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Children
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Diagnosis and Surgical Care of Pediatric Cancers
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Diagnosis and Surgical Care of Pediatric Cancers

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 4591

Special Issue Editors

Dr. Alessandro Boscarelli

E-Mail Website
Guest Editor
Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", 34137 Trieste, Italy
Interests: pediatric surgery; gastrointestinal surgery; minimally invasive surgery; congenital abnormalities; laparoscopic surgery; abdominal surgery
Dr. Jurgen Schleef

E-Mail Website
Guest Editor
Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", 34137 Trieste, Italy
Interests: endoscopic surgery; prenatal diagnostics and counselling; pulmonary malformation; short bowel; bacterial translocation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cancer is attested to be the second most prevalent cause of mortality among children aged 1 to 14 years, to date. Significant progresses have been observed in the field of diagnosis and treatment of pediatric cancers in recent decades. However, surgery remains a cornerstone of the management of pediatric cancers, whether performed at presentation or following neoadjuvant therapies. Notably, in recent years, new techniques have been incorporated into the armamentarium of surgeons dealing with pediatric cancer patients. In particular, laparoscopic- and robotic-assisted surgery have carved their space in the adult cancer population with evidence supporting less pain, shorter hospital stays, lower complications, and equivalent long-term survival and oncologic outcomes; and hopefully they may have a role in pediatric cancer surgery as well. In addition, the improvement in the quality imaging has allowed a three-dimensional visualization and printing to be incorporated into surgical practice, and fluorescence-guided surgery showed the advantage to distinguish anatomical or physiologic differences between cancer and normal tissue.

This Special Issue aims to discuss advances in diagnosis and surgical care of cancers in pediatric age. Colleagues and researchers are invited to submit their manuscripts.

We look forward to receiving your valuable contributions.

Dr. Alessandro Boscarelli
Dr. Jurgen Schleef
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric cancers
  • minimally invasive
  • cancer diagnosis
  • recent advances
  • pediatric surgery
  • children

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (4 papers)

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Research

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9 pages, 983 KiB  
Article
Ex Vivo Fluorescence Confocal Microscopy Meets Innovation and Revolutionary Technology, for “Real-Time” Histological Evaluation, in Pediatric Surgical Oncology
by Donatella Di Fabrizio, Edoardo Bindi, Michele Ilari, Alessandra Filosa, Gaia Goteri and Giovanni Cobellis
Children 2024, 11(12), 1417; https://doi.org/10.3390/children11121417 - 23 Nov 2024
Viewed by 415
Abstract
Background and Aim: Ex vivo fluorescence confocal microscopy (FCM) systems are innovative optical imaging tools that create virtual high-resolution histological images without any standard tissue processing, either freezing or fixing in formalin and embedding in paraffin. These systems have opened an era that [...] Read more.
Background and Aim: Ex vivo fluorescence confocal microscopy (FCM) systems are innovative optical imaging tools that create virtual high-resolution histological images without any standard tissue processing, either freezing or fixing in formalin and embedding in paraffin. These systems have opened an era that would revolutionize pathological examination by providing rapid, real-time assessments across various pathology subspecialties, potentially replacing conventional methods that are tissue- and time-consuming. This study aimed to present the first utilization of FCM in pediatric surgical oncology, focusing on assessing the benefits, particularly in facilitating rapid and accurate diagnosis. Methods: This preliminary study comprised five consecutive patients undergoing surgical biopsy for disease characterization and surgical strategy selection. After biopsy, tissue samples were prepared and analyzed using FCM without sectioning. A pathologist who evaluated macroscopic and microscopic images, once obtained remotely, could promptly indicate any interventions that require timeliness. Samples were then evaluated with conventional methods. Results: All five lesions were deemed suitable for evaluation. Preliminary diagnoses utilizing FCM included atypical Spitz nevus (1), Wilm’s tumor (1), lymph node reactive hyperplasia (1), malignant germ cell tumor of the testis (1), and Hodgkin’s lymphoma (1). Final histopathological analyses revealed atypical Spitz nevus (1), Wilm’s tumor (1), hyperplastic lymphadenopathy with a prevalent marginal pattern (1), mixed nonseminomatous malignant germinal neoplasm consisting of embryonal carcinoma (90%) and yolk sac tumor (10%), and Hodgkin’s lymphoma nodular sclerosis variant (1). In the case of diagnosis of atypical Spitz nevus, the widening of the resection margins was performed in the same surgery. In the case of testicular neoplasm, radical orchiectomy was performed. A high level of agreement between FCM evaluation and definitive histological examination was observed for all parameters evaluated. Conclusions: FCM represents a significant advancement in pathological imaging technology, offering potential benefits in enhancing traditional tissue processing methods. This preliminary report marks the first application of FCM in pediatric surgical oncology. Our findings underscore the promising role of FCM as an adjunctive tool in pediatric oncology, facilitating prompt diagnosis and treatment initiation. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Care of Pediatric Cancers)
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Figure 1

