# Wilms Tumor — GCMD Library living collection

Also covers: neuroblastoma · hypertension · pulmonary metastases · anaplastic histology · favorable histology · renal failure · anaplastic Wilms tumor · favorable histology Wilms tumor

Experts: Dr. Todd Ponsky, Dr. Peter Ehrlich, Dr. Tony Sandler, Dr. Greg Tiao

Updated: n/a · 20 episodes · 328 cited statements

## Episodes
### Fundamentals
- [Wilms Tumor](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533) — video · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533.md)
- [Topics in 10: Wilms Tumor](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583) — podcast · 12:29 · [machine version](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md)

### Medical Management
- [Update Course Rewind: Updates in Wilms Management 2024](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937) — video · 4:07 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937.md)

### Complications
- [Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581) — video · 1:04 · [machine version](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581.md)

### Evidence & Research
- [Wilms Tumor Protocol Violations: Practice Gap discussion at Update Course 2018](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345) — video · 9:55 · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345.md)
- [Wilms Tumor Protocol Violations: 2018 Pediatric Surgery Practice Gap #3](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460) — video · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460.md)
- [Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462) — video · 1:21 · [machine version](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462.md)
- [Journal of Pediatric Surgery Article Highlights: April 2022](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md)
- [Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077.md)
- [Eficacia y efectos renales tardíos de la cirugía conservadora de nefronas en el tratamiento del tumor de Wilms unilateral: una revisión sistemática y un metanálisis](https://origin-library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-8079) — video · 1:02 · [machine version](https://origin-library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-8079.md)
- [Quick Literature Updates Ep 21](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050) — video · 4:04 · [machine version](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050.md)
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371) — video · 1:06 · [machine version](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371.md)
- [Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658) — video · 1:15 · [machine version](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658.md)

### Case-Based Learning
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.md)
- [Wilms Tumor Rapid Fire: Update Course 2015](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993) — video · 8:46 · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993.md)
- [Neuroblastoma](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620.md)

### In-Depth Reviews
- [Wilms Tumor: Audio Chapter](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926) — podcast · 1:04:03 · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926.md)
- [Wilms Tumor: Audio Chapter](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 1:04:03 · [machine version](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md)

### Emerging & Future Directions
- [Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856.md)

## Chapters
- [0:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=1) Case presentation and audience polling on management of metastatic Wilms tumor (Ep 1)
- [1:52](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=112) Lymph node sampling requirement and local versus systemic staging (Ep 1)
- [5:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=320) Management of pulmonary nodules and radiation therapy criteria (Ep 1)
- [8:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481) Summary of take-home points and quality improvement outcomes (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=0) Introduction and Case Presentation (Ep 2)
- [1:54](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=114) Differential Diagnosis and Imaging Features (Ep 2)
- [4:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=290) Workup and Indications for Primary Surgery vs. Preoperative Chemotherapy (Ep 2)
- [8:53](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=533) Staging Systems and Treatment Implications (Ep 2)
- [14:56](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=896) Biopsy Technique and Central Line Placement (Ep 2)
- [19:34](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1174) COG Staging System Details and Treatment Stratification (Ep 2)
- [24:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1456) Management of Pulmonary Metastases (Ep 2)
- [27:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1644) COG vs. SIOP Treatment Philosophies (Ep 2)
- [30:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1831) Surgical Technique: Preoperative Preparation and Approach (Ep 2)
- [37:55](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2275) Operative Technique: Nephroureterectomy and Lymph Node Sampling (Ep 2)
- [41:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2476) Surgical Margins and Tumor Rupture (Ep 2)
- [43:29](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2609) Very Low-Risk Patients: Surgery-Only Cohort (Ep 2)
- [45:27](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2727) Management of IVC Tumor Thrombus (Ep 2)
- [51:56](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3116) Pathology and Risk Stratification (Ep 2)
- [56:41](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3401) Bilateral Wilms Tumor Management (Ep 2)
- [62:34](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3754) Closing Remarks (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=0) Bilateral Wilms Tumor: Nephron-Sparing Surgery and Anaplastic Histology (Ep 3)
- [9:26](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=566) Gastroschisis Management: Bedside Reduction and Tegaderm Closure (Ep 3)
- [16:22](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=982) Complex Gastroschisis with Atresia (Ep 3)
- [19:55](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1195) Vanishing Gastroschisis and Early Re-exploration (Ep 3)
- [22:56](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1376) Apple-Peel Ileal Atresia and Bowel Lengthening (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=0) Initial presentation and management decision for bilateral Wilms tumor (Ep 4)
- [1:45](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=105) Management after incomplete chemotherapy response (Ep 4)
- [3:41](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=221) Surgical approach and pathology results (Ep 4)
- [5:19](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=319) Management of anaplastic findings and completion nephrectomy debate (Ep 4)
- [7:54](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=474) Outcomes and summary principles (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0) Wilms Tumor Protocol Violations Overview (Ep 5)
- [0:04](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=4) Non-Operative Management of Appendicitis as 2018 Practice Gap #2 (Ep 6)
- [0:00](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0) Introduction and Epidemiology of Wilms Tumor (Ep 8)
- [1:17](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=77) Clinical Presentation and Diagnostic Workup (Ep 8)
- [2:55](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=175) Staging System for Wilms Tumor (Ep 8)
- [4:03](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=243) Treatment of Unilateral Wilms Tumor (Ep 8)
- [6:49](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=409) Management of Bilateral Wilms Tumor (Ep 8)
