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Christison-Lagay ER, Brown EG, Bruny J, Funaro M, Glick RD, Dasgupta R, Grant CN, Engwall-Gill AJ, Lautz TB, Rothstein D, Walther A, Ehrlich PF, Aldrink JH, Rodeberg D, Baertschiger RM. Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee. J Pediatr Surg 2024:S0022-3468(24)00201-X. [PMID: 38637207 DOI: 10.1016/j.jpedsurg.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Tunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management. OBJECTIVES To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)? METHODS Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases. STUDY SELECTION Independently performed by 2 reviewers, disagreements resolved by a third reviewer. DATA EXTRACTION Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology. RESULTS Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions. CONCLUSIONS Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care. LEVEL OF EVIDENCE III. This study was registered as PROSPERO 2019 CRD42019124077.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, CA, USA
| | - Jennifer Bruny
- Alaska Pediatric Surgery, Alaska Regional Hospital, Anchorage, AK, USA
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Richard D Glick
- Department of Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Roshni Dasgupta
- Department of Surgery, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christa N Grant
- Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Timothy B Lautz
- Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago IL, USA
| | - David Rothstein
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Ashley Walther
- Department of Surgery, Children's Hospital of Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Peter F Ehrlich
- Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Rodeberg
- Department of Surgery, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, USA
| | - Reto M Baertschiger
- Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Division of Pediatirc Surgery, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebaon, NH, USA.
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Kazmi K, Krueger C, Wong W, Baertschiger RM, Hui C, Nagy A, Navarro OM, Razik F, Schwartz KL, Boggild AK, Morris SK. A Canadian children's hospital's experience with cystic echinococcosis over 30 years: A case series. J Assoc Med Microbiol Infect Dis Can 2024; 8:262-271. [PMID: 38250618 PMCID: PMC10797762 DOI: 10.3138/jammi-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 01/23/2024]
Abstract
Background Cystic echinococcosis (CE) or hydatid disease caused by the cestode Echinococcus granulosus sensu lato is an uncommon infection in Canada especially among children. There are limited reports describing the clinical presentation and management in Canadian children. Methods The medical records of all children diagnosed with CE at a quaternary paediatric centre in Ontario between January 1988 and August 2021 were retrospectively reviewed. The clinical course, management, and outcomes of each case were summarized. Results We report two paediatric cases of cystic echinococcosis (CE) in detail and review four additional cases seen at our institution over 33.5 years. The first case was a previously healthy 12-year-old boy with pulmonary CE resulting in unilateral lung collapse and mediastinal shift, who was presumedly infected while living in the Middle East. The second case was a previously healthy 3-year-old girl with pulmonary CE acquired locally in southern Ontario. Four other cases of CE with hepatic involvement (median age 12.5 years) were identified during the study period. Five out of six patients received both surgical and medical therapy. Conclusion CE is a rare but serious disease seen in southern Canada that has historically been associated with travel or migration. Due to changes in urban wildlife landscapes and increased global migration, CE may become more prevalent in Canadian children. We describe the first locally acquired case in rural southern Ontario diagnosed at our centre. Prompt recognition of this infection in children by health care providers is important to prevent morbidity and mortality.
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Affiliation(s)
- Kescha Kazmi
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carsten Krueger
- Division of Infectious Diseases, Immunology, and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Waison Wong
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Charles Hui
- Division of Infectious Diseases, Immunology, and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Anita Nagy
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Fathima Razik
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre of Global Child Health, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Brown EG, Engwall-Gill AJ, Aldrink JH, Ehrlich PF, Fawcett A, Coakley BA, Rothstein DH, Rich BS, Glick RD, Baertschiger RM, Roach JP, Lautz TB. Unwrapping Nephrogenic Rests and Nephroblastomatosis for Pediatric Surgeons: A Systematic Review Utilizing the PICO Model by the APSA Cancer Committee. J Pediatr Surg 2023; 58:2128-2134. [PMID: 37625940 DOI: 10.1016/j.jpedsurg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Nephrogenic rests (NR) may represent precursor lesions for Wilms tumor (WT), but their clinical course is not fully understood and no guidelines for treatment exist. This study sought to evaluate the outcomes of pediatric patients with NRs related to traditional chemotherapy and surgery. METHODS A PRISMA-P-compliant literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, COCHRANE, and SCOPUS from inception to June 2021. Clinical questions regarding the treatment of NRs, including chemotherapy and surgery, were developed in the population, intervention, comparison, and outcome format. RESULTS Twenty-five studies including 1445 patients met inclusion criteria for evaluating chemotherapy compared to observation for NRs. Eighteen studies including 1392 patients met inclusion criteria for evaluating the role of surgery for NRs. Patients with isolated NRs who underwent observation progressed to WT 33% of the time; chemotherapy reduced the rate of WT to 3.9%. Observation of multiple NRs and diffuse hyperplastic perilobar nephroblastomatosis (DHPLN) led to progression to WT 50% and 100% of the time, respectively. Chemotherapy reduced the rate of WT to 34% for multiple NRs and 46% for DHPLN. Surgery for isolated NRs reduced the risk of WT development from 23.7% in patients with incomplete excision to 3.3% with complete excision; however, 96% of patients with incompletely excised NRs had bilateral disease. CONCLUSIONS Observation with close surveillance for isolated NRs is safe. Treatment with chemotherapy is recommended for patients with multiple NRs and DHPLN. Surgical management of NRs should focus on renal function preservation. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Erin G Brown
- Division of Pediatric Surgery, Department of Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA.
| | | | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Andrea Fawcett
- Health Science Library, Lurie Children's Hospital of Chicago, IL, USA
| | - Brian A Coakley
- Department of Pediatric Surgery, Icahn School of Medicine, Mount Sinai, NY, USA
| | - David H Rothstein
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, USA
| | - Jonathan P Roach
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy B Lautz
- Department of Pediatric Surgery, Lurie Children's Hospital of Chicago, IL, USA
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Kastenberg ZJ, Baertschiger RM, Cuenca AG, Galvan NTN, Lemoine CP, Roach JP, Walther AE, Dunn SP, Goss JA, Healey PJ, Karpelowsky J, Kim ES, Langham MR, Meyers RL, Superina RA, Tiao GM, Weldon CB, Bondoc AJ, Riehle KJ, Vasudevan SA. Critical elements of pediatric liver cancer surgery. Semin Pediatr Surg 2023; 32:151340. [PMID: 38008042 DOI: 10.1016/j.sempedsurg.2023.151340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
The appropriate management of pediatric liver malignancies, primarily hepatoblastoma and hepatocellular carcinoma, requires an in depth understanding of contemporary preoperative risk stratification, experience with advanced hepatobiliary surgery, and a good relationship with one's local or regional liver transplant center. While chemotherapy regimens have become more effective, operative indications more well-defined, and overall survival improved, the complexity of liver surgery in small children provides ample opportunity for protocol violation, inadequate resection, and iatrogenic morbidity. These guidelines represent the distillation of contemporary literature and expert opinion as a means to provide a framework for preoperative planning and intraoperative decision-making for the pediatric surgeon.
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Affiliation(s)
- Zachary J Kastenberg
- University of Utah School of Medicine/Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | | | | | | | - Caroline P Lemoine
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Ashley E Walther
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Stephen P Dunn
- Nemours Children Hospital Delaware, Wilmington, DE 19803, USA
| | - John A Goss
- Texas Children's Hospital / Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | - Eugene S Kim
- Cedars-Sinai Guerin Children's, Los Angeles, CA 90048, USA
| | - Max R Langham
- St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Rebecka L Meyers
- University of Utah School of Medicine/Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Riccardo A Superina
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Greg M Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Alex J Bondoc
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Sanjeev A Vasudevan
- Texas Children's Hospital / Baylor College of Medicine, Houston, TX 77030, USA.
