Journal of pediatric surgery最新文献

{"title":"Evaluating Postoperative Opioid Prescription Fills and Refills for Adolescents Undergoing Surgery","authors":"Rabab M. Barq ,&nbsp;Shadassa Ourshalimian ,&nbsp;Laura Houshmand ,&nbsp;Olivia A. Keane ,&nbsp;Eugene Kim ,&nbsp;Lorraine I. Kelley-Quon","doi":"10.1016/j.jpedsurg.2024.162007","DOIUrl":"10.1016/j.jpedsurg.2024.162007","url":null,"abstract":"<div><h3>Introduction</h3><div>Prescription drug monitoring programs (PDMPs) are state-run databases that track controlled substances to reduce substance use and diversion. The accuracy of PDMPs for adolescents who receive postoperative opioid prescriptions is unknown.</div></div><div><h3>Methods</h3><div>This prospective cohort study was conducted at a free-standing tertiary children’s hospital from 2019 to 2020. Adolescents 13-20 y undergoing elective surgery commonly associated with an opioid prescription at discharge were enrolled. Prescription opioid fills and refills were measured through five data sources: (1) Electronic Medical Record (EMR) prescription orders (2) postoperative clinic notes, (3) California’s PDMP and (4) adolescent and (5) parent surveys. UpSet plots were used to visualize and quantify data overlap between sources.</div></div><div><h3>Results</h3><div>The majority of the 55 adolescents enrolled were Hispanic/Latino (52.7%), female (54.5%), and underwent posterior spinal fusion (41.8%). Of 42 adolescents with an opioid prescription in the EMR, the greatest overlap in data sources occurred between the EMR and PDMP (92.9%) with only 19% of adolescents having their opioid prescription fill captured in all five data sources. Two patients (3.6%) who did not receive an opioid prescription based on EMR or survey data were identified in the PDMP. Survey data indicated that eight adolescents (19.0%) refilled their opioid prescription. However, the PDMP only captured four (9.5%) refills.</div></div><div><h3>Conclusion</h3><div>Discrepancies exist among EMR, PDMP, and survey documentation of prescription opioid dispensing and refills for adolescents undergoing surgery. These findings highlight the need to capture multiple data sources when tracking prescription opioid dispensing. Additionally, there is opportunity for improved accuracy within prescription drug monitoring programs.</div></div><div><h3>Type of Study</h3><div>Prospective Cohort Study.</div></div><div><h3>Level of Evidence</h3><div>Level 4.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162007"},"PeriodicalIF":2.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Many Lymph Nodes are Enough in Paratesticular Rhabdomyosarcoma?","authors":"Katelyn A. Spencer ,&nbsp;Brittany Levy ,&nbsp;Will Cranford ,&nbsp;Christopher J. McLouth ,&nbsp;Haley Copeland ,&nbsp;Jonathan C. Routh ,&nbsp;David A. Rodeberg ,&nbsp;Amanda F. Buchanan","doi":"10.1016/j.jpedsurg.2024.162040","DOIUrl":"10.1016/j.jpedsurg.2024.162040","url":null,"abstract":"<div><h3>Background</h3><div>Treatment strategies for paratesticular rhabdomyosarcoma (PT RMS) are based on stage, which requires accurate lymph node (LN) evaluation. Previous methodology for determining quantity of LN for negative nodal status is based on LN positivity rates, without accounting for the relationship between LNs or amongst patients. This study aims to quantify the chance of missing involved LNs based on LN yield (LNY) using a previously established methodology in comparison to current recommendations.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, patients with a diagnosis of PT RMS were queried from 2004 to 2018. Patients &gt;10 years and those ≤10 years with cN1 disease were included, based on COG guidelines for who should undergo retroperitoneal LN sampling (RPLNS). The beta-binomial model was used to calculate the rate of false negative RPLNS and identified the LNY threshold to reduce the risk of a missing an involved LN node to &lt;10 %.</div></div><div><h3>Results</h3><div>Sixty-two patients were included for analysis over the study period. Median LNY was 17 (IQR 9–28.75), and the median number of involved LNs was 2.5 (IQR 2–5). The median LN density was 0.27 (IQR 0.10–0.34). Application of the beta-binomial model identified that a LNY of 26 LNs corresponds to a &lt;10 % chance of missing occult disease (Fig. 3).</div></div><div><h3>Conclusion</h3><div>Previous models estimate that sampling of 7–12 LN is adequate for accurate staging. However, the beta binomial model quantifies sampling at least 26 LNs to reduce the chance of missing occult metastatic disease to &lt;10 % in the majority of patients. Surgeons should consider this false negative rate during RPLNS for patients with PT RMS.