- [8:37](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=517) Management of Intravascular Tumor Extension (Ep 8)
- [9:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=593) Treatment of Metastatic Disease (Ep 8)
- [11:03](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=663) Summary and Closing (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:11](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=11)
- 14% of patients required a repeat laparotomy — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:20](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=20)
- The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence — Sophia Schermerhorn (clinical) [Ep 18 · 0:21](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=21)
- In Wilms tumor, obstruction typically occurred within the first year — Sophia Schermerhorn (clinical) [Ep 18 · 0:26](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=26)
- In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up — Sophia Schermerhorn (clinical) [Ep 18 · 0:29](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=29)
- Radiation dose was not associated with re-operation risk — Sophia Schermerhorn (clinical) [Ep 18 · 0:34](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=34)
- Secondary malignancy was uncommon in this cohort — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:37](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=37)
- Hypertension after nephrectomy was not increased compared to population norms — Sophia Schermerhorn (clinical) [Ep 18 · 0:37](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=37)
- Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:45](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=45)
- Scoliosis has multi-factorial contributors including surgery and possibly radiation — Sophia Schermerhorn (clinical) [Ep 18 · 0:45](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=45)
- Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up — Sophia Schermerhorn (guideline) [Ep 18 · 0:58](https://origin-library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuro-11581?t=58)
- Non-operative management of perforated appendicitis has been known for a long time. (clinical) [Ep 6 · 0:19](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management. (clinical) [Ep 6 · 0:19](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management. (clinical) [Ep 6 · 0:35](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management resulted in decreased hospital stays compared to operative management. (clinical) [Ep 6 · 0:35](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management resulted in decreased days of disability compared to operative management. (clinical) [Ep 6 · 0:35](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account. (guideline) [Ep 6 · 0:52](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=52)
- APSA was not making a flat out recommendation to start doing non-operative appendicitis. — Gibbons (opinion) [Ep 6 · 1:08](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=68)
- The data on non-operative appendicitis management is becoming more clear. — Gibbons (opinion) [Ep 6 · 1:14](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=74)
- The choice between operative and non-operative appendicitis management remains dealer's choice. — Gibbons (opinion) [Ep 6 · 1:06](https://origin-library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=66)
- Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:12](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=12)
- Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:20](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=20)
- The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:31](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=31)
- After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:37](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=37)
- Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:44](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=44)
- Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:44](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=44)
- Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health — Sophia Schermerhorn (opinion) [Ep 17 · 0:51](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=51)
- Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors — Sophia Schermerhorn (opinion) [Ep 17 · 1:00](https://origin-library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-11371?t=60)
- Lymph nodes must be taken out during nephrectomy for Wilms tumor (guideline) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Failure to take out lymph nodes automatically upstages Wilms tumor patients (guideline) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- There is both a local and systemic staging system for Wilms tumor (clinical) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Pulmonary metastases do not preclude primary nephrectomy in Wilms tumor (guideline) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- Primary nephrectomy in metastatic Wilms tumor affects whether the patient receives radiation therapy (clinical) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- There is a local stage for Wilms tumor and a patient staging for Wilms tumor — Erlick (clinical) [Ep 5 · 0:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- Omission of lymph node biopsies is a major protocol violation in Wilms tumor surgery — Erlick (opinion) [Ep 5 · 0:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall — Andrew Davidoff (epidemiological) [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=0)
- Approximately 75% of Wilms tumor cases occur in children younger than five years of age with a peak incidence at two to three years of age — Andrew Davidoff (epidemiological) [Ep 7 · 0:30](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=30)
- Survival for patients with Wilms tumor when considered as a whole is currently greater than 90% — Andrew Davidoff (epidemiological) [Ep 7 · 1:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=60)
- Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality — Andrew Davidoff (epidemiological) [Ep 7 · 1:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=80)
- Children with Wilms tumor typically present with an asymptomatic abdominal mass — Andrew Davidoff (clinical) [Ep 7 · 3:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=180)
- Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension — Andrew Davidoff (clinical) [Ep 7 · 3:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=200)
- CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound — Andrew Davidoff (guideline) [Ep 7 · 4:10](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=250)
- Intravascular tumor extension occurs in about 6% of Wilms tumor cases — Andrew Davidoff (epidemiological) [Ep 7 · 5:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=320)
- The most common site of metastatic spread of Wilms tumor is the lungs — Andrew Davidoff (clinical) [Ep 7 · 6:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=380)
- Stage one Wilms tumors are localized tumors confined within the renal capsule — Andrew Davidoff (guideline) [Ep 7 · 7:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=440)
- Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins — Andrew Davidoff (guideline) [Ep 7 · 7:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=460)
- Stage three criteria include biopsy or rupture (pre-operative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or administration of preoperative chemotherapy — Andrew Davidoff (guideline) [Ep 7 · 8:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=480)
- Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four — Andrew Davidoff (epidemiological) [Ep 7 · 8:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=530)
- Patients with synchronous bilateral Wilms tumor are stage five — Andrew Davidoff (guideline) [Ep 7 · 9:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=560)
