study from the European Pediatric Surgical Audit. Arch Dis Child Fetal Neonatal Ed 2024; 109:412-420. [PMID: 38195217 DOI: 10.1136/archdischild-2023-326311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a rare birth defect with substantial mortality. This study aims to generate a population-based overview of CDH care and outcomes in the Netherlands. Moreover, it assesses interhospital variations between the two Dutch CDH expert centres. METHODS This study uses data from the Dutch branch of the European Pediatric Surgical Audit, a prospective clinical audit for congenital anomalies. Data of all patients with CDH treated between 2014 and 2021 were included for epidemiological analysis. For comparative analyses, patients presenting after the neonatal period or not treated in the two CDH expert centres were excluded. Identified interhospital variations were assessed using regression analysis. RESULTS In the study period, 283 children with CDH were born, resulting in a national prevalence rate of 2.06/10 000 live births. The patient population, treatment and outcomes at 1 year were comparable between the hospitals, except for length of hospital stay. Regression analysis identified the treating hospital as the strongest significant predictor thereof. Other factors associated with longer length of stay include the presence of other malformations, intrathoracic liver position on prenatal ultrasound, extracorporeal membrane oxygenation treatment, patch repair, complicated postoperative course and discharge to home rather than to another care facility. CONCLUSION Outcomes of CDH care throughout the Netherlands are comparable. However, the length of stay differed between the two hospitals, also when adjusting for other covariates. Further qualitative analysis to explain this interhospital variation is indicated. Our findings underscore the potential of clinical auditing as a quality measurement tool in rare conditions.
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Affiliation(s)
- Nadine Maria Teunissen
- Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Horst Daniels
- Division of Paediatric Surgery, Department of Surgery, Radboudumc, Nijmegen, Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ivo de Blaauw
- Division of Paediatric Surgery, Department of Surgery, Radboudumc, Nijmegen, Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, Netherlands
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Ganji N, Kalish B, Offringa M, Li B, Anderson J, Baruchel S, Blakely M, De Coppi P, Eaton S, Gauda E, Hall N, Heath A, Livingston MH, McNair C, Mitchell R, Patel K, Pechlivanoglou P, Pleasants-Terashita H, Pryor E, Radisic M, Shah PS, Thébaud B, Wang K, Zani A, Pierro A. Translating regenerative medicine therapies in neonatal necrotizing enterocolitis. Pediatr Res 2024:10.1038/s41390-024-03236-x. [PMID: 38806665 DOI: 10.1038/s41390-024-03236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Niloofar Ganji
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - Brian Kalish
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Offringa
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Bo Li
- Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - James Anderson
- Departments of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sylvain Baruchel
- Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - Martin Blakely
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Estelle Gauda
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Statistical Science, University College London, London, UK
| | | | - Carol McNair
- Neonatal Intensive Care Unit, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Ketan Patel
- Micregen Ltd, Thames Valley Science Park, Reading, UK
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Hazel Pleasants-Terashita
- Neonatal Intensive Care Unit, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Erin Pryor
- NEC Society, 140 B St. Ste 5 #128, Davis, CA, USA
| | - Milica Radisic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bernard Thébaud
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO) and CHEO Research Institute, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kasper Wang
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Agostino Pierro
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Translational Medicine, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada.
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Department of Physiology, University of Toronto, Toronto, ON, Canada.