Figure 1
<p>Skin lesion was excised by pediatric surgeon and the specimen was divided in three sections and colored with fluorescent dyes (<b>A</b>: one section). Vivascope scanned each section of the lesion, and the virtual slides were acquired with different grades of magnification (<b>B</b>–<b>D</b>).</p> Full article ">Figure 2
<p>Low power slide scan: the lesion was originally cut in three sections, which were examined using confocal microscopy. Then, the same sections were put in the block for processing. The silhouette of the lesion is dermal-based (<b>A</b>). An intermediate power view demonstrates the sparing of the epidermis by the lesion, which showed a well-circumscribed superficial border and a clear-cut margin at the bottom without extending into the ipodermal fat (<b>B</b>,<b>C</b>). Cellular composition of the lesion, characterized by epithelioid plumped cells with wide eosinophilic cytoplasm, along with cytological nuclear details, were perfectly preserved at the definitive staining after confocal microscopy examination (<b>D</b>).</p> Full article ">
14 pages, 2167 KiB  
Article
Exploring Pediatric Vertebral, Sacral, and Pelvic Osteosarcomas through the NCDB: Demographics, Treatment Utilization, and Survival Outcomes
by Pemla Jagtiani, Mert Karabacak, Matthew T. Carr, Zeynep Bahadir, Peter F. Morgenstern and Konstantinos Margetis
Children 2024, 11(8), 1025; https://doi.org/10.3390/children11081025 - 21 Aug 2024
Viewed by 753
Abstract
Background and Objectives: Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. Methods: We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, [...] Read more.
Background and Objectives: Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. Methods: We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, and pelvic osteosarcomas in children 0 to 21 years. Our analysis involved logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. Results: The study population included 207 patients. For vertebral osteosarcomas, 62.5% of patients were female, and 78.1% were white. Regional lymph node involvement predicted 80 times higher mortality hazard (p = 0.021). Distant metastasis predicted 25 times higher mortality hazard (p = 0.027). For sacral and pelvic osteosarcomas, 58.3% of patients were male, and 72% were white. Patients with residual tumor were 4 times more likely to have prolonged LOS (p = 0.031). No residual tumor (HR = 0.53, p = 0.03) and radiotherapy receipt (HR = 0.46, p = 0.034) were associated with lower mortality hazards. Distant metastasis predicted 3 times higher mortality hazard (p < 0.001). Hispanic ethnicity was linked to lower resection odds (OR = 0.342, p = 0.043), possibly due to language barriers affecting patient understanding and care decisions. Conclusions: In conclusion, our examination of NCDB offers a thorough exploration of demographics, treatment patterns, and results, highlighting the importance of personalized approaches to enhance patient outcomes. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Care of Pediatric Cancers)
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Figure 1