- For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group — Andrew Davidoff (guideline) [Ep 7 · 10:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=620)
- Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures — Andrew Davidoff (clinical) [Ep 7 · 11:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=680)
- Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin — Andrew Davidoff (guideline) [Ep 7 · 11:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=710)
- Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D — Andrew Davidoff (guideline) [Ep 7 · 12:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=760)
- For stage one tumors weighing less than 550 grams (tumor plus kidney) in patients less than 2 years of age, no adjuvant chemotherapy is given — Andrew Davidoff (guideline) [Ep 7 · 13:05](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=785)
- Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis — Andrew Davidoff (clinical) [Ep 7 · 14:10](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=850)
- Lymph node sampling should be performed even in the absence of abnormal nodes on pre-operative imaging or gross inspection because these circumstances don't reliably predict lymph node negativity — Andrew Davidoff (guideline) [Ep 7 · 14:35](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=875)
- Partial nephrectomy for patients with unilateral non-syndromic disease or laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial — Andrew Davidoff (guideline) [Ep 7 · 15:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=920)
- About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease — Andrew Davidoff (epidemiological) [Ep 7 · 16:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=980)
- Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma — Andrew Davidoff (guideline) [Ep 7 · 16:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1000)
- A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis — Andrew Davidoff (guideline) [Ep 7 · 17:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1060)
- Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass — Andrew Davidoff (clinical) [Ep 7 · 18:15](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1095)
- A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor — Andrew Davidoff (guideline) [Ep 7 · 18:35](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1115)
- Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy — Andrew Davidoff (guideline) [Ep 7 · 19:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1140)
- Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor — Andrew Davidoff (guideline) [Ep 7 · 19:30](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1170)
- Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor — Andrew Davidoff (clinical) [Ep 7 · 20:30](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1230)
- Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity — Andrew Davidoff (clinical) [Ep 7 · 21:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1280)
- Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium — Andrew Davidoff (guideline) [Ep 7 · 21:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1310)
- Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove — Andrew Davidoff (guideline) [Ep 7 · 22:10](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1330)
- About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis — Andrew Davidoff (epidemiological) [Ep 7 · 23:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1380)
- Stage four patients with radiographic disappearance of lung metastasis or tissue confirmation of no viable tumor at week six are considered rapid responders and continue three drug chemotherapy — Andrew Davidoff (guideline) [Ep 7 · 23:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1420)
- Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation — Andrew Davidoff (guideline) [Ep 7 · 24:30](https://origin-library.globalcastmd.com/watch/wilms-tumor-2533?t=1470)
- Hepatoblastoma is the most common malignant liver tumor in the pediatric population (epidemiological) [Ep 11 · 0:00](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0)
- There are around 250 new cases of hepatoblastoma per year (epidemiological) [Ep 11 · 0:20](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20)
- Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years (clinical) [Ep 11 · 0:10](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10)
- Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children — Greg Tiao (epidemiological) [Ep 11 · 0:46](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46)
- Neuroblastoma is the most common solid malignancy in the pediatric population (epidemiological) [Ep 11 · 1:14](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74)
- Hemangioma is the most common liver lesion in children (epidemiological) [Ep 11 · 1:40](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100)
- Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size — Greg Tiao (clinical) [Ep 11 · 2:20](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140)
- Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty (clinical) [Ep 11 · 2:46](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response (clinical) [Ep 11 · 2:46](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma — Greg Tiao (clinical) [Ep 11 · 3:13](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging — Greg Tiao (clinical) [Ep 11 · 3:13](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy (clinical) [Ep 11 · 3:39](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- The most important intervention for survival is to achieve complete resection (clinical) [Ep 11 · 3:39](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation — Greg Tiao (clinical) [Ep 11 · 4:25](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265)
- Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled (clinical) [Ep 11 · 4:50](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290)
- The right hepatic vein differentiates anterior and posterior sections of the right liver — Greg Tiao (clinical) [Ep 11 · 5:41](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341)
- The right portal vein separates superior and inferior segments of the right liver — Greg Tiao (clinical) [Ep 11 · 6:02](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362)
- The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) — Greg Tiao (clinical) [Ep 11 · 6:51](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor — Greg Tiao (clinical) [Ep 11 · 6:51](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis (clinical) [Ep 11 · 8:01](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481)
- Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today — Greg Tiao (clinical) [Ep 11 · 8:15](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections — Greg Tiao (clinical) [Ep 11 · 8:15](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant (clinical) [Ep 11 · 9:12](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552)
- It is important to consult a transplant center early for pre-text 3 and 4 tumors — Greg Tiao (clinical) [Ep 11 · 9:35](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575)
- The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage — Greg Tiao (clinical) [Ep 11 · 10:27](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- The PHITT study has been ongoing for three years — Greg Tiao (clinical) [Ep 11 · 10:27](https://origin-library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- The management approach discussed is based on US protocols, which differ from European SIOP protocols. (guideline) [Ep 1 · 2:30](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=150)
- In Hong Kong, for Wilms tumor they tend to follow American protocols, though for various tumors they use either European or American protocols. — Ken Wong (clinical) [Ep 1 · 3:15](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=195)
- When there are multiple lung masses, a correct assumption can be made that they represent metastases without biopsy. (clinical) [Ep 1 · 5:33](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=333)