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5
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Rich BS, Brown EG, Rothstein DH, Baertschiger RM, Jackson GA, Roach JP, Naik-Mathuria B, Tracy ET, Mattei P, Glick RD, Ehrlich PF, Aldrink JH, Rodeberg D, Lautz TB. The Utility of Intraoperative Neuromonitoring in Pediatric Surgical Oncology. J Pediatr Surg 2023; 58:1708-1714. [PMID: 36907768 DOI: 10.1016/j.jpedsurg.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Intraoperative nerve monitoring (IONM) is a technique used to decrease the possibility of nerve-associated morbidity and damage to nearby neural structures during complex surgical procedures. The use and potential benefits of IONM in pediatric surgical oncology are not well-described. METHODS An overview of the current literature was performed to elucidate the various techniques that may be useful to pediatric surgeons for resection of solid tumors in children. RESULTS The physiology and common types of IONM relevant to the pediatric surgeon are described. Important anesthetic considerations are reviewed. Specific applications for IONM that may be useful in pediatric surgical oncology are then summarized, including its use for monitoring the recurrent laryngeal nerve, the facial nerve, the brachial plexus, spinal nerves, and lower extremity nerves. Troubleshooting techniques regarding common pitfalls are then proposed. CONCLUSION IONM is a technique that may be beneficial in pediatric surgical oncology to minimize nerve injury during extensive tumor resections. This review aimed to elucidate the various techniques available. IONM should be considered as an adjunct for the safe resection of solid tumors in children in the proper setting with the appropriate level of expertise. A multidisciplinary approach is advised. Additional studies are necessary to further clarify the optimal use and outcomes in this patient population. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA.
| | - Erin G Brown
- Division of Pediatric Surgery, University of California, Davis Children's Hospital, Sacramento, CA, USA
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - G Adam Jackson
- Division of Neurophysiology, BioTronic Neuro Network (BNN), St. Joseph's Hospital, Chicago, IL, USA
| | - Jonathan P Roach
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke Children's Hospital and Health Center, Durham NC, USA
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Rodeberg
- Division of Pediatric Surgery, Kentucky Children's Hospital, Lexington, KY, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, IL, USA
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Esbenshade AJ, Kahalley LS, Wistinghausen B, Cash T, Baertschiger RM, Zarnegar-Lumley S, Green A, Dhall G. Children's Oncology Group's 2023 blueprint for research: Young investigators. Pediatr Blood Cancer 2023; 70 Suppl 6:e30567. [PMID: 37438856 PMCID: PMC10587891 DOI: 10.1002/pbc.30567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
The Children's Oncology Group (COG) Young Investigators (YI) Committee is an administrative committee in which liaisons represent 30 COG committees, and was created to facilitate the integration of YIs into the organization, and prepare them for future COG leadership roles. The mentorship program has mentored over 400 YIs since 2005 and currently has 175 active participants. The COG YI Master Roster is a database YIs can join, which allows them to post their interests and accomplishments to COG leadership, and 321 YIs have already joined this list. The YI Committee has held virtual symposia designed to describe how COG operates and provide guidance on how YIs can reach their goals; over 300 YIs have attended these since 2021 and have consistently rated them as helpful. Through these and other elements of the program, the YI Committee remains committed to developing a future pipeline of new investigators.
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Affiliation(s)
- Adam J Esbenshade
- Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Lisa S. Kahalley
- Baylor College of Medicine, Department of Pediatrics, Houston, TX, USA
- Texas Children’s Cancer and Hematology Center, Texas Children’s Hospital, Houston, TX, USA
| | | | - Thomas Cash
- Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Reto M. Baertschiger
- Hospital for Sick Children, Toronto, ON, Canada, and Children’s Hospital at Dartmouth, Geisel School of Medicine, Lebanon, NH, USA
| | - Sara Zarnegar-Lumley
- Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Adam Green
- Children’s Hospital of Colorado, Denver, CO, USA
| | - Girish Dhall
- Chidren’s Hospital of Alabama, Birmingham, AL, USA
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Quaglietta PR, Baertschiger RM. Incidence and severity of pediatric appendicitis during the COVID‑19 pandemic. World J Pediatr 2023:10.1007/s12519-023-00712-y. [PMID: 37039925 PMCID: PMC10088576 DOI: 10.1007/s12519-023-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Paula Rosanna Quaglietta
- Division of General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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Kissoondoyal A, DeSousa E, Quaglietta PR, Indersie E, Cairo S, Malkin D, Luques L, Baertschiger RM. Abstract 3540: Reduction in cell viability of hepatoblastoma cells following inhibtion of Hsp90. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Hepatoblastoma (HB) is the most frequent liver tumor in children. While most tumors respond well to treatment with good outcomes, there are a subgroup of refractory tumors for which novel therapies are required. Emerging literature has suggested a role of Hsp90 in HB progression. One possible mechanism hypothesizes that Hsp90 helps stabilize misfolded proteins that contribute to HB progression including β-catenin. Our study aimed to investigate if inhibition of Hsp90 would affect the cell viability of hepatoblastoma cell lines in vitro.
Methods: Commercially available HEPG2, and patient xenograft-derived hepatoblastoma cell lines (HB214, HB279, and HB303) were analyzed for differences in Hsp90 gene expression by qRTPCR as well as cell viability (n = 3 replicates for each cell line) using the MTS assay. Differences in cell viability for each cell line were further examined after treatment with a 0.1µM or 0.25µM dose of 17-AAG (an HSP90 inhibitor) for 48H. We examined gene expression and the MTS assay cell viability data using linear mixed effects modelling followed by t-tests to examine specific comparisons (significance at p < 0.05).
Results: Hsp90 gene expression was significantly increased in HEPG2 cells (p < 0.001) and in HB279 cells (p < 0 .05), but not in HB214, or HB303 cells, compared to HUVECs control cells. Examining clinically relevant characteristics, significant improvements to model fit were found with the inclusion of sex (p < 0.01), β-catenin deletion status (p < 0.01), and a higher PRETEXT stage but not from examining if cell lines were derived from metastatic parent tumors. While we observed no significant cell line viability differences between individual HB cell lines at baseline (0µM 17-AAG treatment) or overall significant differences for treatment with either 0.1µM or 0.25µM dosages of 17-AAG, there were differences in cell viability for individual HB cell lines. We observed significant decreases in cell viability in HEPG2 cells with 0.1µM (p < 0.05) and 0.25µM (p < 0.05), as well as in HB279 cells with 0.1µM (p < 0.05) and 0.25µM (p < 0.05) 17-AAG treatments but observed no effect of 17-AAG treatment on cell viability in HB214, or HB303 cells. Similar improvements in model fit were observed with the inclusion of sex (p < 0.01), β-catenin deletion status (p < 0.01), and a higher PRETEXT stage (p < 0.001), but not from examining if cell lines were derived from metastatic parent tumors.
Conclusion: HB cell lines express Hsp90 at levels correlated with age, β-catenin deletion status, and risk stage. Moreover, the expression levels of Hsp90 corresponded to the sensitivity of each cell line to the Hsp90 inhibitor 17-AAG, with cells more highly expressing Hsp90 having a greater reduction in cell viability. Continuing to understand the mechanisms of Hsp90 action in HB, particularly through the previously demonstrated connection with β-catenin, may identify potential targetable therapies in the care of HB.
Citation Format: Ashby Kissoondoyal, Emily DeSousa, Paula R. Quaglietta, Emilie Indersie, Stefano Cairo, David Malkin, Lisandro Luques, Reto M. Baertschiger. Reduction in cell viability of hepatoblastoma cells following inhibtion of Hsp90. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3540.
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9
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Quaglietta PR, Kissoondoyal A, Malkin E, Mejia S, Gong A, Malkin D, Baertschiger RM. Abstract 5309: Isolation and validation of small extracellular vesicles from rhabdomyosarcoma cells. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Extracellular vesicles (EVs) are nano-sized (30-1000 nm) membranous particles released by nearly all cell types. EV biology is a rapidly growing field, however its relative novelty and the intrinsic heterogeneity of EVs result in a lack of standardized and reproducible protocols. We sought to develop and validate an EV isolation method using rhabdomyosarcoma cell lines, with multiple characterization/validation methods, to improve the reproducibility and reliability of EV research in pediatric cancer research. EVs were isolated and analyzed in triplicate from 4 rhabdomyosarcoma cell lines (RH4, RH18, RH30, RD), of varying clinical characteristics including subtype, TP53 status and FOXO1 fusion status. Cells were grown to 70% confluency in six 175cm2 flasks, to ensure sufficient EV content for all downstream analyses, then incubated for 48 hours in media containing 10% EV-depleted FBS. The resultant 120mL of conditioned media (CM) per cell line was collected and subject to differential ultracentrifugation to isolate EVs. CM was centrifuged twice, then concentrated to less than 10mL using 3kDa MWCO filter tubes. Concentrated CM was centrifuged twice before passing through a 0.22μm pore-sized syringe filter prior to the final ultracentrifugations. The sample was ultracentrifuged and the EV pellet was carefully washed, re-centrifuged and resuspended in 100μL of PBS. Protein analysis by Western blot confirmed the presence of EV markers (syntenin-1, TSG101) and absence of non-EV markers (calnexin, histone H2Ax). EV quantification and size distributions were evaluated by NanoSight nanoparticle tracking analysis and visualized by transmission electron microscopy. All isolations were positive for EV markers and negative for non-EV markers by Western Blotting. All isolations showed similar size distributions by nanoparticle tracking analysis, within the range of 30-250nm. EVs in each sample with the typical cup-like shape were observed in electron microscope images of EVs. Overall, our method demonstrates good reproducibility of EV isolations from multiple rhabdomyosarcoma cell lines. This methodology can be used as a baseline for other cell lines to provide greater consensus within the field, allowing further discoveries analyzing the secretome of patient-derived cell lines with the potential to translate into more specific diagnostic tools.