Figure 1
<p>Kaplan-Meier survival estimates over time (<b>A</b>) grouped by primary site, (<b>B</b>) grouped by age category for vertebral osteosarcomas, (<b>C</b>) grouped by age category for sacral and pelvic osteosarcomas, (<b>D</b>) grouped by stage for vertebral osteosarcomas, (<b>E</b>) grouped by stage for sacral and pelvic osteosarcomas, (<b>F</b>) grouped by surgery receipt for vertebral osteosarcomas, (<b>G</b>) grouped by surgery receipt for sacral and pelvic osteosarcomas, (<b>H</b>) grouped by radiotherapy receipt for vertebral osteosarcomas, (<b>I</b>) grouped by radiotherapy receipt for sacral and pelvic osteosarcomas, (<b>J</b>) grouped by chemotherapy receipt for vertebral osteosarcomas, (<b>K</b>) grouped by chemotherapy receipt for sacral and pelvic osteosarcomas.</p> Full article ">Figure 2
<p>Heatmaps depicting the rates of (<b>A</b>) surgery by age category for vertebral osteosarcomas, (<b>B</b>) surgery by age category for sacral and pelvic osteosarcomas, (<b>C</b>) radiotherapy by age category for vertebral osteosarcomas, (<b>D</b>) radiotherapy by age category for sacral and pelvic osteosarcomas, (<b>E</b>) chemotherapy by age category for vertebra osteosarcomas, (<b>F</b>) chemotherapy by age category for sacral and pelvic osteosarcomas.</p> Full article ">Figure 3
<p>Multivariate Cox proportional hazards model evaluating the impact of selected variables (with <span class="html-italic">p</span>-values &lt; 0.2 from a preliminary univariate Cox proportional hazards analysis) on the mortality risk of patients with vertebral osteosarcomas.</p> Full article ">Figure 4
<p>Multivariate Cox proportional hazards model evaluating the impact of selected variables (with <span class="html-italic">p</span>-values &lt; 0.2 from a preliminary univariate Cox proportional hazards analysis) on the mortality risk of patients with sacral and pelvic osteosarcomas.</p> Full article ">
12 pages, 2877 KiB  
Article
Surgery in Bilateral Wilms Tumor—A Single-Center Experience
by Fernanda Kelly Marques de Souza, Mayara Caroline Amorim Fanelli, Alexandre Alberto Barros Duarte, Maria Teresa de Seixas Alves, Henrique Manoel Lederman, Monica dos Santos Cypriano and Simone de Campos Vieira Abib
Children 2023, 10(11), 1790; https://doi.org/10.3390/children10111790 - 7 Nov 2023
Cited by 1 | Viewed by 1548
Abstract
The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of [...] Read more.
The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute—GRAACC—Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Care of Pediatric Cancers)
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Graphical abstract

Graphical abstract
Full article ">Figure 1
<p>Surgical technique. (<b>A</b>) Manual compression of the renal parenchyma for bleeding control; (<b>B</b>) Reconstruction with “wrapping the parenchyma”.</p> Full article ">Figure 2
<p>Patients included in this study.</p> Full article ">Figure 3
<p>Approach to renal units in the first procedure.</p> Full article ">Figure 4
<p>Kaplan–Meier curve showing overall survival probabilities (Time = time in months). The shaded area represents the 95% confidence interval.</p> Full article ">