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162040"},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complication Rates and Variability in Gastrojejunostomy Tube Usage in Infants and Children","authors":"Oliver S. Zhao ,&nbsp;Maren E. Shipe ,&nbsp;Melissa E. Danko ,&nbsp;Eunice Y. Huang ,&nbsp;Jamie R. Robinson","doi":"10.1016/j.jpedsurg.2024.162047","DOIUrl":"10.1016/j.jpedsurg.2024.162047","url":null,"abstract":"<div><h3>Background</h3><div>Gastrojejunostomy tube (GJT) placement is commonly performed for enteral access and post-pyloric feeding in children with gastric feeding intolerance. Prior studies have suggested the risk of surgical complications is elevated in infants compared to older children. We aim to characterize GJT usage in children and investigate the risk factors for postoperative complications through two national databases.</div></div><div><h3>Methods</h3><div>We performed a multi-institutional retrospective cohort study on children who underwent GJT placement utilizing two national databases, the Pediatric American College of Surgeons National Surgical Quality Improvement Program (Ped-NSQIP) and the Pediatric Health Information System (PHIS). Analyses were performed within each cohort separately to determine differences in outcomes between infants (&lt;1 year of age) and non-infants (≥1 year of age). Multivariable logistic regression was performed to determine associations with postoperative complications.</div></div><div><h3>Results</h3><div>Infants did not have an increased rate of surgical complications compared to non-infants in the Ped-NSQIP cohort (26.9 % vs. 29.0 %, <em>p</em> = 0.84) or PHIS cohort (35.3 % vs. 30.7 %, <em>p</em> = 0.07). There was an increased risk of complications in African American infants (OR 1.93, 95 % CI 1.01–3.67) and non-infants (OR 1.64, 95 % CI 1.27–2.10) and for urgent procedures or emergent procedures in both infants and non-infants (OR 5.42–6.46 and OR 2.12–2.61, respectively). GJT placement and complication rates significantly varied across institutions.</div></div><div><h3>Conclusion</h3><div>We demonstrate substantial but similar overall complication rates of GJT placement between infants and non-infants. These findings suggest age alone should not negate placement of GJTs when indicated for enteral access in children.</div></div><div><h3>Level of Evidence</h3><div>3.</div></div><div><h3>Type of study</h3><div>Multi-institutional, retrospective, cohort study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"Article 162047"},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of Botulinum Toxin Injection Into the External Anal Sphincters: An Effective New Treatment of Chronic Functional Constipation in Children.","authors":"Alireza S Keshtgar As, Ahmad Suliman, Hemanshoo Thakkar, Iman Selim","doi":"10.1016/j.jpedsurg.2024.162049","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162049","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin (BT) is a well-recognised treatment of chronic functional constipation (FC) and soiling refractory to medical treatment. The aims of this study were to assess the short and long-term outcomes of BT injection into the external anal sphincter muscles (EAS) for chronic FC treatment.</p><p><strong>Methods: </strong>We studied 196 children unresponsive to medical management of chronic FC, soiling, painful defecation and withholding behaviour (Rome III criteria) from April 2011 to January 2023. All patients underwent anorectal manometry (ARM) and endosonography-guided BT injection (Dysport® or Botox®) 10 units/kg body weight (maximum 200 units) into the EAS muscles at 3 and 9 o'clock positions and colonic transit study. Outcomes were measured using a validated symptom severity (SS) score questionnaire pre-operatively, at 3-6 months and 12-24 months follow up including: defecation frequency and pain, soiling, laxative(s), general health, behaviour, symptom improvement and faecaloma. Sum of scores ranged from 0 (best) to 65 (worst). We used Wilcoxon signed-rank test for matched-pairs related analysis and data presented as median (range) and p value < 0.05 was considered significant.</p><p><strong>Results: </strong>196 patients (104 male) with a median age of 7 (1-16) years underwent anorectal investigations and BT injection into the external anal sphincters during 12 year study period. The median short and long term follow-up was 4 (1-27) months and 16 (5-60) months, respectively. 