- If you treat the patient and lung nodules go away, you presume that represents metastatic disease; if there is a residual nodule after treatment, that is an indication to resect it. (clinical) [Ep 1 · 6:03](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=363)
- Previously, if a nodule was not present on plain film it was not considered significant even if seen on CT, but now CT is the diagnostic test of choice and impacts therapy. (clinical) [Ep 1 · 6:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=384)
- For a single lung nodule, patients are treated and if it resolves, it is presumed to be metastatic Wilms tumor. (clinical) [Ep 1 · 6:41](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=401)
- What is avoided by proving a nodule is not metastatic is radiation therapy to the lungs, not chemotherapy. (clinical) [Ep 1 · 7:12](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=432)
- If lung nodules resolve after 6 weeks of treatment, regardless of how many there are, no radiation to the lungs is given. (guideline) [Ep 1 · 7:18](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=438)
- For lung nodules to avoid radiation therapy, they must completely disappear; if there is a residual nodule, you cannot distinguish scar from active tumor and must biopsy or continue therapy with radiation. (clinical) [Ep 1 · 7:43](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=463)
- APSA has addressed the lymph node sampling practice gap through expert questions, the NAT exam, and annual meeting educational efforts. (clinical) [Ep 1 · 9:29](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- The current status for bilateral Wilms tumor with positive lymph nodes and lung metastasis is to start chemotherapy without biopsy. (guideline) [Ep 4 · 0:54](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=54)
- Tumor shrinkage is defined as a decrease of 50% in tumor size. (clinical) [Ep 4 · 1:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=60)
- When bilateral Wilms tumors stop shrinking after chemotherapy, it is usually because of mesenchymal differentiation and not anaplastic tumor. (clinical) [Ep 4 · 3:52](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=232)
- Wilms tumors are heterogeneous and biopsy might miss foci of anaplasia. — Dan (clinical) [Ep 4 · 2:49](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=169)
- The concept with bilateral Wilms tumor is to preserve as much kidney tissue as possible. — Dan (clinical) [Ep 4 · 2:11](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=131)
- If a tumor has not been biopsied and is not responding to chemotherapy, there may be anaplastic elements that would respond to a more aggressive chemotherapy regimen. — Dan (clinical) [Ep 4 · 2:25](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=145)
- Bilateral nephron-sparing surgery can be performed surprisingly often in large bilateral Wilms tumors. (clinical) [Ep 4 · 4:07](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=247)
- The surgical technique for bilateral nephron-sparing involves putting the kidneys on ice, clamping the vessels, then sharp dissection to remove the tumor. (clinical) [Ep 4 · 4:15](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=255)
- Stage 3 local Wilms tumor requires radiation on both sides. (guideline) [Ep 4 · 5:03](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=303)
- Recurrence of anaplastic Wilms tumor portends a very bad outcome. — Dan (clinical) [Ep 4 · 6:10](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=370)
- Salvage is difficult for anaplastic Wilms tumor recurrence, despite chemotherapy. — Dan (clinical) [Ep 4 · 6:18](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=378)
- Bilateral Wilms tumors are no longer biopsied upfront; they are treated with chemotherapy first. — Dan (guideline) [Ep 4 · 6:44](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=404)
- Once anaplastic Wilms tumor recurs, it is very hard to salvage. — Dan (clinical) [Ep 4 · 7:11](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=431)
- Multifocal Wilms tumors raise concern about the underlying embryology of the kidney and risk for developing additional tumors. — Dan (clinical) [Ep 4 · 7:42](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=462)
- Mutations in WT1 or WT2 increase risk for additional Wilms tumors. (clinical) [Ep 4 · 7:53](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=473)
- 97% of large bilateral kidney tumors in children are Wilms tumor. (epidemiological) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=515)
- Upfront chemotherapy without biopsy is appropriate for bilateral kidney tumors because only a very small percentage are not Wilms tumor. (guideline) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=515)
- 97% of bilateral kidney tumors in children are Wilms tumor, with only a small percentage being other diagnoses — Tony Sandler (epidemiological) [Ep 3 · 9:12](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction) — Tony Sandler (guideline) [Ep 3 · 1:32](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation — Tony Sandler (clinical) [Ep 3 · 4:19](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- Bilateral nephron-sparing surgery is feasible even in large bilateral Wilms tumors by placing kidneys on ice, clamping vessels, and performing sharp dissection — Tony Sandler (clinical) [Ep 3 · 4:44](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia — Dan (clinical) [Ep 3 · 3:27](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- Recurrence of anaplastic Wilms tumor portends a very bad outcome and salvage is difficult despite chemotherapy — Dan (clinical) [Ep 3 · 6:48](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- Multifocal Wilms tumors raise concern about underlying embryologic abnormalities of the kidney and risk of developing additional tumors — Dan (clinical) [Ep 3 · 8:15](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy — Tony Sandler (opinion) [Ep 3 · 7:56](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- For gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl — Todd Ponsky (clinical) [Ep 3 · 9:58](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=598)
- Tegaderm closure of gastroschisis without fascial closure allows cicatrization over 3 days to 8 weeks, with feeding started when bowel function returns rather than waiting for complete closure — Tony Sandler (clinical) [Ep 3 · 14:52](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=892)
- When gastroschisis defect dilates during silo reduction attempts, Tegaderm closure alone can still achieve successful cicatrization without fascial closure — Tony Sandler (clinical) [Ep 3 · 15:32](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=932)
- Umbilical hernias after gastroschisis closure will close spontaneously if no fascia was cut; if fascia is cut, a permanent defect results — Tony Sandler (clinical) [Ep 3 · 12:54](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally — Todd Ponsky (opinion) [Ep 3 · 14:27](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=867)
- In gastroschisis with intestinal atresia and pristine bowel, creating an ostomy through the umbilical fascial ring is technically favorable because the bowel size matches the ring and provides good tissue for suturing (clinical) [Ep 3 · 17:49](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- Primary anastomosis in gastroschisis with atresia is risky because the proximal bowel is massively dilated and distal bowel is decompressed, creating a tenuous anastomosis in bowel that has been outside the abdomen (clinical) [Ep 3 · 18:36](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the extent of remaining intra-abdominal bowel from external examination — Tony Sandler (clinical) [Ep 3 · 21:01](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1261)
