Abstract:
PURPOSE:Initial Children's Oncology Group (COG) management for Wilms' tumor (WT) consists of primary nephroureterectomy with lymph node sampling. While this provides accurate staging to define further treatment, it may result in intraoperative spill (IOS), which is associated with higher recurrence rates and therefore requires more intensive therapy. The purpose of this study is to determine current rates and identify factors which may predispose a patient to IOS. METHODS:The study population was drawn from the AREN03B2 renal tumor banking and classification study of the Children's Oncology Group. All children with a first time occurrence of a renal mass were eligible for the study. At the time of enrollment and prior to risk stratification, the institution is required to submit operative notes, pathology specimens, a chest computed tomography scan (CT), and a contrast-enhanced CT or magnetic resonance imaging (MRI) of the abdomen and pelvis for central imaging review. These data are then used to determine an initial risk classification and therapeutic protocol eligibility. Patients who had a unilateral nephroureterectomy for favorable histology WT underwent further review to assure data accuracy and to clarify details regarding the spill. Analyses were performed using chi square and logistic regression. Odd ratios (OR) are shown with 95% confidence intervals. RESULTS:There were 1,131 primary nephrectomies for unilateral WT with an IOS rate of 9.7% with an additional 1.8% having possible tumor spill during renal vein or IVC tumor thrombectomy. IOS correlated with diameter (>12 cm, p<0.0001) and laterality (right, p=0.0414). Simple logistic regression indicated that IOS increased 2.7% [p=0.0240, OR 1.027 (1.004, 1.052)] with each 1 cm increase in diameter (3 - 21 cm) and 4.7% [p=0.0147 OR 1.047 (1.009, 1.086)] with each 100 g increase in weight (80 - 1800 g). Multiple logistic regression indicated that laterality [right p=0.048, OR 1.46 (1.004, 2.110)] and weight (p=0.03, OR 1.039 (1.003, 1.075) were predictive of IOS when diameter was included as a continuous variable. Diameter as a binary variable was highly prognostic of IOS (p=0.0002), while laterality and weight were not significant. CONCLUSIONS:Intraoperative tumor spill occurs in about one out of every ten cases of primary nephroureterectomies for WT. Right-sided and larger tumors are at higher risk of IOS.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Gow KW,Barnhart DC,Hamilton TE,Kandel JJ,Chen MK,Ferrer FA,Price MR,Mullen EA,Geller JI,Gratias EJ,Rosen N,Khanna G,Naranjo A,Ritchey ML,Grundy PE,Dome JS,Ehrlich PFdoi
10.1016/j.jpedsurg.2012.10.015subject
Has Abstractpub_date
2013-01-01 00:00:00pages
34-8issue
1eissn
0022-3468issn
1531-5037pii
S0022-3468(12)00791-9journal_volume
48pub_type
临床试验,杂志文章,多中心研究abstract:PURPOSE:The purpose of the study was to compare outcomes of pediatric patients with high-risk metastatic neuroblastoma who received radiotherapy (RT) with those of patients who did not. PATIENTS AND METHODS:We reviewed the records of 63 patients with newly diagnosed metastatic neuroblastoma treated at our institution ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.11.003
更新日期:2010-04-01 00:00:00
abstract:PURPOSE:In oncology practice, angioembolization has been reported for tumor reduction before surgery, treatment of life-threatening conditions, and for palliative care. Nevertheless, the overall experience with angioembolization for the treatment of tumors is limited. We report our experience in 7 nonvascular solid ped...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.04.037
更新日期:2009-09-01 00:00:00
abstract::Calcified caval thrombus should be considered in any infant or child where calcifications are noted in the high right retroperitoneal area on plain x-rays of the abdomen. Although typically bullet-shaped in configuration, the calcium distribution in the neonate may be atypical or incompletely developed, suggesting neu...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(78)80471-0
更新日期:1978-08-01 00:00:00
abstract:BACKGROUND:No previous report has, to our knowledge, been made on anal mucosal electric sensation in postoperative patients with anorectal malformations (ARMs). We studied the anal mucosal electric sensory threshold (AMEST) in comparison with clinical manifestation. METHODS:The study included 25 patients with ARMs who...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2005.03.055
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abstract::Lipoblastoma is a rare benign mesenchymal tumor of embryonal fat that occurs almost exclusively in infants and children. Although lipoblastomas can affect any part of the body, only 5 cases affecting the scrotum have previously been reported. We present a case of an intrascrotal lipoblastoma with a novel karyotype. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.10.093
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abstract::Histologic studies of the human chorionic gonadotropin (hCG) producing hepatoblastoma were made for seven cases encountered in Japan. It was found in all cases that multinucleated tumor giant cells in several figures were admixed in usual hepatoblastoma tissue and one of them was confirmed to be hCG positive immunohis...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(87)80258-0
更新日期:1987-05-01 00:00:00
abstract::A brief resume of the highlights in the history of oesophageal atresia is presented. This is followed by research into the etiology, ontogeny and embryology, and microbiological studies. A revised classification of risk factors with consequent survival statistics is presented. Lessons learned in the management of the ...
