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  • Hepatic resections for pediatric hepatoblastoma: analysis of 30-day outcomes using the National Surgical Quality Improvement Program-Pediatric database. Pediatric surgery international Thobani, H., Durrani, R., Raymond, S. L., Shah, A. A., Islam, S., Khan, F. A. 2024; 40 (1): 230

    Abstract

    BACKGROUND: Surgical resection remains the cornerstone of treatment for hepatoblastoma in children and offers the best chance of disease-free survival. We aimed to analyze the 30day outcomes of hepatic resection for hepatoblastoma stratified by extent using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P).METHODS: We queried NSQIP-P for children undergoing resection of Hepatoblastoma from 2012 to 2021. Relevant clinical characteristics and outcomes were extracted for multivariate logistic regression to identify predictors of common adverse outcomes.RESULTS: We included 458 children with a median age of 1.90years. Overall complications were rare, and perioperative blood transfusion (64.2%) and postoperative ventilation>48h (10.0%) were the only adverse events prevalent in more than 5% of patients. Median transfusion volume was 15.7ml/kg. On multivariate regression, only patients undergoing Trisectionectomy (aOR=3.387, 95% C.I.=1.348-8.510) had higher odds of receiving>75th percentile blood transfusion. Furthermore, only perioperative transfusion and postoperative ventilation>48h were statistically more common in patients undergoing extended versus standard resections.CONCLUSIONS: Outcomes following resection of hepatoblastoma are excellent, with low rates of postoperative adverse events. Although children undergoing trisectionectomy likely require greater transfusion volume, extended hepatic resections do not appear to have worse 30day outcomes despite greater operative complexity and duration.

    View details for DOI 10.1007/s00383-024-05820-y

    View details for PubMedID 39154089

  • Pancreatic masses in children: a single-center experience over two decades. European journal of pediatrics McRae, J. J., Thobani, H., Sacks, M. A., Raymond, S. L., Shah, A., Radulescu, A., Khan, F. A. 2024

    Abstract

    Pancreatic masses are extremely rare in pediatric patients, with limited data available. This lack of data makes the diagnosis and management of these tumors in children extremely challenging. Therefore, we aimed to describe the presentations, clinical course, and outcomes of children with pancreatic tumors at our center. A retrospective analysis was performed of all pediatric patients diagnosed with pancreatic masses between 2003 and 2022 in an academic freestanding children's hospital. Data including demographics, clinical presentation, workup, management, and subsequent morbidity and mortality were collected and aggregated. Furthermore, we reviewed cases of pancreatic tumor resections in the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) database to identify common adverse outcomes and measures for quality improvement. In total, 17 patients were identified at our institution. Diagnoses included solid pseudopapillary (n = 9), gastrinoma (n = 1), rhabdomyosarcoma (n = 2), pancreatoblastoma (n = 2), and insulinoma (n = 1). Two patients did not have a histopathologic diagnosis and were excluded from subsequent analysis. Overall, 12 patients underwent surgical intervention, with the most common procedures being pancreaticoduodenectomy and distal pancreatectomy, and all 12 were known to be alive at last contact. There were 3 deaths, all due to complications related to metastatic disease. Furthermore, 30-day postoperative outcomes in the NSQIP-P dataset for pancreatic surgeries in pediatric patients are excellent, with negligible morbidity and no mortalities after the index surgery.Children with pancreatic tumors amenable to surgical resection appear to have adequate long-term survival. Short-term outcomes at diagnosis are excellent and mainly appear to be influenced by the presence of metastatic disease at initial presentation.• Pancreatic masses are a rare entity in children with limited data on their presentation, management and surgical outcomes. • Solid Pseudopapillary tumors are one of the most common pancreatic tumors in children with a fair prognosis after surgical intervention.• Surgical management of pediatric patients with pancreatic tumors is safe and effective in patients who do not have aggressive tumor types or metastatic disease. • Our case series provides a notable cohort of these pancreatic tumors with insight into the presentation, management and outcomes of five of these tumor types.

    View details for DOI 10.1007/s00431-024-05731-z

    View details for PubMedID 39145888

    View details for PubMedCentralID 10941481