Citation Format: Paula R. Quaglietta, Ashby Kissoondoyal, Ethan Malkin, Salvador Mejia, Ann Gong, David Malkin, Reto M. Baertschiger. Isolation and validation of small extracellular vesicles from rhabdomyosarcoma cells. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5309.
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Affiliation(s)
| | | | - Ethan Malkin
- 2Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Salvador Mejia
- 3Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Ann Gong
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Malkin
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Le HD, Wolinska JM, Baertschiger RM, Himidan SA. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023; 33:181-190. [PMID: 36948212 DOI: 10.1055/s-0043-1767830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
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Affiliation(s)
- Hau D Le
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Justyna M Wolinska
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharifa A Himidan
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada
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11
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Quaglietta PR, Ramjist JK, Antwi J, Kissoondoyal A, Lapidus-Krol E, Baertschiger RM. Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery. J Pediatr Surg 2023; 58:931-938. [PMID: 36775681 PMCID: PMC9851992 DOI: 10.1016/j.jpedsurg.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children. METHODS We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018-June 2019) and COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables. RESULTS A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution. CONCLUSION Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare. LEVEL OF EVIDENCE Level III for "Treatment Studies".
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Affiliation(s)
- Paula R Quaglietta
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Joshua K Ramjist
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jeffrey Antwi
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ashby Kissoondoyal
- Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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12
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Lautz TB, Fahy AS, Helenowski I, Wayne JD, Baertschiger RM, Aldrink JH. Higher rates of regional disease but improved outcomes in pediatric versus adult melanoma. J Pediatr Surg 2022; 57:425-429. [PMID: 34872730 DOI: 10.1016/j.jpedsurg.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Malignant melanoma is rare in the pediatric population and management is largely extrapolated from adult guidelines. Adult data have shown that immediate completion lymph node dissection (CLND) does not improve overall survival in selected patients with clinically node negative, sentinel lymph node-positive disease. Current nodal management in children is unknown. METHODS The National Cancer Database (NCDB) was queried for patients with melanoma from 2012-2017 and patients categorized as pediatric (≤18 years, n=962) or adult (n=327,987). Factors associated with CLND in children with positive SLNB were evaluated in multivariable analysis. Kaplan-Meier survival analysis was performed. RESULTS Compared to adults, children present with thicker primary tumors (T3 or T4 26.5% vs 15.5%, p<0.001), resulting in higher rates of nodal assessment with SLN biopsy or LND (60.2% vs 36.6%, p<0.001) and higher rates of regional nodal disease (35.1% vs 23.4%, p<0.001). Children underwent higher rates of CLND after SLN biopsy (10.4% vs 4.1%) and upfront lymph node dissection (15.2% vs 8.7%). A decreased rate of CLND was noted in 2017 compared to 2012 (odds ratio (OR) 0.16 (p=0.005). CLND was performed more often on multivariable analysis for older pediatric age (>12 years, OR=1.6, p=0.037) and lower extremity primary (OR=0.29, p<0.001). Children with regional nodal disease have improved 3-year overall survival compared to adults (96.5% vs 71.0%, p<0.001). CONCLUSIONS Children with melanoma have higher rates of nodal disease but better survival than adults. As in adults, there has been a recent increase in close nodal observation rather than CLND for patients with positive SLN. Further study of nodal surveillance for pediatric patients is warranted.
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Affiliation(s)
- Timothy B Lautz
- Department of Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Irene Helenowski
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey D Wayne
- Division of Surgical Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, FB Suite 6B1, Columbus, OH 43205, United States.
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13
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Cohen-Gogo S, Kanwar N, Shaikh F, Baertschiger RM, Shlien A, Malkin D, Putra J, Coblentz A, Villani A, Gupta AA, Morgenstern DA. Response to Alpelisib in an Adolescent With PIK3CA-Mutated Metastatic Gastrointestinal Stromal Tumor. JCO Precis Oncol 2022; 6:e2200105. [PMID: 35917491 DOI: 10.1200/po.22.00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sarah Cohen-Gogo
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Nisha Kanwar
- Division of Pathology and Laboratory Medicine, The Hospital for Sick Children, Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Furqan Shaikh
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Adam Shlien
- Division of Pathology and Laboratory Medicine, The Hospital for Sick Children, Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Juan Putra
- Department of Pathology, Boston Children's Hospital, Boston, MA
| | - Ailish Coblentz
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anita Villani
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Daniel A Morgenstern
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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14
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Rodrigues C, Peretz Soroka H, Pierro A, Baertschiger RM, Cypel M, Donahoe L, Tsang DS, Cho J, De Perrot M, Waddell TK, Gupta AA. Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study. Curr Oncol 2022; 29:4260-4266. [PMID: 35735449 PMCID: PMC9221731 DOI: 10.3390/curroncol29060340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Extra-pleural pneumonectomy (EPP) involves the removal of the parietal and visceral pleura, ipsilateral lungs, pericardium, and hemi diaphragm. In patients with advanced sarcoma in the pleura, EPP is often the only option for local control. The aim of our study was to review our institutional experience with EPP. Of ten patients in our study, five were alive without disease at last follow-up after multi-modality therapy including EPP. Two patients had local recurrence and died of progressive disease. One patient died of brain metastasis, one patient died of radiation induced sarcoma, and one patient died of surgical complications. Our results suggest that EPP is a feasible option for patients when used in combination with chemotherapy and radiation. Moreover, high-volume cancer centers should discuss the use of EPP during tumor board discussion. Abstract Sarcoma can present as locally advanced disease involving pleura for which extra-pleural pneumonectomy (EPP) may be the only surgical option to ensure adequate local control. Data were collected on patients who underwent EPP between January 2009 and August 2021 at Princess Margret Hospital and SickKids (Toronto) using the CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration). Ten patients with locally advanced sarcoma involving the pleura, aged 4 to 59 years (median 19.5 years) underwent EPP. Nine (90%) received pre-operative chemotherapy and eight (80%) achieved an R0 resection. Hemithoracic radiation was administered preoperatively (n = 6, 60%) or postoperatively (n = 4, 40%). Five (50%) patients were alive without disease at last follow-up (median 34.2 months) and time from EPP to last FU was median 29.2 months (range 2.2–87.5). Two patients (20%) had local recurrence, 4.3 and 5.8 months from EPP, and both died from progressive disease, 13.1 and 8.2 months from EPP, respectively. One patient died from brain metastasis (17 months), one died from radiation associated osteosarcoma (66 months), and one died from surgical complications (heart failure from constrictive pericarditis). EPP offers a feasible and life-prolonging surgical consideration for patients with locally advanced sarcoma involving the pleura in combination with chemotherapy and radiation. Consequently, EPP should be considered during multi-disciplinary tumor board discussions at high-volume centers.
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Affiliation(s)
- Caroline Rodrigues
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Hagit Peretz Soroka
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Agostino Pierro
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Reto M. Baertschiger
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - John Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Abha A. Gupta
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence: ; Tel.: +1-416-946-2252; Fax: +1-416-946-6546
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15
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Morgan KM, Anderson KT, Johnston ME, Dasgupta R, Crowley JJ, Fahy AS, Lapidus-Krol E, Baertschiger RM, Lautz TB, Many BT, Marquart JP, Gainer H, Lal DR, Rich BS, Glick RD, MacArthur TA, Polites SF, Kastenberg ZJ, Short SS, Meyers RL, Talbot L, Abdelhafeez A, Prajapati H, Davidoff AM, Rubaclava N, Newman E, Ehrlich PF, Rothstein DH, Roach JP, Ladd P, Janek KC, Le HD, Leraas HJ, Tracy ET, Bisset L, Mora MC, Warren P, Aldrink JH, Malek MM. Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study. J Pediatr Surg 2022; 57:1013-1017. [PMID: 35307194 DOI: 10.1016/j.jpedsurg.2022.01.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients. METHODS A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions. Localization and resection success, time in interventional radiology (IR), operating room (OR) and total anesthesia time, complications, and technical problems were compared between techniques. RESULTS 225 patients were included with an average of 1.3 lesions (range 1-5). Median nodule size and depth were 4 mm (range 0-30) and 5.4 mm (0-61), respectively. The most common localization techniques were: wire + methylene blue dye (MBD) (28%), MBD only (25%), wire only (14%), technetium-99 only (11%), coil + MBD (7%) and coil only (5%). Localization technique was associated with institution (p < 0.01); technique and institution were significantly associated with mean IR, OR, and anesthesia time (all p < 0.05). Comparing techniques, there was no difference in successful IR localization (range 92-100%, p = 0.75), successful resection (94-100%, p = 0.98), IR technical problems (p = 0.22), or operative complications (p = 0.16). CONCLUSIONS Many IR localization techniques for small pulmonary nodules in children can be successful, but there is wide variability in application by institution and in procedure time. LEVEL OF EVIDENCE Retrospective review, Level 3.