26 (13 %) patients had autism and 14 (7.1 %) had attention deficit hyperactivity disorder (ADHD). Median anal sphincter resting pressure was of 55 (20.5-113) mmHg. The pre-operative total SS score improved from median 31/65 (4-57) before BT treatment to median 15/65 (0-49) at 4-month after BT injection and median 16/65 (0-56) at 16-month follow-up, p < 0.001. 80 % (104/130) of patients showed significant short-term and 79 % (71/90) showed long-term improvement of their chronic FC symptoms following BT injections. 9 % (18/196) children required second BT injection for symptom recurrence and 18.3 % (36/196) required formation of an antegrade colonic enema (ACE) stoma.</p><p><strong>Conclusion: </strong>BT injection is an effective and safe new treatment of chronic FC unresponsive to conventional medical treatments. In our experience, 80 % of children have significant improvement of their symptoms and 9 % require repeat BT injection during a long term follow-up.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162049"},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotics in Pediatric Urology: A Review.","authors":"Mohan S Gundeti, Judah Huberman-Shlaes","doi":"10.1016/j.jpedsurg.2024.162022","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162022","url":null,"abstract":"<p><strong>Background: </strong>Recent technological advances have enabled pediatric urologist to push the envelope of minimally invasive techniques. Recently, implementing robots into laparoscopic procedures has enabled the mitigation of certain drawbacks, opening the door for the implementation of minimally invasive techniques. The purpose of this review is to identify the current state surrounding robotic surgery and explore future directions for the field.</p><p><strong>Methods: </strong>The authors undertook a literature search to explore the current state of robotic surgery in pediatric procedures.</p><p><strong>Results: </strong>While operative times are longer for robotic surgery, robotic surgery operations have reported shorter post-operative hospital stays, lower pain medication use, and similar success rates relative to open procedures. New advances in training may enable improved training paradigms for novice surgeons, decreasing future operative times.</p><p><strong>Conclusion: </strong>Evidence from the field suggests robotic surgery is an optimal alternative to open procedures, conferring advantages to both the patient and surgeon.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162022"},"PeriodicalIF":2.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Initiation of Statewide Pediatric Trauma Collaborative and Hospital Preventable Transfer Rates.","authors":"Jack H Scaife, Christopher E Clinker, Abigail J Alexander, Stephanie E Iantorno, R Scott Eldredge, Robert A Swendiman, Stephen J Fenton, Katie W Russell","doi":"10.1016/j.jpedsurg.2024.162004","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162004","url":null,"abstract":"<p><strong>Introduction: </strong>The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals that have implemented guidelines to optimize pediatric trauma care. The purpose of this study was to determine whether preventable transfer (PT) rates decreased following the establishment of the UTPN and what hospital characteristics were associated with decreased preventable transfers.</p><p><strong>Methods: </strong>Children with traumatic injuries transferred from hospitals in the UPTN to the state's only Level I Pediatric Trauma Center between 2013 and 2023 were retrospectively analyzed. A PT was a child discharged within 48 h of arrival without surgical intervention or advanced imaging studies. The main hospital-level outcome measure was an overall decrease in PT after the UPTN establishment in 2019.</p><p><strong>Results: </strong>After 2019, 34 of the 46 hospitals meeting inclusion criteria saw a decrease in the percentage of PTs, while 12 saw an increase in PT rate, with an overall median change of -7 % (IQR -14 %, 0 %). We observed that hospitals with decreased PT had higher rates of PT before the establishment of the UPTN and had higher overall transfer volume than hospitals without a decreased PT rate. Can we put the overall p value in this?</p><p><strong>Conclusion: </strong>Most hospitals were able to successfully decrease PT rates following the creation of the UPTN. More smaller hospitals did not successfully decrease PT, so more work may need to be done to target lower-volume hospitals.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162004"},"PeriodicalIF":2.