- Re-exploration at 2 weeks after gastroschisis closure (rather than the traditional 4-6 weeks) can reveal that inflamed gastroschisis bowel has transformed into functional intestine suitable for anastomosis — Tony Sandler (clinical) [Ep 3 · 22:07](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- Bianchi procedure is preferred over STEP for bowel lengthening because a patient can undergo Bianchi followed by STEP if needed, but once STEP is performed, lengthening options are limited — Greg (opinion) [Ep 3 · 26:46](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- In neonatal ileal atresia with dilated proximal bowel, plication is preferred over tapering to preserve bowel length for potential future lengthening procedures — Tony Sandler (clinical) [Ep 3 · 28:10](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- Plication of dilated bowel in ileal atresia usually unravels with time, allowing the bowel to be used later for lengthening procedures — Tony Sandler (clinical) [Ep 3 · 26:13](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1573)
- In many centers, high-risk obstetric teams deliver gastroschisis cases early by C-section, resulting in less thick and matted bowel at birth (clinical) [Ep 3 · 11:11](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- For gastroschisis reduction at bedside, babies are intubated and paralyzed, a stitch is placed in the fascia with cord left as a biological patch, and Opsite dressing is applied; patients are kept paralyzed for 1-2 days (clinical) [Ep 3 · 11:53](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=713)
- Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. — Andrew Davidoff (clinical) [Ep 8 · 0:28](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- Children with Wilms tumor typically present with an asymptomatic abdominal mass. — Andrew Davidoff (clinical) [Ep 8 · 1:20](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension. — Andrew Davidoff (clinical) [Ep 8 · 1:20](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound. — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- CT will confirm the presence of a solid renal mass and afford the opportunity to visualize the contralateral kidney to confirm its presence and function and to exclude synchronous bilateral disease. — Andrew Davidoff (clinical) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- Intravascular tumor extension occurs in about 6% of Wilms tumor cases. — Andrew Davidoff (epidemiological) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- The most common site of metastatic spread of Wilms tumor is the lungs. — Andrew Davidoff (clinical) [Ep 8 · 2:44](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. — Andrew Davidoff (guideline) [Ep 8 · 2:44](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Circumstances that make Wilms tumor stage 3 include biopsy or rupture (preoperative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or the administration of preoperative chemotherapy. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Failure to perform upfront resection but instead administering neoadjuvant chemotherapy in the COG results in classification of a tumor as stage 3, thus mandating the use of flank irradiation and doxorubicin, each associated with significant long-term toxicities. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Careful lymph node sampling is a critical part of any operation for Wilms tumor because the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis. — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Lymph node sampling should be performed even in the absence of abnormal nodes on preoperative imaging or on gross inspection during operative exploration, since these circumstances don't reliably predict lymph node negativity. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Partial nephrectomy for patients with unilateral, non-syndromic disease and laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. — Andrew Davidoff (epidemiological) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Children with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs (as used for stage 3 or 4 favorable histology) to shrink tumors prior to surgery and facilitate preservation of normal renal parenchyma, due to increased risk of renal failure. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Patients with Wilms tumor arising in a solitary kidney or those with unilateral Wilms tumor at increased risk for developing metachronous tumor are also treated with neoadjuvant chemotherapy, though these patients usually don't receive doxorubicin. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. — Andrew Davidoff (clinical) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. — Andrew Davidoff (guideline) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. — Andrew Davidoff (clinical) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. — Andrew Davidoff (clinical) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. — Andrew Davidoff (clinical) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Primary resection of tumors with extension above the level of the hepatic veins or especially into the atrium is associated with higher operative morbidity, so neoadjuvant chemotherapy is generally used in these circumstances. — Andrew Davidoff (guideline) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- Thrombus that extends above the hepatic veins and persists to this extent after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove the full extent of disease. — Andrew Davidoff (clinical) [Ep 8 · 8:42](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. — Andrew Davidoff (epidemiological) [Ep 8 · 9:58](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. — Andrew Davidoff (guideline) [Ep 8 · 9:58](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- Stage 4 patients treated with three-drug chemotherapy who have radiographic disappearance of their lung metastases or tissue confirmation that residual nodules don't contain viable tumor at week 6 imaging re-evaluation will be considered rapid responders, will continue on three-drug chemotherapy, but won't receive pulmonary irradiation. — Andrew Davidoff (guideline) [Ep 8 · 9:58](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- Patients who don't have complete resolution of pulmonary nodules at 6 weeks will be considered slow or incomplete responders, will be switched to more intensive chemotherapy regimen, and will receive whole lung irradiation. — Andrew Davidoff (guideline) [Ep 8 · 10:47](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=647)
- Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress — Daniel von Allmen (clinical) [Ep 9 · 2:00](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- Familial neuroblastoma occurs in approximately 1% of patients — Tony Sandler (epidemiological) [Ep 9 · 3:27](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery — Daniel von Allmen (clinical) [Ep 9 · 7:24](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival — Tony Sandler (clinical) [Ep 9 · 9:09](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly — Erika Newman (guideline) [Ep 9 · 9:58](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA — Erika Newman (guideline) [Ep 9 · 13:20](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma — Tony Sandler (opinion) [Ep 9 · 12:43](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=763)
- Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor — Daniel von Allmen (clinical) [Ep 9 · 14:21](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly — Erika Newman (clinical) [Ep 9 · 14:50](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=890)
- Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy — Erika Newman (clinical) [Ep 9 · 15:42](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful — Daniel von Allmen (clinical) [Ep 9 · 22:12](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status — Tony Sandler (clinical) [Ep 9 · 23:50](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma — Erika Newman (epidemiological) [Ep 9 · 26:56](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment — Erika Newman (clinical) [Ep 9 · 28:04](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1684)
- Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor — Erika Newman (clinical) [Ep 9 · 28:55](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1735)
- Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy — Erika Newman (clinical) [Ep 9 · 29:45](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1785)
- NMEC amplification automatically means high-risk neuroblastoma regardless of other factors — Tony Sandler (clinical) [Ep 9 · 31:38](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category — Erika Newman (clinical) [Ep 9 · 33:49](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months) — Tony Sandler (guideline) [Ep 9 · 35:25](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant — Erika Newman (clinical) [Ep 9 · 37:20](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy — Tony Sandler (clinical) [Ep 9 · 45:31](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies — Daniel von Allmen (clinical) [Ep 9 · 43:17](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect — Erika Newman (clinical) [Ep 9 · 42:40](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2560)
- COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients) — Daniel von Allmen (clinical) [Ep 9 · 44:04](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival — Daniel von Allmen (clinical) [Ep 9 · 45:28](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection — Daniel von Allmen (epidemiological) [Ep 9 · 46:10](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2770)
- Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes — Tony Sandler (clinical) [Ep 9 · 46:50](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2810)
- High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence — Tony Sandler (clinical) [Ep 9 · 47:40](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed — Daniel von Allmen (clinical) [Ep 9 · 50:54](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=3054)
- There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings — Daniel von Allmen (clinical) [Ep 9 · 51:30](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=3090)
- Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction — Tony Sandler (clinical) [Ep 9 · 53:13](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60% — Tony Sandler (clinical) [Ep 9 · 53:44](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor — Tony Sandler (clinical) [Ep 9 · 54:40](https://origin-library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)
- In North America, the preferred approach for resectable Wilms tumor is primary nephrectomy (total nephrectomy and ureterectomy with lymph node sampling). — Peter Ehrlich (guideline) [Ep 10 · 6:23](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383)
- Preoperative chemotherapy is recommended if tumor extends into the IVC beyond the infrahepatic vena cava, if tumor is so large it compromises respiratory status, if major liver or bowel resection would be required, if only one functioning kidney exists, or if bilateral tumors are present. — Peter Ehrlich (guideline) [Ep 10 · 7:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=421)
- The 'claw sign' on CT—normal kidney displaced into a horseshoe pattern around a mass—is a classic feature of Wilms tumor. — Peter Ehrlich (clinical) [Ep 10 · 3:49](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229)
- Wilms tumor tends to push structures out of the way rather than growing into them, whereas neuroblastoma grows around structures like blood vessels. — Peter Ehrlich (clinical) [Ep 10 · 4:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256)
- If a tumor requires major liver or bowel resection, biopsy and preoperative chemotherapy are preferred because complication rates are higher when these organs are resected at the same time as the kidney, and most tumors will respond to chemotherapy. — Peter Ehrlich (clinical) [Ep 10 · 10:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=624)
- Biopsy with residual gross tumor has always been treated as stage 3 abdominal disease, requiring three-drug chemotherapy plus flank radiation. — Peter Ehrlich (guideline) [Ep 10 · 11:18](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=678)
- Evidence suggests higher risk of tumor rupture when tumors reach 13-15 centimeters or larger, which may warrant consideration of preoperative chemotherapy. — Peter Ehrlich (clinical) [Ep 10 · 14:33](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873)
- For biopsy, open biopsy provides large tissue sections; large-core needle biopsy (10-20 cores) has proven accurate in several series. Fine needle aspiration or single-pass true-cut biopsy cannot diagnose anaplasia and should not be used. — Peter Ehrlich (guideline) [Ep 10 · 17:19](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1039)
- COG stage 1 is tumor limited to kidney, completely resected, no capsular invasion, no rupture or biopsy, vessels of renal sinus not involved, negative margins, and negative regional lymph nodes. — Peter Ehrlich (guideline) [Ep 10 · 20:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1200)
- COG stage 2 is complete resection with negative margins but tumor extends beyond kidney through capsular penetration, renal sinus invasion, or blood vessel involvement within the nephrectomy specimen outside the primary kidney. — Peter Ehrlich (guideline) [Ep 10 · 20:28](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228)
- COG stage 3 includes: biopsy with gross residual tumor, positive lymph nodes, peritoneal surface penetration with implants, positive margins, microscopic residual from intraoperative spill, incomplete resection, piecemeal removal, or renal vein division with tumor present. — Peter Ehrlich (guideline) [Ep 10 · 21:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1260)
- COG stage 4 is hematogenous metastasis to lung, liver (most common), bone, or brain. Stage 5 is bilateral renal tumor involvement. — Peter Ehrlich (guideline) [Ep 10 · 21:58](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1318)
- Stage 1-2 abdominal disease without lung metastases receives two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation, significantly reducing late effects including renal failure, second malignancies, and cardiovascular disease. — Peter Ehrlich (guideline) [Ep 10 · 23:08](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1388)
- If a patient has a lung lesion but stage 1-2 abdominal disease after primary nephrectomy with negative lymph nodes, the child avoids abdominal radiation (though still receives chemotherapy for the lung lesion). — Peter Ehrlich (clinical) [Ep 10 · 24:15](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455)
- Recent COG data shows approximately 40% of patients with pulmonary metastases who have complete response at 6 weeks can avoid pulmonary radiation without affecting event-free or overall survival, with 80-85% not relapsing. — Peter Ehrlich (clinical) [Ep 10 · 26:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1584)
- Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer, a significant late effect. — Peter Ehrlich (epidemiological) [Ep 10 · 26:08](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568)
- For a single lung lesion remaining at 6 weeks that did not respond to chemotherapy, thoracoscopic biopsy is reasonable because 50-60% of such lesions may not be cancer (could be scar), and if benign, the patient would not need pulmonary radiation. — Peter Ehrlich (clinical) [Ep 10 · 28:09](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1689)
- SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with evaluation at 4 and 8 weeks, then resection followed by post-chemotherapy pathology-based risk stratification (low, intermediate, high risk). — Peter Ehrlich (guideline) [Ep 10 · 30:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1816)
- In SIOP protocols, predominantly blastema component after preoperative chemotherapy is a negative prognostic factor, but blastema percentage does not correlate with outcome in COG primary nephrectomy patients. — Peter Ehrlich (clinical) [Ep 10 · 31:19](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1879)