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Affiliation(s)
- Katrina M Morgan
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | - K Tinsley Anderson
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States
| | - Michael E Johnston
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Roshni Dasgupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - John J Crowley
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States
| | | | | | | | - Timothy B Lautz
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Benjamin T Many
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - John P Marquart
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Haley Gainer
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Dave R Lal
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Barrie S Rich
- Cohen Children's Medical Center, Queens, NY, United States
| | | | | | | | | | - Scott S Short
- University of Utah, Salt Lake City, UT, United States
| | | | | | | | | | | | | | - Erika Newman
- C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | | | | | - Patricia Ladd
- Children's Hospital Colorado, Aurora, CO, United States
| | - Kevin C Janek
- American Family Children's Hospital, Madison, WI, United States
| | - Hau D Le
- American Family Children's Hospital, Madison, WI, United States
| | | | | | - Logan Bisset
- Duke University Medical Center, Durham, NC, United States
| | - Maria C Mora
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Patrick Warren
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Marcus M Malek
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States.
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16
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Short SS, Kastenberg ZJ, Wei G, Bondoc A, Dasgupta R, Tiao GM, Watters E, Heaton TE, Lotakis D, La Quaglia MP, Murphy AJ, Davidoff AM, Mansfield SA, Langham MR, Lautz TB, Superina RA, Ott KC, Malek MM, Morgan KM, Kim ES, Zamora A, Lascano D, Roach J, Murphy JT, Rothstein DH, Vasudevan SA, Whitlock R, Lal DR, Hallis B, Bütter A, Baertschiger RM, Lapidus-Krol E, Putra J, Tracy ER, Aldrink JH, Apfeld J, Le HD, Park KY, Rich BS, Glick RD, Fialkowski EA, Utria AF, Meyers RL, Riehle KJ. Histologic type predicts disparate outcomes in pediatric hepatocellular neoplasms: A Pediatric Surgical Oncology Research Collaborative study. Cancer 2022; 128:2786-2795. [PMID: 35561331 DOI: 10.1002/cncr.34256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/06/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a rare cancer in children, with various histologic subtypes and a paucity of data to guide clinical management and predict prognosis. METHODS A multi-institutional review of children with hepatocellular neoplasms was performed, including demographic, staging, treatment, and outcomes data. Patients were categorized as having conventional HCC (cHCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB-HCC). Univariate and multivariate analyses identified predictors of mortality and relapse. RESULTS In total, 262 children were identified; and an institutional histologic review revealed 110 cHCCs (42%; 69 normal background liver, 34 inflammatory/cirrhotic, 7 unknown), 119 FLCs (45%), and 33 HB-HCCs (12%). The authors observed notable differences in presentation and behavior among tumor subtypes, including increased lymph node involvement in FLC and higher stage in cHCC. Factors associated with mortality included cHCC (hazard ratio [HR], 1.63; P = .038), elevated α-fetoprotein (HR, 3.1; P = .014), multifocality (HR, 2.4; P < .001), and PRETEXT (pretreatment extent of disease) stage IV (HR, 5.76; P < .001). Multivariate analysis identified increased mortality in cHCC versus FLC (HR, 2.2; P = .004) and in unresectable tumors (HR, 3.4; P < .001). Disease-free status at any point predicted survival. CONCLUSIONS This multi-institutional, detailed data set allowed a comprehensive analysis of outcomes for children with these rare hepatocellular neoplasms. The current data demonstrated that pediatric HCC subtypes are not equivalent entities because FLC and cHCC have distinct anatomic patterns and outcomes in concert with their known molecular differences. This data set will be further used to elucidate the impact of histology on specific treatment responses, with the goal of designing risk-stratified algorithms for children with HCC. LAY SUMMARY This is the largest reported granular data set on children with hepatocellular carcinoma. The study evaluates different subtypes of hepatocellular carcinoma and identifies key differences between subtypes. This information is pivotal in improving understanding of these rare cancers and may be used to improve clinical management and subsequent outcome in children with these rare malignancies.
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Affiliation(s)
- Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Guo Wei
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Alex Bondoc
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Greg M Tiao
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dimitra Lotakis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael P La Quaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Max R Langham
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Timothy B Lautz
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Riccardo A Superina
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Katherine C Ott
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katrina M Morgan
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Abigail Zamora
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan Roach
- Department of Pediatric Surgery, Children's Hospital of Colorado, Denver, Colorado
| | - Joseph T Murphy
- Division of Pediatric Surgery, Children's Medical Center, University of Texas Southwestern, Dallas, Texas
| | - David H Rothstein
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dave R Lal
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Reto M Baertschiger
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eveline Lapidus-Krol
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juan Putra
- Division of Pediatric Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elisabeth R Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jordan Apfeld
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Hau D Le
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Keon Y Park
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Alan F Utria
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kimberly J Riehle
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
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Aldrink JH, Glick RD, Baertschiger RM, Kulaylat AN, Lautz TB, Christison-Lagay E, Grant CN, Tracy E, Dasgupta R, Brown EG, Mattei P, Rothstein DH, Rodeberg DA, Ehrlich PF. Update on pediatric testicular germ cell tumors. J Pediatr Surg 2022; 57:690-699. [PMID: 33975708 DOI: 10.1016/j.jpedsurg.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Testicular germ cell tumors are uncommon tumors that are encountered by pediatric surgeons and urologists and require a knowledge of appropriate contemporary evaluation and surgical and medical management. METHOD A review of the recommended diagnostic evaluation and current surgical and medical management of children and adolescents with testicular germ cell tumors based upon recently completed clinical trials was performed and summarized in this article. RESULTS In this summary of childhood and adolescent testicular germ cell tumors, we review the initial clinical evaluation, surgical and medical management, risk stratification, results from recent prospective cooperative group studies, and clinical outcomes. A summary of recently completed clinical trials by pediatric oncology cooperative groups is provided, and best surgical practices are discussed. CONCLUSIONS Testicular germ cell tumors in children are rare tumors. International collaborations, data-sharing, and enrollment of patients at all stages and risk classifications into active clinical trials will enhance our knowledge of these rare tumors and most importantly improve outcomes of patients with testicular germ cell tumors. LEVEL OF EVIDENCE This is a review article of previously published and referenced level 1 and 2 studies, but also includes expert opinion level 5, represented by the American Pediatric Surgical Association Cancer Committee.
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Affiliation(s)
- Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States.