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnets in Paediatric Surgery.","authors":"Oliver J Muensterer","doi":"10.1016/j.jpedsurg.2024.162042","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162042","url":null,"abstract":"<p><p>Magnetism, recognized in ancient Greece and China, is a fundamental physical force influencing numerous domains, including medicine and surgery. Historically, the medical use of magnets dates back over two millennia. As proof, the ancient Sanskrit medical textbook Sushruta Samhita describes the removal of a metallic arrow lodged in the flesh with a magnet. Modern uses span from diagnostic to therapeutic applications, including in paediatric surgery. High-field magnetism, utilized in Magnetic Resonance Imaging and Transcranial Magnetic Stimulation (TMS), shows promise for various medical conditions, including depression and neurodegenerative diseases. Despite controversy surrounding low-field magnetism, its potential remains a topic of interest. One of the applications in paediatric surgery that has been evaluated in a randomized controlled trial is magnetic acupuncture for supplementary treatment of postoperative pain. As most paediatric surgeons are well aware, the use of magnets also poses risks, particularly in children, where ingested magnets can cause severe gastrointestinal complications. Regulations have tightened in response to increasing cases of magnet ingestion-related injuries but more needs to be done to avoid injury. Currently, magnets play crucial roles in a variety of medical applications, including magnetic cell sorting and therapeutic devices. Notably, magnetic compression anastomosis, which uses magnets to facilitate luminal tissue joining, have seen significant advancements. Innovations include devices for oesophageal atresia repair, with recent studies showing promising results in animal models and early clinical trials. Future research should focus on optimizing magnetic devices, expanding their applications, and ensuring safety. The continued exploration of magnetism's effects on living tissues and the development of new magnetic technologies could revolutionize medical and surgical practices, particularly in paediatric care.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162042"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal Anastomosis During Enterostomy Takedown Using a 5 mm Miniature Endostapler Compared to Conventional Handsewn Technique.","authors":"Ahmed Gamal Abdelmalek Moursi, Stephan Rohleder, Marilena Christofi, Oliver J Muensterer, Tatjana T König","doi":"10.1016/j.jpedsurg.2024.162041","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162041","url":null,"abstract":"<p><strong>Aim: </strong>Enterostomy takedown is common in neonates with Hirschsprung's disease, anorectal malformations, or necrotizing enterocolitis. Stapled bowel anastomosis has become routine in adults, but size of up to 12 mm diameter precludes performing enterostomy takedown in young infants using regular intestinal staplers. After the introduction of miniature (5 mm diameter) staplers, we increasingly used them for enterostomy takedown. This study compares enterostomy takedown using the miniature stapler (MS) to the conventional hand-sewn (HS) technique.</p><p><strong>Methods: </strong>Retrospective review of all children <3 years of age undergoing enterostomy closure at our institution from 2008 to 2023 were retrospectively reviewed. Demographics, operative times, complications, and outcomes were compared between those who underwent the procedure using MS versus HS technique. Data are quoted as median (range).</p><p><strong>Results: </strong>A total of 102 patients were enrolled, including MS (n = 26) and HS (n = 76) anastomoses. There were no statistical differences in age, sex, or indication for enterostomy. Enterostomy takedown using MS was faster [82.5 (44-218) versus 147 (52-381) minutes, p < 0.001) and associated with earlier commencement of feedings [2 (1-6) versus 4 (1-24) days, p = 0.001], as well as shorter length-of-stay [6 (2-20) versus 17 (3-52) days, p < 0.001), compared to the HS technique.</p><p><strong>Conclusions: </strong>This is the first study that systematically evaluates the novel 5 mm ministapler for enterostomy takedown in young children. Its use was associated with quicker operative times, earlier feeding and shorter hospital stay. These findings are especially relevant in children with co-morbidities who do not tolerate longer anesthesia times. Randomized, controlled trials should be performed to prospectively confirm these findings.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162041"},"PeriodicalIF":2.