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7
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Kuhlen M, Kunstreich M, Pape UF, Seitz G, Lessel L, Vokuhl C, Frühwald MC, Vorwerk P, Redlich A. Lymph node metastases are more frequent in paediatric appendiceal NET ≥1.5 cm but without impact on outcome - Data from the German MET studies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108051. [PMID: 38430702 DOI: 10.1016/j.ejso.2024.108051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Paediatric appendiceal neuroendocrine tumours (appNET) are very rare tumours, mostly detected incidentally by histopathological evaluation after appendectomy. Treatment recommendations are based on adult data considering high-risk NET as defined by European Neuroendocrine Tumour Society (ENETS) guidelines for completion right-sided hemicolectomy (RHC). Recent data suggest that less aggressive therapy may be justified. PROCEDURE Analysis of children and adolescents with appNET prospectively registered with the German Malignant Endocrine Tumour (MET) studies between 1997 and 2022. RESULTS By December 2022, 662 patients (64.7% females, 35.3% male) had been reported. Median age was 13.3 years [4.5-17.9], median duration of follow-up 2.2 years [0-10.9]. No distant metastases were reported. Tumour size was <1 cm in 63.5%, 1-2 cm in 33.2%, and >2 cm in 3.2% of patients. WHO grade 1 and 2 tumours were diagnosed in 76.9% and 23.1% of patients, respectively. Lymphovascular invasion and lymph node metastases were associated with tumour size ≥1.5 cm. 27.0% of patients presented with high-risk NET according to ENETS criteria. Of those, only 55.9% underwent secondary oncological right hemicolectomy. Neither distant metastases, nor recurrences or disease-related deaths occurred in patients with appendectomy only as well as in patients with completion RHC. Overall and event-free survival were both 100%. CONCLUSIONS Internationally harmonized consensus recommendations on treatment of children and adolescents with appendiceal NET are urgently needed to avoid completion RHC in high-risk patients.
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Affiliation(s)
- Michaela Kuhlen
- Paediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
| | - Marina Kunstreich
- Paediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Department of Paediatrics, Paediatric Haematology/Oncology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ulrich-Frank Pape
- Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumorzentrum, Hamburg, Germany
| | - Guido Seitz
- Department of Paediatric Surgery and Urology, Center for Paediatric Surgery of the University Hospital Giessen-Marburg, Marburg, Germany; Department of Paediatric Surgery, Center for Paediatric Surgery of the University Hospital Giessen-Marburg, Giessen, Germany
| | - Lienhard Lessel
- Department of Paediatrics, Paediatric Haematology/Oncology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christian Vokuhl
- Department of Pathology, Section of Paediatric Pathology, Bonn, Germany
| | - Michael C Frühwald
- Paediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Peter Vorwerk
- Department of Paediatrics, Paediatric Haematology/Oncology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Antje Redlich
- Department of Paediatrics, Paediatric Haematology/Oncology, Otto-von-Guericke-University, Magdeburg, Germany
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Madadi-Sanjani O, Ure BM. Benchmarks for Pediatric Surgical Registries: Recommendations for the Assessment and Grading of Complications. Eur J Pediatr Surg 2024; 34:182-188. [PMID: 37871645 DOI: 10.1055/a-2196-1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Procedure-related registries in general surgical practice offer a platform for prospective trials, the pooling of data, and detailed outcome analysis. Recommendations by the Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) collaboration and Outcome4Medicine have further improved the uniform reporting of complications and adverse events.In the pediatric surgical network, disease-specific registries for rare and inherited congenital anomalies are gaining importance, fostering international collaborations on studies of low-incidence diseases. However, to date, reporting of complications in the pediatric surgical registries has been inconsistent. Therefore, the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) recently endorsed the validation of the first severity grading system for children. The planned reform of the European Paediatric Surgical Audit (EPSA) registry, which includes the implementation of the Clavien-Madadi classification, represents a further effort to establish uniform outcome reporting.This article provides an overview of experiences with surgical registries and complication reporting, along with the potential application of this knowledge to future pediatric surgical practice.
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Affiliation(s)
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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9
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Eaton S. I Walk the Line: Between Basic Science and Paediatric Surgery. J Pediatr Surg 2024; 59:172-176. [PMID: 37940464 DOI: 10.1016/j.jpedsurg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
The role of a basic scientist working with paediatric surgeons is not an obvious one. However, there are several levels at which science can contribute to the speciality, and also ways that scientists can learn useful lessons from paediatric surgery. As most conditions treated by paediatric surgeons have low case numbers, we need to find ways of defining optimal treatment and developing novel therapies within a challenging number of patients.
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Affiliation(s)
- Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, UK.
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