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Kids, University of Toronto, Toronto, Ontario, Canada
| | - Afif N Kulaylat
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States
| | - Emily Christison-Lagay
- Department of Surgery, Division of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Christa N Grant
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Elisabeth Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati OH, United States
| | - Erin G Brown
- Division of Pediatric Surgery, Department of Surgery, University of California Davis, Sacramento, CA, United States
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David H Rothstein
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - David A Rodeberg
- Department of Surgery, Division of Pediatric Surgery, East Carolina University, Greenville, NC, United States
| | - Peter F Ehrlich
- Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
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18
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Grant CN, Rhee D, Tracy ET, Aldrink JH, Baertschiger RM, Lautz TB, Glick RD, Rodeberg DA, Ehrlich PF, Christison-Lagay E. Pediatric solid tumors and associated cancer predisposition syndromes: Workup, management, and surveillance. A summary from the APSA Cancer Committee. J Pediatr Surg 2022; 57:430-442. [PMID: 34503817 DOI: 10.1016/j.jpedsurg.2021.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Cancer predisposition syndromes (CPS) are a heterogeneous group of inherited disorders that greatly increase the risk of developing malignancies. CPS are particularly relevant to pediatric surgeons since nearly 10% of cancer diagnoses are due to inherited genetic traits, and CPS often contribute to cancer development during childhood. MATERIALS/METHODS The English language literature was searched for manuscripts, practice guidelines, and society statements on "cancer predisposition syndromes in children". Following review of these manuscripts and cross-referencing of their bibliographies, tables were created to summarize findings of the most common CPS associated with surgically treated pediatric solid malignancies. RESULTS Pediatric surgeons should be aware of CPS as the identification of one of these syndromes can completely change the management of certain tumors, such as WT. The most common CPS associated with pediatric solid malignancies are outlined, with an emphasis on those most often encountered by pediatric surgeons: neuroblastoma, Wilms' tumor, hepatoblastoma, and medullary thyroid cancer. Frequently associated non-tumor manifestations of these CPS are also included as a guide to increase surgeon awareness. Screening and management guidelines are outlined, and published genetic testing and counseling guidelines are included where available. CONCLUSION Pediatric surgeons play an important role as surgical oncologists and are often the first point of contact for children with solid tumors. In their role of delivering a diagnosis and developing a follow-up and treatment plan as part of a multidisciplinary team, familiarity with common CPS will ensure evidence-based practices are followed, including important principles such as organ preservation and intensified surveillance plans. This review defines and summarizes the CPS associated with common childhood solid tumors encountered by the pediatric surgeon, as well as common non-cancerous disease stigmata that may help guide diagnosis. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Daniel Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC, United States
| | - Peter F Ehrlich
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, United States
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, United States
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Beaulieu-Jones BR, Bingham S, Rhynhart KK, Croitoru DP, Singleton MN, Rutman MS, Baertschiger RM. Incorporating a Trauma-Informed Care Protocol Into Pediatric Trauma Evaluation: The Pediatric PAUSE Does Not Delay Imaging or Disposition. Pediatr Emerg Care 2022; 38:e52-e58. [PMID: 33181796 DOI: 10.1097/pec.0000000000002278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma evaluation in the emergency department (ED) can be a stressful event for children. With the goal of minimizing pain, anxiety, and unneeded interventions in stable patients, we implemented the Pediatric PAUSE at our level 1 adult/level 2 pediatric trauma center. The Pediatric PAUSE is a brief protocol performed after the primary survey, which addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, and Explain to patient/Engage with PICU team. The aim was to assess whether performing the PAUSE interfered with timeliness of emergent imaging in pediatric patients and their disposition. METHODS We identified all patients aged 0 to 18 years evaluated as trauma activations at our institution after the Pediatric PAUSE was implemented (October 1, 2016-March 31, 2017) as well as 2 analogous 6-month pre-PAUSE periods. Patient demographics, time to imaging studies, and time to ED disposition were analyzed. RESULTS One hundred seventy-two patients met the study criteria, with a mean age of 10.9 years and mean injury severity score of 10.6. One hundred fifteen participants (68.5%) were transferred from other hospitals, and 101 (87.8%) had ≥1 imaging study performed before arrival. The Pediatric PAUSE was performed for 41 (25%) of 163 study participants. There was no difference in time to first imaging study in participants for whom the PAUSE was performed (18.4 vs 15.0 minutes, P = 0.09). CONCLUSIONS The PAUSE is a practice intervention designed to address the psychosocial needs of pediatric trauma patients and their families to help prevent posttraumatic stress symptoms. Implementation did not interfere with the timeliness of first imaging in pediatric trauma patients.
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Affiliation(s)
| | - Sarah Bingham
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock
| | - Kurt K Rhynhart
- Section of Trauma and Acute Care Surgery, Department of Surgery, Dartmouth-Hitchcock
| | | | - Marcy N Singleton
- Pediatric Intensive Care, Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock
| | - Maia S Rutman
- Section of Emergency Medicine, Department of Medicine/Pediatrics, Dartmouth-Hitchcock, Lebanon, NH
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20
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Waters VJ, Baertschiger RM, Kitai I. Inguinal mass in a 4-month-old boy. CMAJ 2021; 192:E845. [PMID: 32690560 DOI: 10.1503/cmaj.200056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Valerie J Waters
- Divisions of Infectious Diseases, Department of Pediatrics (Waters, Kitai), and of General Surgery, Department of Surgery (Baertschiger), The Hospital for Sick Children, University of Toronto, Toronto, Ont.
| | - Reto M Baertschiger
- Divisions of Infectious Diseases, Department of Pediatrics (Waters, Kitai), and of General Surgery, Department of Surgery (Baertschiger), The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - Ian Kitai
- Divisions of Infectious Diseases, Department of Pediatrics (Waters, Kitai), and of General Surgery, Department of Surgery (Baertschiger), The Hospital for Sick Children, University of Toronto, Toronto, Ont
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21
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Grant CN, Aldrink J, Lautz TB, Tracy ET, Rhee DS, Baertschiger RM, Dasgupta R, Ehrlich PF, Rodeberg DA. Lymphadenopathy in children: A streamlined approach for the surgeon - A report from the APSA Cancer Committee. J Pediatr Surg 2021; 56:274-281. [PMID: 33109346 DOI: 10.1016/j.jpedsurg.2020.09.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Lymphadenopathy is a common complaint in children. Pediatric surgeons are often called upon to evaluate, treat, and/or biopsy enlarged lymph nodes. With many nonsurgical causes in the differential diagnosis, the surgeon plays the important role of providing reassurance and timely diagnosis while minimizing the pain and morbidity associated with surgical interventions in children. The purpose of this summary paper is to provide a management guide for surgeons working up children with lymphadenopathy. MATERIALS/METHODS The English language literature was searched for "lymphadenopathy in children". All manuscript types were considered for review, regardless of medical specialty, with emphasis placed on published guidelines, algorithms, and reviews. After thorough review of these manuscripts and cross-referencing of their bibliographies, the attached algorithm was developed, with emphasis on the role and timing of surgical intervention. RESULTS The APSA Cancer Committee developed the attached algorithm to fill a gap in the surgical literature. It outlines lymphadenopathy workup and treatment with emphasis on the role and timing of surgical intervention. CONCLUSION This review defines and summarizes the common etiologies and presentations of lymphadenopathy in children, and offers a straightforward algorithm for evaluation of and treatment with an emphasis on malignancy risk and surgical management. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Department of Surgery, Milton S. Hershey Medical Center, Hershey, PA.
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC
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22
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Taenzer AH, Baertschiger RM, Cazaban CG, Evans RE, Murphy M, Wasserman J, Goodman DC. Epidemiology of Surgical Procedures, Anesthesia, and Imaging Studies by Gestational Age during the First Year of Life in Medicaid-Insured Infants. J Pediatr 2021; 229:147-153.e1. [PMID: 33098841 DOI: 10.1016/j.jpeds.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the rate of surgical procedures, anesthetic use, and imaging studies by prematurity status for the first year of life we analyzed data for Texas Medicaid-insured newborns. STUDY DESIGN We developed a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 4 subcohorts: extremely premature, very premature, moderate/late premature, and term. RESULTS In 1 102 958 infants, surgical procedures per 100 infants were 135.9 for extremely premature, 35.4 for very premature, 15.5 for moderate/late premature, and 6.5 for term. Anesthetic use was 62.0 for extremely premature, 20.8 for very premature, 11.1 for moderate/late premature, and 5.6 for the term subcohort. The most common procedures in the extremely premature were neurosurgery, intubations, and procedures that facilitated caloric intake (gastrostomy tubes and fundoplications). The annual rates for the first year of life for chest radiograph ranged from 15.0 per year for the extremely premature cohort to 0.6 for term infants and for magnetic resonance imaging (MRI) from 0.3 to 0.01. MRI was the most common imaging study with anesthesia support in all maturity levels. MRIs were done in extremely premature without anesthesia in over 90% and in term infants in 57.2%. CONCLUSIONS Surgical procedures, anesthetic use, and imaging studies in infants are common and more frequent with higher a degree of prematurity while the use of anesthesia is lower in more premature newborns. These findings can provide direction for outcome studies of surgery and anesthesia exposure.