journal_title:Journal of pediatric surgery
pub_type: 历史文章,杂志文章,评审
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更新日期:2006-10-01 00:00:00
abstract::From 1964 to 1985 inclusive, gastric tubes have been constructed in 36 infants and children to replace a congenitally defective esophagus or an esophagus with acquired irreparable damage. This report reviews our entire series to date covering a 21-year experience. There were 24 boys and 12 girls ranging in age from 3 ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(87)80021-0
更新日期:1987-01-01 00:00:00
abstract::Forty-six records of infant girls with so-called imperforate anus have been reviewed to determine the position of the rectal opening in relation to the hymen. Eight of these children proved to have the cloacal deformity, in which the rectum enters high into a single tube and just behind the opening of a double or sept...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(75)90099-8
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abstract::Follow-up evaluation was performed on two groups of children, all premature infants who had undergone surgical ligation of a patent ductus arteriosus in the first days of life (Group I, 12 months postligation; Group II, 4 years postligation). Overall, two of 11 patients had significant functional scoliosis associated ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(86)80007-0
更新日期:1986-10-01 00:00:00
abstract:BACKGROUND:We examine the mechanism of aortic lengthening in a novel rodent model of tissue expander stimulated lengthening of arteries (TESLA). METHODS:A rat model of TESLA was examined with a single stretch stimulus applied at the time of tissue expander insertion with evaluation of the aorta at 2, 4 and 7day time p...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2015.09.008
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND/PURPOSE:The management of neonates with giant omphalocele remains challenging and multiple strategies have been described. We present the case of a 34-week-old neonate with isolated giant omphalocele managed with an external surgical skin closure system as a component of a staged closure strategy. CASE PRES...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2010.05.004
更新日期:2010-07-01 00:00:00
abstract::Primary malignant tumors of the stomach are rare in children. During the years 1952--1977, eight children were seen at Childrens Hospital of Los Angeles with primary malignant tumors of the stomach. The patients were between the ages of 20 mo and 17 hr and included 5 males and 3 females. The series consisted of 3 mali...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(80)80508-2
更新日期:1980-10-01 00:00:00
abstract:BACKGROUND:The incidence of Hickman catheter sepsis is 10% to 40%, with resultant catheter loss in one third of infections. Urokinase causes dissolution of colonized intracatheter fibrin thrombi and may improve salvage. STUDY AIMS:To evaluate the efficacy of 12-hour-interval slow-push urokinase infusion in addition to...