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Surgery in Paediatric Oncology: Expanding Boundaries and Defining Relevant Indications.","authors":"Thomas Blanc, Kiarash Taghavi, Mathilde Glenisson, Carmen Capito, Vincent Couloigner, Nicolas Vinit, Sabine Sarnacki","doi":"10.1016/j.jpedsurg.2024.162017","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162017","url":null,"abstract":"<p><p>This article reviews the establishment and progress of the Multidisciplinary Paediatric Robotic Program in a high-volume paediatric surgery department at Hôpital Necker-Enfants Malades, Paris, France. A major foundational principle of the program was to establish a safe and secure environment for patients and staff, both pre-operatively, intra-operatively and post-operatively. This founding principle when applied systematically has allowed increasing confidence across the program and service. The robotic platform allows for precision surgery when approaching tumours, with freedom of movement adapted to meticulous vascular and organ dissection. Surgical feasibility is based on tumour characteristics, pre-operative imaging, with a focus on vascular and organ involvement, considering goals of surgery and surgical experience. Case complexity has been gradually increased (where appropriate) through an iterative process. The future of surgery is robotic, and even more so image-guided surgery, and this synergy has been instrumental when approaching tumour surgery in children. The current principles that guide application of robot-assisted surgery in paediatric tumours are presented. With this blueprint, excellent oncological outcomes can be achieved while utilising a minimally invasive approach in children with selected endocrine, neuroblastic and renal tumours.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162017"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaches to the Diagnosis and Management of Paediatric Ovarian Tumours and Oncological Outcomes in a Single-centre Study. Evidence in Support Of IPSO Reccomendations","authors":"Anastasia Mentessidou,&nbsp;Claire Jackson","doi":"10.1016/j.jpedsurg.2024.162009","DOIUrl":"10.1016/j.jpedsurg.2024.162009","url":null,"abstract":"<div><h3>Background</h3><div>Approaches to paediatric ovarian tumours vary. Cross-sectional imaging is reliable but not always performed. Laparoscopic tumourectomy, although popular, is not recommended by International Paediatric Surgical Oncology Society (IPSO); tumour spillage remains the main concern. We aimed to investigate the reliability of preoperative evaluation and identify perioperative factors associated with adverse outcomes.</div></div><div><h3>Methods</h3><div>Single-centre retrospective study (2015–2022) of clinical presentation, preoperative investigation, operative approaches and oncological outcomes in all females &lt;18 years treated for ovarian tumours. Logistic regression was used to identify predictors of malignancy and of second disease events. Data are presented as median (IQR) or rates.</div></div><div><h3>Results</h3><div>Sixty girls aged 12.5 (10–15) years with follow-up of 51 (30.5–76.3) months were included. Incidence of malignant and low malignant potential tumours was 19/60 (32%). Tumour size and consistency proved predictive of malignancy. Clinical assessement, tumour markers and cross-sectional imaging combined showed 75% sensitivity, 100% specificity and 7% misclassified malignancy rate. Second disease events (11/60, 18%) were associated with misclassified malignancy (2/11 vs. 1/49, <em>p</em> = 0.04) and positive margins (4/11 vs. 5/49, <em>p</em> = 0.02). Ovarian-sparing surgery did not influence second events (5/11 vs. 28/49, <em>p</em> = 0.48). There was no significant association between second events and laparoscopic tumourectomy (3/11 vs. 20/49, <em>p</em> = 0.40); spillage rate was however more frequent with laparoscopy (5/11 vs. 2/32, <em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>Misclassified malignancy, noted in 7% of patients undergoing optimal work-up, adversely impacted outcomes, highlighting the importance of oncological principles in both oophorectomy and ovarian-sparing surgery. Malignancy incidence and misclassification can be underestimated when tumours with malignant behaviour potential, such as immature teratomas and borderline tumours, are grouped as benign. There was no direct association between operative approaches and second events. Laparoscopy, however, failed to maintain oncological principles more frequently than open surgery and hence risks upstaging of paediatric ovarian pathology.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162009"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}