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Affiliation(s)
- Andreas H Taenzer
- Children's Hospital at Dartmouth (CHaD), Dartmouth Hitchcock Medical Center, Department of Anesthesiology & Pediatrics, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Ganduglia Cazaban
- Department of Management, Policy, and Community Health, University of Texas School of Public Health, Dallas, TX
| | - Rebecca E Evans
- Department of Anesthesiology and Pediatrics, Larner College of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Megan Murphy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jared Wasserman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; The Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH
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23
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Christison-Lagay E, Baertschiger RM. Management of Differentiated Thyroid Carcinoma in Pediatric Patients. Surg Oncol Clin N Am 2021; 30:235-251. [PMID: 33706898 DOI: 10.1016/j.soc.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Differentiated thyroid carcinomas are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. Differentiated thyroid carcinoma in children is more likely to demonstrate nodal involvement and is associated with higher recurrence rates than seen in adults. Decisions regarding extent of surgical resection are based on clinical and radiologic features, cytology, and risk assessment. Total thyroidectomy and compartment-based resection of involved lymph node basins form the cornerstone of treatment. The use of molecular genetics to inform treatment strategies and the use of targeted therapies to unresectable progressive disease is evolving.
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Affiliation(s)
- Emily Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT, USA.
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Room 1524, 555 University Ave, Toronto, ON M5G 1X8, Canada
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24
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Malek MM, Behr CA, Aldrink JH, Dasgupta R, Heaton TE, Gehred A, Lautz TB, Baertschiger RM, Christison-Lagay ER, Tracy ET, Rhee DS, Rodeberg D, Austin MT, Ehrlich PF. Minimally invasive surgery for pediatric renal tumors: A systematic review by the APSA Cancer Committee. J Pediatr Surg 2020; 55:2251-2259. [PMID: 32386972 DOI: 10.1016/j.jpedsurg.2020.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED Minimally invasive nephrectomy is performed routinely for adult renal tumors and for many benign pediatric conditions. Although open radical nephroureterectomy remains the standard of care for Wilms tumor and most pediatric renal malignancies, there are an increasing number of reports of minimally invasive surgery (MIS) for those operations as well. The APSA Cancer Committee performed a systematic review to better understand the risks and benefits of MIS in pediatric patients with renal tumors. METHODS The search focused on MIS for renal tumors in children and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. The initial database search identified 491 published articles, and after progressive review of abstracts and full-length articles, 19 were included in this review. RESULTS There were two direct comparison studies where open surgery and MIS were compared. The remaining studies reported only on minimally invasive nephrectomy. Across all studies, there were a total of 151 patients, 126 of which had Wilms tumor and 10 patients had RCC. 104 patients had MIS, with 47 patients having open surgery. In the two studies in which open surgery and MIS were directly compared, more lymph nodes were harvested during open surgery (median = 2 (MIS) vs 5 (open); mean = 2.47 (MIS) vs 3.8 (open)). Many noncomparison studies reported the harvest of 2 of fewer lymph nodes for Wilms tumor. Several MIS patients were also noted to have intraoperative spill or positive margins. Survival between groups was similar. CONCLUSIONS There is a lack of evidence to support MIS for pediatric renal tumors. This review demonstrates that lymph node harvest has been inadequate for MIS pediatric nephrectomy and there appears to be an increased risk for intraoperative spill. Survival data are similar between groups, but follow-up times were inconsistent and patient selection was clearly biased, with only small tumors being selected for MIS. TYPE OF STUDY Review article. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcus M Malek
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Christopher A Behr
- Department of Surgery, Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Todd E Heaton
- Department of Surgery, Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Gehred
- Grant Morrow, III MD Medical Library, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | | | - Emily R Christison-Lagay
- Division of Pediatric General and Thoracic Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT
| | - Elisabeth T Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center
| | - Daniel S Rhee
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Rodeberg
- Department of Surgery, Division of Pediatric Surgery, East Carolina University, Greenville, NC
| | - Mary T Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
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25
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Rhee DS, Rodeberg DA, Baertschiger RM, Aldrink JH, Lautz TB, Grant C, Meyers RL, Tracy ET, Christison-Lagay ER, Glick RD, Mattei P, Dasgupta R. Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee. J Pediatr Surg 2020; 55:1987-1995. [PMID: 32674846 DOI: 10.1016/j.jpedsurg.2020.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma is the most common soft tissue sarcoma in children and young adults and requires multimodality treatment. The purpose of this review is to present an update on risk stratification as well as surgical and medical management strategies in pediatric rhabdomyosarcoma. METHODS A comprehensive review of the current literature on pediatric rhabdomyosarcoma, including the most recent Children's Oncology Group studies and several international collaboratives, was performed by the authors and key findings were summarized in the manuscript. RESULTS FOXO1 fusion status is a stronger prognostic factor than histology and is now used for risk stratification in treatment protocols. For assessment of regional nodal involvement, FDG-PET-CT shows poor sensitivity and specificity to detect histologically confirmed nodal metastasis. Thus, surgical assessment of regional lymph nodes is required for rhabdomyosarcoma of the extremities or trunk as well as paratesticular rhabdomyosarcoma in patients ≥10 years of age, although adherence to surgical guidelines remains poor. Hemiscrotectomy performed for scrotal violation in paratesticular rhabdomyosarcoma has not shown an improvement in event free survival and is not recommended. CONCLUSIONS Surgical and medical treatment strategies for rhabdomyosarcoma in children continue to evolve. This review provides current evidence-based treatment standards with an emphasis on surgical care. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David A Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Christa Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, Yale New Haven Children's Hospital, New Haven, CT
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY
| | - Peter Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Lautz TB, Farooqui Z, Jenkins T, Heaton TE, Doski JJ, Cooke-Barber J, Murphy AJ, Davidoff AM, Mansfield SA, Kim ES, Zuber S, Goodhue C, Vasudevan SA, LaQuaglia MP, Piche N, Le-Nguyen A, Aldrink JH, Malek MM, Siow VS, Glick RD, Rich BS, Meyers RL, Short SS, Butter A, Baertschiger RM, Fialkowski EA, Dasgupta R. Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study. Int J Cancer 2020; 148:1164-1171. [PMID: 32818304 DOI: 10.1002/ijc.33264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023]
Abstract
Complete surgical resection of pulmonary metastatic disease in patients with osteosarcoma is crucial to long-term survival. Open thoracotomy allows palpation of nodules not identified on imaging but the impact on survival is unknown. The objective of this study was to compare overall survival (OS) and pulmonary disease-free survival (DFS) in children who underwent thoracotomy vs thoracoscopic surgery for pulmonary metastasectomy. A multi-institutional collaborative group retrospectively reviewed 202 pediatric patients with osteosarcoma who underwent pulmonary metastasectomy by thoracotomy (n = 154) or thoracoscopy (n = 48). Results were analyzed by Kaplan-Meier survival estimates and multivariate Cox proportional hazard regression models. With median follow-up of 45 months, 135 (67.5%) patients had a pulmonary relapse and 95 (47%) patients were deceased. Kaplan-Meier analysis showed no significant difference in 5-year pulmonary DFS (25% vs 38%; P = .18) or OS (49% vs 42%, P = .37) between the surgical approaches of thoracotomy and thoracoscopy. In Cox regression analysis controlling for other factors impacting outcome, there was a significantly increased risk of mortality (HR 2.11; P = .027; 95% CI 1.09-4.09) but not pulmonary recurrence (HR 0.96; P = .90; 95% CI 0.52-1.79) with a thoracoscopic approach. However, in the subset analysis limited to patients with oligometastatic disease, thoracoscopy had no increased risk of mortality (HR 1.16; P = .62; 0.64-2.11). In conclusion, patients with metastatic osteosarcoma and limited pulmonary disease burden demonstrate comparable outcomes after thoracotomy and thoracoscopy for metastasectomy. While significant selection bias in these surgical cohorts limits the generalizability of the conclusions, clinical equipoise for a randomized clinical trial in patients with oligometastatic disease is supported.