- Outcomes for stage 1 and stage 2 patients are basically identical between COG and SIOP treatment approaches. — Peter Ehrlich (clinical) [Ep 10 · 33:58](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2038)
- Some Wilms tumor patients present with low hemoglobin because the tumor ruptures internally and bleeds. — Peter Ehrlich (clinical) [Ep 10 · 34:46](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2086)
- Acquired von Willebrand disease occurs in Wilms tumor patients; in most cases it is meaningless, but a few case series report significant intraoperative bleeding until tumor removal. — Peter Ehrlich (clinical) [Ep 10 · 35:11](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111)
- Right-sided tumors can cause complications including adrenal vein injury, duodenal injury (due to proximity), superior mesenteric artery injury, and IVC injury due to anatomic distortion. — Peter Ehrlich (clinical) [Ep 10 · 36:25](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2185)
- Wilms tumors can cause intense inflammatory reaction making them adherent to diaphragm or liver; taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided. — Peter Ehrlich (clinical) [Ep 10 · 42:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551)
- The main factor predicting outcome in stage 3 disease is whether lymph nodes are positive, along with genetic changes including loss of heterozygosity and 1Q gain. — Peter Ehrlich (clinical) [Ep 10 · 32:50](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1970)
- Patients with loss of heterozygosity of both 1p and 16q (5-7% of patients) have significantly worse outcomes regardless of stage. Stage 1-2 patients with LOH have about 10% lower overall survival; stage 3-4 patients have 18% lower survival. — Peter Ehrlich (clinical) [Ep 10 · 54:41](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281)
- Patients with both 1p and 16q loss of heterozygosity receive augmented therapy: doxorubicin is added for stage 1-2 disease, and five-drug regimen M is used for stage 3-4 disease. — Peter Ehrlich (guideline) [Ep 10 · 55:07](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3307)
- IVC tumor extension is not a negative prognostic factor if the tumor is completely resected. — Peter Ehrlich (clinical) [Ep 10 · 46:27](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2787)
- Major complication rate for primary surgery with tumor extending beyond infrahepatic IVC is 26-30%, including mortality, increased transfusions, and ICU stay, supporting preoperative chemotherapy for these cases. — Peter Ehrlich (clinical) [Ep 10 · 48:49](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929)
- Favorable histology Wilms tumor has three components: blastema, stroma, and epithelial (triphasic tumor). Tumors with only two components are also considered favorable histology. — Peter Ehrlich (clinical) [Ep 10 · 52:39](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3159)
- Unfavorable histology is classified as focal anaplasia or diffuse anaplasia based on number of high-power fields showing anaplasia, with different treatments for each. — Peter Ehrlich (clinical) [Ep 10 · 55:58](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3358)
- Clear cell sarcoma of the kidney has reasonable treatment outcomes, particularly for low stages. Rhabdoid tumors have poor outcomes except for stage 1; most present at stage 3-4 with terrible outcomes. — Peter Ehrlich (clinical) [Ep 10 · 57:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3421)
- Renal cell carcinoma in children has no good therapy, particularly for metastatic disease. — Peter Ehrlich (clinical) [Ep 10 · 56:51](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411)
- Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 10 · 57:46](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3466)
- The strategy for bilateral Wilms tumor is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy of at least one kidney (ideally both) to avoid dialysis. — Peter Ehrlich (guideline) [Ep 10 · 58:07](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3487)
- Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% compared to 88% for unilateral tumors; overall survival was 80% vs. 95%. — Peter Ehrlich (epidemiological) [Ep 10 · 58:40](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3520)
- Maximum tumor response to chemotherapy in most children with Wilms tumor occurs by 12 weeks, and early response at 6 weeks predicts late response. — Peter Ehrlich (clinical) [Ep 10 · 59:37](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577)
- In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. In a recent COG study of 250 enrolled patients, only one turned out to have rhabdoid tumor. — Peter Ehrlich (epidemiological) [Ep 10 · 60:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3631)
- Biopsy is recommended for bilateral tumors in older patients (8-10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely. — Peter Ehrlich (guideline) [Ep 10 · 61:56](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3716)
- If biopsying bilateral tumors, both kidneys should be biopsied because there is discordant pathology in up to 20% of patients. — Peter Ehrlich (clinical) [Ep 10 · 62:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3736)
- A small subset of very young patients (<24 months) with stage 1 favorable histology tumors <550g can be treated with surgery alone without chemotherapy, with >95% overall survival. Those who relapse (about 10%) have 100% salvage with chemotherapy. — Peter Ehrlich (clinical) [Ep 10 · 43:32](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612)
- Dr. Christina Theodoro states this study is a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myelomeningocele repair. — Christina Theodorou (clinical) [Ep 12 · 2:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174)
- The technique involves exposing the fetal back, re-exposing the spinal cord, identifying the myelomeningocele defect, placing an extracellular matrix patch with placental stem cells facing the spinal cord in direct contact, closing the skin, and returning the baby to the uterus to continue gestation until term. — Christina Theodorou (clinical) [Ep 12 · 3:27](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207)
- Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive the stem cells. — Christina Theodorou (clinical) [Ep 12 · 3:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234)
- Dr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation. — Todd Ponsky (clinical) [Ep 12 · 4:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248)
- The survey included self-identified specialists within the field of fetal surgery, yet only 4% of those people reported receiving formal training in fetal surgery. — Natalie Lopyan (epidemiological) [Ep 12 · 5:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313)
- Dr. Natalie Lopian suggests it will be interesting to see whether fetal surgery exposure becomes a requirement during training or whether fetal centers become the primary training ground for fetal surgeons as the field expands. — Natalie Lopyan (opinion) [Ep 12 · 6:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=378)
- Dr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery. — Todd Ponsky (opinion) [Ep 12 · 6:38](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398)
- The study was not designed to link subspecialization of fetal surgery to outcomes and was not designed to provide a clear definition of a fetal surgery center. — Natalie Lopyan (clinical) [Ep 12 · 7:26](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446)
- European colleagues following SIOP guidelines would offer chemotherapy without biopsy for Wilms tumor. (guideline) [Ep 15 · 0:47](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=47)
- At COG (Children's Oncology Group) sites in North America, the approach would be resection and diagnosis. (guideline) [Ep 15 · 0:59](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=59)