journal_title:Journal of pediatric surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0022-3468(94)90359-x
更新日期:1994-06-01 00:00:00
abstract:PURPOSE:Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative gra...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2013.11.041
更新日期:2014-02-01 00:00:00
abstract::Malignant melanomas are the most common skin cancer in the pediatric population. Melanoma incidence is extremely low in infants, and metastatic disease is even less common. We present the case of an 11-month-old girl who presented with a non-pigmented lesion that progressed to an ulcerated lesion. Pathology was found ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2014.01.007
更新日期:2014-04-01 00:00:00
abstract::Four children with dermatomyositis were recently seen with gastrointestinal perforations. The sites of perforation in the four cases were: (1) the duodenum, esophagus, and colon; (2) the duodenum; (3) the distal stomach; and (4) the traverse colon. The gastric and transverse colon perforations were intraperitoneal and...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(85)80479-6
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND:Many children evaluated for child abuse have non-inflicted injuries due to supervisory neglect. Despite its prevalence, supervisory neglect has received minimal attention. METHODS:We performed a retrospective review of patients maintained in a hospital forensic registry. Text analytics software was used to ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2019.10.010
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND/PURPOSE:The treatment of children with Hirschsprung's disease beginning in the proximal jejunum remains a challenge for the pediatric surgeon. These patients need a definitive parenteral nutrition, which could lead to a liver impairment. The goal of this work is to assess the quality of life after combined l...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2003.50072
更新日期:2003-03-01 00:00:00
abstract::Successful portal decompression presents a unique challenge in children. The meso-caval shunt, utilizing the large caliber iliac vein in constructing the anastomosis, has been accepted as the standard operative procedure for treating these patients. Technical and anatomic difficulties, however, often prevent the succe...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(79)80572-2
更新日期:1979-02-01 00:00:00
abstract:PURPOSE:Some have suggested that the criteria for weight loss surgery in adolescents be stricter than those currently recommended for adults by the National Institutes of Health (NIH). The aim of the current study is to define the characteristics of adolescents who meet NIH consensus criteria for bariatric surgery in a...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2008.12.033
更新日期:2009-10-01 00:00:00
abstract::Malignant peripheral nerve sheath tumors account for approximately 5% to 10% of all soft tissue sarcomas in which 25% to 50% are diagnosed in patients with neurofibromatosis 1 (NF1). Tumors are often located in the proximal portion of the upper and lower extremities and trunk, whereas cervical vagus nerve localization...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2011.04.058
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:The increasing prevalence of obesity has necessitated the increasing use of bariatric surgery in the adolescent population. Outcomes following laparoscopic sleeve gastrectomy (LSG) among adolescents, however, have not been well-studied. We report outcomes following LSG as a first-line surgical therapy in pat...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2016.08.023
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The distribution of ganglion cells in the transition zone of Hirschsprung Disease (HD) colons is extremely variable. Determining the resection margin based on intraoperative biopsies may be imprecise. Multiphoton microscopy (MPM) is a novel imaging technology with the ability to visualize tissues in real tim...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2013.03.025
更新日期:2013-06-01 00:00:00
abstract::We describe the successful use of ultrasound-guided retrieval of a submandibular stone with a basket, in a 13-year-old child. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2006.05.059
更新日期:2006-10-01 00:00:00
abstract::A polyethylene glycol electrolyte solution was evaluated as a mechanical bowel preparation prior to surgery in an outpatient setting. Twelve children underwent outpatient bowel preparation (OPBP) prior to a variety of surgical procedures. The technique was well tolerated and consistently produced a well-prepared intes...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(89)80725-0
更新日期:1989-07-01 00:00:00
abstract:PURPOSE:The aim of this study was to determine the role of magnetic resonance urography (MRU) in preoperative diagnostic workup of children with hydronephrosis in a prospective clinical study with comparison of MRU, standard diagnostic investigations, and intraoperative findings. METHODS:Thirty-one children with hydro...
journal_title:Journal of pediatric surgery
pub_type: 临床试验,杂志文章
doi:10.1053/jpsu.2002.35408
更新日期:2002-10-01 00:00:00
abstract:PURPOSE:The purpose of the study was to determine the accuracy of acoustic radiation force impulse (ARFI) ultrasound elastography in assessing the degree of liver disease in children with short bowel syndrome (SBS). METHODS:A prospective observational cohort study of patients with SBS who underwent a liver biopsy and ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2019.02.039
更新日期:2019-06-01 00:00:00
abstract:PURPOSE:Retinoids play an important role in lung development. Recently, prenatal treatment with retinoic acid (RA) has been reported to stimulate alveologenesis in hypoplastic lungs in the nitrofen model of congenital diaphragmatic hernia (CDH). Chicken ovalbumin upstream promoter-transcription factor II (COUP-TFII) is...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.04.027
更新日期:2009-10-01 00:00:00
abstract::Necrotizing fasciitis occurs when the inflammation (cellulitis) spreads beyond the umbilicus to include the subcutaneous tissue and underlying fascia. Presently, omphalitis is relatively uncommon because of aseptic delivery techniques and antimicrobial therapy. One hundred three neonates aged 7 to 28 days, with varyin...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(94)90133-3
更新日期:1994-11-01 00:00:00