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Affiliation(s)
- Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Zishaan Farooqui
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd Jenkins
- Departments of Pediatrics and Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John J Doski
- Division of Pediatric Surgery, UT San Antonio, San Antonio, Texas, USA
| | - Jo Cooke-Barber
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Samuel Zuber
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Catherine Goodhue
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Michael P LaQuaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nelson Piche
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Le-Nguyen
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vei Shaun Siow
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Andreana Butter
- Division of Pediatric Surgery, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, NH, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Division of Thoracic and General Surgery, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Sheikh F, Brandt RJ, Tsapakos MJ, Baertschiger RM, Croitoru DP. CT-guided blood tattoo for thoracoscopic excision of lung lesions in pediatric patients. J Thorac Dis 2020; 12:4284-4291. [PMID: 32944340 PMCID: PMC7475583 DOI: 10.21037/jtd-19-3800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To describe a single-institutional experience with an innovative technique using CT-guided injection of autologous blood for localization of nonpleural-based pulmonary nodules prior to thoracoscopic excisional biopsy in pediatric patients. Methods A retrospective review of all patients under the age of 18 with lung lesions suspected to be malignant that were not pleural-based lesions and were not of adequate size to visualize at thoracoscopy, who underwent CT-guided blood tattoo (CGBT) localization between 2006-2019. CGBT was performed under general anesthesia by injecting 0.5-10 mL of autologous blood into the area of the lesions. The patients were then immediately transferred from interventional radiology to the operating room for thoracoscopic excision of the lesion. Demographics, location of lesions, indication for biopsy, and pathology were reviewed. Results In eleven pediatric patients (ages ranging from 4-18 years), preoperative CGBT localization of pulmonary nodules resulted in successful thoracoscopic excisional biopsy. All resections were diagnostic and 82% (9/11 cases) represented a metastatic malignancy as confirmed by pathology. Malignant nodules ranged from 2 to 14 mm in size, while a 13 mm nodule in a patient with history of AML was determined to be an organizing pneumonia and a 12 mm nodule in a second patient revealed a caseating granuloma consistent with Crohn's disease. One patient with a failed attempt at excisional biopsy without preoperative localization then underwent CGBT one week later with successful thoracoscopic excision of the nodule. Conclusions CT-guided blood tattoo is a safe option for localization of nonpleural-based lung nodules prior to thoracoscopic excision in pediatric patients.
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Affiliation(s)
- Fariha Sheikh
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ryan J Brandt
- Department of Radiology, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael J Tsapakos
- Department of Radiology, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Reto M Baertschiger
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Daniel P Croitoru
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Beaulieu-Jones BR, Croitoru DP, Baertschiger RM. Advanced providers in pediatric surgery: Evaluation of role and perceived impact. J Pediatr Surg 2020; 55:583-589. [PMID: 31351706 DOI: 10.1016/j.jpedsurg.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/29/2019] [Accepted: 07/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The shortage of medical doctors in certain geographies and certain disciplines, resident work hour limitations and the demonstrated positive impact of advanced providers (nurse practitioners, physician assistants and clinical nurse specialists) on the quality and efficiency of care in numerous specialties have led to broader integration of advanced providers in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 nurse practitioner coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of advanced providers among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to advanced provider coverage and their perceived impact on care delivery and patient satisfaction. METHODS A 14-item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N = 1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of advanced providers in their practice and their perceived impact on patient care. Descriptive statistics were performed to characterize the function of advanced providers in pediatric surgery practices. Further analysis was performed to assess for geographic differences in staffing practices using United States Census Divisions. RESULTS A total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering "email send out" and "email opening" rates respectively), with 47.6% employed at free standing children's hospitals and 41.1% employed at a children's hospital within an adult hospital. Nearly all respondents (N = 244, 91.7%) reported the presence of advanced providers in their practice with nurse practitioners (N = 216) and physician assistants (N = 101) most commonly represented. The majority of advanced providers (N = 189, 77.8%) covered both general surgery and trauma patients. Advanced providers worked nearly equally in the outpatient (N = 219, 89.8%) and inpatient setting (N = 232, 95.1%), though less often in the neonatal (N = 131) or pediatric (N = 126) intensive care unit. Fifteen percent of surgeons (N = 40) reported that advanced providers provided 24/7 coverage within their surgical practice. Surgeons reported that advanced providers had a very positive (75%) or positive (21%) impact on their clinical practice, with none reporting a negative impact. Surgeons also reported that advanced providers had a very positive (74%) or positive (21%) impact on perceived patient satisfaction. The main area in which surgeons reported the most significant impact of associate providers was continuity of care (N = 77), efficiency of service (N = 66) and education of parents and patients (N = 53). CONCLUSION Pediatric surgical practices of all types are broadly utilizing advanced providers. Surgeons report that the integration of advanced providers across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service. Advanced providers likely represent part of the solution to delivering quality care in current delivery systems. STUDY TYPE Prospective Study/ Survey LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Daniel P Croitoru
- Dartmouth Hitchcock Medical Center, Pediatric Surgery, Department of Surgery, Lebanon, NH
| | - Reto M Baertschiger
- Dartmouth Hitchcock Medical Center, Pediatric Surgery, Department of Surgery, Lebanon, NH.
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29
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Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, Ehrlich P, Dasgupta R, Baertschiger RM, Lautz TB, Rhee DS, Langham MR, Malek MM, Meyers RL, Nathan JD, Weil BR, Polites S, Madonna MB. Update on neuroblastoma. J Pediatr Surg 2019; 54:383-389. [PMID: 30305231 DOI: 10.1016/j.jpedsurg.2018.09.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022]
Abstract
Neuroblastoma is an embryonic cancer arising from neural crest stem cells. This cancer is the most common malignancy in infants and the most common extracranial solid tumor in children. The clinical course may be highly variable with the possibility of spontaneous regression in the youngest patients and increased risk of aggressive disease in older children. Clinical heterogeneity is a consequence of the diverse biologic characteristics that determine patient risk and survival. This review will focus on current progress in neuroblastoma staging, risk stratification, and treatment strategies based on advancing knowledge in tumor biology and genetic characterization. TYPE OF STUDY: Review article. LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Erika A Newman
- C.S Mott Children's Hospital, The University of Michigan Medicine, Ann Arbor, MI.
| | | | | | - Mary Austin
- Memorial Hermann Texas Medical Center, Houston, TX
| | - Todd E Heaton
- Memorial Sloan Kettering Cancer Center, NY, New York
| | | | - Peter Ehrlich
- C.S Mott Children's Hospital, The University of Michigan Medicine, Ann Arbor, MI
| | | | | | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | | | - Max R Langham
- University of Tennessee Health Science Center and St. Jude Children's Research Hospital, Memphis, TN
| | - Marcus M Malek
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Rebecka L Meyers
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - Brent R Weil
- Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | | | - Mary Beth Madonna
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
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30
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Merali N, Wilcox AR, Croitoru DP, Baertschiger RM. Infantile Hypertrophic Pyloric Stenosis Following Repair of H-type Tracheoesophageal Fistula Repair and Post-operative Erythromycin Therapy. J Neonatal Surg 2019. [DOI: 10.47338/jns.v8.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present a rare case of a newborn with H-type tracheoesophageal fistula (TEF) who developed pyloric stenosis postoperatively, 10 days after he was started on erythromycin to promote gastric emptying. We report this case to describe the relationship between H-type TEF repair, erythromycin therapy, and the development of infantile hypertrophic pyloric stenosis.
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Engbrecht BW, Baertschiger RM. American Pediatric Surgical Association Trauma Committee Position Statement on the Use of All-Terrain Vehicles by Children and Youth, 2018. J Pediatr Surg 2018; 53:1444-1445. [PMID: 29752137 DOI: 10.1016/j.jpedsurg.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Brett W Engbrecht
- Pediatric Trauma Program, Penn State Children's Hospital, Milton S. Hershey Medical Center, 500 University Drive, H113, Hershey, PA 17033.
| | - Reto M Baertschiger
- Pediatric Trauma Program, Children's Hospital at Dartmouth (CHaD), Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001.
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Sgroi A, Mai G, Morel P, Baertschiger RM, Gonelle-Gispert C, Serre-Beinier V, Buhler LH. Transplantation of encapsulated hepatocytes during acute liver failure improves survival without stimulating native liver regeneration. Cell Transplant 2011; 20:1791-803. [PMID: 21396154 DOI: 10.3727/096368911x564976] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to evaluate the effects of intraperitoneal transplantation of encapsulated human hepatocytes on liver metabolism and regeneration of mice with acute liver failure. Primary human hepatocytes were immortalized using lentiviral vectors coding for antiapoptotic genes and microencapsulated using alginate-polylysine polymers. In vitro, immortalized human hepatocytes showed low, but stable, synthetic and catabolitic functions over time, when compared to primary hepatocytes. In vivo, mice with acute liver failure and transplanted with encapsulated immortalized human hepatocytes had a significantly improved survival and biochemical profile, compared to mice transplanted with empty capsules. Serum levels of cytokines implicated in liver regeneration were lower in mice transplanted with hepatocytes compared to mice receiving empty capsules. This decrease was significant for IL-6 and HGF at 3 h. Measurement of liver regeneration showed no significant difference between mice transplanted with hepatocytes compared to control groups. Intraperitoneal transplantation of encapsulated immortalized hepatocytes significantly improved survival of mice with acute liver failure by providing metabolic support and without modifying liver regeneration. The lower levels of cytokines implicated in liver regeneration suggest that the metabolic support provided by the encapsulated hepatocytes reduced the inflammatory stress on the liver and herein decreased the regenerative trigger on residual hepatocytes. These data emphasize that metabolic function and regeneration of hepatocytes are two distinct aspects that need to be studied and approached separately during acute liver failure.