Review

Jump to: Research

23 pages, 6951 KiB  
Review
Wilms Tumor with Vena Caval Intravascular Extension: A Surgical Perspective
by Daniel B. Gehle, Zachary D. Morrison, Huma F. Halepota, Akshita Kumar, Clark Gwaltney, Matthew J. Krasin, Dylan E. Graetz, Teresa Santiago, Umar S. Boston, Andrew M. Davidoff and Andrew J. Murphy
Children 2024, 11(8), 896; https://doi.org/10.3390/children11080896 - 25 Jul 2024
Viewed by 1150
Abstract
Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus [...] Read more.
Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus extension is usually diagnosed by imaging. Neoadjuvant chemotherapy is indicated for thrombus extension above the level of the hepatic veins and often leads to thrombus regression, obviating the need for cardiopulmonary bypass in cases of cardiac thrombus at diagnosis. In cases of tumor extension to the retrohepatic cava, neoadjuvant therapy is not strictly indicated, but it may facilitate the regression of tumor thrombi, making resection safer. Hepatic vascular isolation and cardiopulmonary bypass increase the risk of bleeding and other complications when utilized for tumor thrombectomy. Fortunately, WT patients with vena caval with or with intracardiac extension have similar overall and event-free survival when compared to patients with WT without intravascular extension when thrombectomy is successfully performed. Still, patients with metastatic disease at presentation or unfavorable histology suffer relatively poor outcomes. Dedicated pediatric surgical oncology and pediatric cardiothoracic surgery teams, in conjunction with multimodal therapy directed by a multidisciplinary team, are preferred for optimized outcomes in this patient population. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Care of Pediatric Cancers)
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Figure 1

Figure 1
<p>Diagram of Wilms tumor intravascular involvement classification system proposed by Abdullah et al. [<a href="#B11-children-11-00896" class="html-bibr">11</a>] wherein (1) indicates infrahepatic, (2) indicates retrohepatic, (3) indicates suprahepatic, (4) indicates right atrial, and (5) indicates right ventricular tumor thrombus extension. Created with <a href="http://BioRender.com" target="_blank">BioRender.com</a>.</p> Full article ">Figure 2
<p>A five-year-old female presented with a right-sided Wilms tumor (WT) with infrahepatic inferior vena cava (IVC) extension. She underwent neoadjuvant chemotherapy followed by nephrectomy, cavotomy, and thrombectomy. (<b>A</b>) Preoperative computed tomography (CT) demonstrating a right-sided WT with infrahepatic IVC thrombus (arrow) in the coronal plane and (<b>B</b>) sagittal plane. (<b>C</b>) Three-dimensional reconstruction of preoperative CT, showing the right-sided WT and intravascular thrombus (yellow) within the IVC (blue) and iliac veins, with adjacent aorta (red) and left kidney (brown). (<b>D</b>) Intraoperative photo with the patient’s head towards the top left, demonstrating the right-sided mass and vascular isolation with vessel loops around the right renal vein (bottom), infrarenal IVC (right), left renal vein (top right), and suprarenal IVC (top left) prior to cavotomy and thrombectomy. (<b>E</b>) Final surgical specimen, demonstrating vena cava thrombus (arrow) removed en bloc with the right kidney and tumor.</p> Full article ">Figure 3
<p>A 5-year-old female presented with a large right kidney mass with intravascular extension to the inferior vena cava (IVC) and right atrium (RA). She underwent neoadjuvant chemotherapy followed by local control surgery. Final pathology was reported as clear cell sarcoma of the kidney. (<b>A</b>) Preoperative computed tomography after neoadjuvant therapy demonstrating persistent right atrial thrombus (arrow) in the coronal plane. (<b>B</b>) Preoperative transthoracic echocardiogram with a heterogeneous, echogenic mass in the RA. (<b>C</b>) Intraoperative photograph after resection of right kidney and tumor, with the right renal vein obliterated by tumor and divided near its confluence with the IVC (yellow circle), a blue vessel loop around the infrarenal IVC (bottom), the liver reflected cephalad (top), and abdominal viscera reflected towards the patient’s left (right on photograph). (<b>D</b>) Delivery of a heterogeneous mass in forceps out of the right atrium after cardiopulmonary bypass initiation. (<b>E</b>) Piecemeal resection of tumor thrombus (yellow circle) during partial cavectomy (blue oval) of retrohepatic IVC, with the patient’s liver reflected cephalad (bottom left). (<b>F</b>) Following bovine pericardial patch repair of partial retrohepatic cavectomy (see the <a href="#app1-children-11-00896" class="html-app">Supplementary Materials Video S2</a> for a video of intraoperative steps from this case).</p> Full article ">
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