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Affiliation(s)
- Antonino Sgroi
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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33
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Baertschiger RM, Gonelle-Gispert C, Morel P, Sgroi A, Serre-Beinier V, Stouffs M, Jaconi ME, Bühler LH. Transplantation of mouse embryonic stem cells induces hematopoietic and tissue chimerism in rats. Xenotransplantation 2011; 17:362-9. [PMID: 20973278 DOI: 10.1111/j.1399-3089.2010.00603.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Embryonic stem cells (ESC) can differentiate into all cell lineages, and ESC-like cells were shown to induce hematopoietic chimerism and tolerance in allogeneic models. The aim of our study was to test the capacity of mouse ESC (mESC) to engraft in rats in a xenotransplantation setting. Forty-six rats were transplanted intravenously with 1 million mESC, without immunosuppression (group 1, n = 23) or with cyclosporine (group 2, n = 23). Three months after mESC transplantation, skin grafts were performed from allogeneic, xenogeneic identical to mESC, or xenogeneic third party donors. At day 27 post-transplant, we detected circulating mouse cells in the blood of 4/23 and 5/23 animals of group 1 and group 2, respectively. Chimerism was confirmed by PCR. We also identified long-term surviving murine cells within livers of chimeric animals. Skin grafts showed no difference in survival between allogeneic and xenogeneic donors. Transplantation of xenogeneic mouse ESC induced short-term chimerism in the blood and persistent tissue chimerism in the liver of recipient rats, but did not induce tolerance to skin grafts. Improved immunosuppressive protocols should be tested to prolong chimerism and allow tolerance.
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34
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Baertschiger RM, Serre-Beinier V, Morel P, Bosco D, Peyrou M, Clément S, Sgroi A, Kaelin A, Buhler LH, Gonelle-Gispert C. Fibrogenic potential of human multipotent mesenchymal stromal cells in injured liver. PLoS One 2009; 4:e6657. [PMID: 19684854 PMCID: PMC2722022 DOI: 10.1371/journal.pone.0006657] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 07/07/2009] [Indexed: 12/26/2022] Open
Abstract
Multipotent mesenchymal stromal cells (MSC) are currently investigated clinically as cellular therapy for a variety of diseases. Differentiation of MSC toward endodermal lineages, including hepatocytes and their therapeutic effect on fibrosis has been described but remains controversial. Recent evidence attributed a fibrotic potential to MSC. As differentiation potential might be dependent of donor age, we studied MSC derived from adult and pediatric human bone marrow and their potential to differentiate into hepatocytes or myofibroblasts in vitro and in vivo. Following characterization, expanded adult and pediatric MSC were co-cultured with a human hepatoma cell line, Huh-7, in a hepatogenic differentiation medium containing Hepatocyte growth factor, Fibroblast growth factor 4 and oncostatin M. In vivo, MSC were transplanted into spleen or liver of NOD/SCID mice undergoing partial hepatectomy and retrorsine treatment. Expression of mesenchymal and hepatic markers was analyzed by RT-PCR, Western blot and immunohistochemistry. In vitro, adult and pediatric MSC expressed characteristic surface antigens of MSC. Expansion capacity of pediatric MSC was significantly higher when compared to adult MSC. In co-culture with Huh-7 cells in hepatogenic differentiation medium, albumin expression was more frequently detected in pediatric MSC (5/8 experiments) when compared to adult MSC (2/10 experiments). However, in such condition pediatric MSC expressed alpha smooth muscle more strongly than adult MSC. Stable engraftment in the liver was not achieved after intrasplenic injection of pediatric or adult MSC. After intrahepatic injection, MSC permanently remained in liver tissue, kept a mesenchymal morphology and expressed vimentin and alpha smooth muscle actin, but no hepatic markers. Further, MSC localization merges with collagen deposition in transplanted liver and no difference was observed using adult or pediatric MSC. In conclusion, when transplanted into an injured or regenerating liver, MSC differentiated into myofibroblasts with development of fibrous tissue, regardless of donor age. These results indicate that MSC in certain circumstances might be harmful due to their fibrogenic potential and this should be considered before potential use of MSC for cell therapy.
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Affiliation(s)
- Reto M. Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Véronique Serre-Beinier
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Philippe Morel
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Domenico Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Marion Peyrou
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Sophie Clément
- Department of Pathology and Immunology, Medical School of Geneva, Geneva, Switzerland
| | - Antonino Sgroi
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - André Kaelin
- Department of Pediatric Orthopedics, Children's Hospital, University Hospital of Geneva, Geneva, Switzerland
| | - Leo H. Buhler
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Carmen Gonelle-Gispert
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
- * E-mail:
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35
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Baertschiger RM, Buhler LH. Xenotransplantation literature update March-April, 2008. Xenotransplantation 2008; 15:277-80. [PMID: 18957050 DOI: 10.1111/j.1399-3089.2008.00485.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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37
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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38
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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39
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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40
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Baertschiger RM, Buhler LH. Xenotransplantation literature update March-April, 2007. Xenotransplantation 2007. [DOI: 10.1111/j.1399-3089.2007.00411.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Sgroi A, Baertschiger RM, Morel P, Buhler LH. [Xenotransplantation, soon a clinical reality?]. Rev Med Suisse 2007; 3:1632-6. [PMID: 17708231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Organ transplantation has encountered great development during the 80's. However, the number of organ donations and transplantations performed stabilized during the 90ies, with a concomitant increase of patients on the waiting list. Xenotransplantation, i.e. the use of animal organs for transplantation to humans, is one among various alternatives to human organ donation. Xenotransplantation offers several advantages, e.g. it would be possible to transplant all patients at an early stage of their disease. The main barriers to xenotransplantation are the strong immunological responses that human develop against animal antigens and zoonoses. To overcome these hurdles, genetically modified pigs have been engineered by cloning and could allow the initiation of new clinical trials in a near future.
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Affiliation(s)
- Antonino Sgroi
- Unité d'investigations chirurgicales, HUG, 1211 Geneve 14
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42
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Baertschiger RM, Buhler LH. Xenotransplantation literature update January-February, 2007. Xenotransplantation 2007; 14:273-7. [PMID: 17489870 DOI: 10.1111/j.1399-3089.2007.00397.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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Baertschiger RM, Buhler LH. Xenotransplantation literature update November-December 2006. Xenotransplantation 2007; 14:166-70. [PMID: 17381692 DOI: 10.1111/j.1399-3089.2007.00388.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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44
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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45
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Baertschiger RM, Buhler LH. Xenotransplantation literature update July-August, 2006. Xenotransplantation 2006; 13:571-5. [PMID: 17059585 DOI: 10.1111/j.1399-3089.2006.00356.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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Baertschiger RM, Buhler LH. Xenotransplantation literature update May-June 2006. Xenotransplantation 2006; 13:475-80. [PMID: 16925673 DOI: 10.1111/j.1399-3089.2006.00339.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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Baertschiger RM, Buhler LH. Xenotransplantation literature update March-April 2006. Xenotransplantation 2006; 13:368-70. [PMID: 16768731 DOI: 10.1111/j.1399-3089.2006.00322.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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48
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Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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Baertschiger RM, Morel P, Berney T. [Islets of Langerhans or pancreas transplantation in the treatment of type 1 diabetes]. Rev Med Suisse 2006; 2:1462-6. [PMID: 16783991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Type I diabetes is one of the big challenges in medicine of the 21st century, being a chronic disease with a high incidence and long term complications. Intensive insulin treatment can reduce these complications but harbors the risk of hypoglycemic events impacting on the quality of life of patients. Pancreas and islet of Langerhans transplantation are interesting alternatives to restore physiologic glucose metabolism. One could think that there might be some competition between these two treatments, but donor and recipient selection criteria are different and these two methods are therefore complementary. Here we discuss the adequate donor selection and the different settings of beta cell replacement therapy for type I diabetes, their risks and their benefit.
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Affiliation(s)
- R M Baertschiger
- Laboratoire d'isolement et de transplantation cellulaire, HUG, 1211 Genève 14
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Baertschiger RM, Buhler LH. Xenotransplantation literature update November-December 2005. Xenotransplantation 2006; 13:96-9. [PMID: 16623798 DOI: 10.1111/j.1399-3089.2006.00285.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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