- Doxorubicin would be added to chemotherapy even for a low stage tumor under certain conditions. (clinical) [Ep 15 · 1:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=77)
- Doxorubicin is added when there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 15 · 2:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=137)
- Loss of heterozygosity at 1P and 16Q shows higher recurrence in Wilms tumor. (clinical) [Ep 15 · 2:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=145)
- For surgeons, there will be more waiting for the biology results before determining if chemotherapy is needed, affecting decisions about port placement. (clinical) [Ep 15 · 2:43](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=163)
- It is not accurate to tell patients that if they are less than 2 years of age and the tumor is less than 550g, they will not need chemotherapy, because biology studies may require adding chemotherapy. (clinical) [Ep 15 · 2:56](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=176)
- Chemotherapy must be added if there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 15 · 3:09](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=189)
- Even in stage 1 favorable histology, chemotherapy is still added if there is loss of heterozygosity at 1P and 16Q. (clinical) [Ep 15 · 3:26](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=206)
- In North America, the Children's Oncology Group recommends primary nephrectomy and ureterectomy with lymph node sampling for the majority of children with renal tumors. — Peter Ehrlich (guideline) [Ep 2 · 6:23](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=383)
- Preoperative chemotherapy is recommended if the tumor compromises the child's respiratory status, making them a poor operative candidate. — Peter Ehrlich (guideline) [Ep 2 · 7:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=421)
- If tumor extends into the inferior vena cava beyond the intrahepatic level (behind the liver or up to the atrium), preoperative chemotherapy is recommended. — Peter Ehrlich (guideline) [Ep 2 · 7:33](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=453)
- Massive tumors that would require resection of large parts of liver or bowel should receive preoperative chemotherapy because the majority will respond. — Peter Ehrlich (guideline) [Ep 2 · 7:57](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=477)
- If the child has only one functioning kidney, preoperative chemotherapy is recommended to avoid nephrectomy. — Peter Ehrlich (guideline) [Ep 2 · 8:21](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=501)
- Children with bilateral renal tumors, Wilms tumor predisposition syndromes (Wagr, Denys-Drash, Beckwith-Wiedemann), or multicentric tumors should not undergo primary nephrectomy. — Peter Ehrlich (guideline) [Ep 2 · 8:33](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=513)
- Complication rates are higher if liver or bowel must be resected at the same time as the kidney. — Peter Ehrlich (clinical) [Ep 2 · 10:38](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=638)
- If gross tumor is left behind or the tumor is only biopsied, it is treated as a stage 3 abdominal tumor requiring 3-drug chemotherapy plus flank radiation. — Peter Ehrlich (guideline) [Ep 2 · 11:18](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=678)
- The maximum response of most children with Wilms tumor to chemotherapy occurs by 12 weeks. — Peter Ehrlich (clinical) [Ep 2 · 59:37](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3577)
- In the COG staging system, treatment is determined by both local abdominal stage and disease stage. — Peter Ehrlich (guideline) [Ep 2 · 19:44](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1184)
- Stage 1 tumor is limited to the kidney, completely resected, with no capsular invasion, no rupture or biopsy prior to removal, no renal sinus vessel involvement, negative margins, and negative regional lymph nodes. — Peter Ehrlich (guideline) [Ep 2 · 20:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1201)
- Stage 2 tumor is completely resected with negative margins but extends beyond the kidney through capsular penetration, renal sinus soft tissue invasion, or blood vessel involvement outside the primary kidney. — Peter Ehrlich (guideline) [Ep 2 · 20:28](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1228)
- Stage 3 includes tumors that are biopsied with gross residual, have positive lymph nodes, penetrate the peritoneal surface with implants, have positive margins, have microscopic residual from intraoperative spill, cannot be completely resected, or must be removed in pieces. — Peter Ehrlich (guideline) [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1260)
- Stage 4 is hematogenous metastasis to lung, liver, bone, or brain. — Peter Ehrlich (guideline) [Ep 2 · 21:58](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1318)
- Stage 5 is bilateral renal tumor involvement. — Peter Ehrlich (guideline) [Ep 2 · 22:06](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1326)
- Patients with stage 1 or 2 abdominal disease without lung metastases receive only 2-drug chemotherapy (vincristine and dactinomycin) for shorter duration with lower toxicity and significantly lower risk of late effects. — Peter Ehrlich (guideline) [Ep 2 · 23:08](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1388)
- The main late effects of Wilms tumor treatment are renal failure, second malignancies, pregnancy problems in females, hypertension, and cardiovascular disease, primarily caused by radiation and doxorubicin. — Peter Ehrlich (clinical) [Ep 2 · 23:37](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1417)
- If a child has stage 1 or 2 abdominal disease, they do not require abdominal radiation regardless of lung metastases status. — Peter Ehrlich (guideline) [Ep 2 · 24:06](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1446)
- A recent COG study showed that approximately 40% of patients with pulmonary metastases who achieve complete response by 6 weeks of chemotherapy do not need pulmonary radiation, with 80-85% remaining relapse-free. — Peter Ehrlich (clinical) [Ep 2 · 26:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1584)
- Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer. — Peter Ehrlich (epidemiological) [Ep 2 · 26:08](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1568)
- Pulmonary radiation causes pneumonitis and long-term restrictive lung disease. — Peter Ehrlich (clinical) [Ep 2 · 26:20](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1580)
- In the SIOP protocols, all patients start with chemotherapy without biopsy in most cases, using higher doses of two drugs, with evaluation at 4 and 8 weeks before proceeding to resection. — Peter Ehrlich (guideline) [Ep 2 · 30:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1831)
- SIOP uses post-chemotherapy, post-nephrectomy classification into low risk, intermediate risk, and high risk based on percentage of blastemal components and presence of anaplasia. — Peter Ehrlich (guideline) [Ep 2 · 31:06](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1866)
- Some children with Wilms tumor develop acquired von Willebrand disease; in the majority of cases it is meaningless, but a few case series report significant bleeding during surgery until the tumor is removed. — Peter Ehrlich (clinical) [Ep 2 · 35:11](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2111)
- Wilms tumors characteristically show a 'claw sign' on imaging where normal kidney is displaced into a horseshoe pattern, appearing to grab the mass coming out of it. — Peter Ehrlich (clinical) [Ep 2 · 3:49](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=229)
- Wilms tumor tends to push structures out of the way rather than growing around them, whereas neuroblastoma grows around structures like blood vessels. — Peter Ehrlich (clinical) [Ep 2 · 4:16](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=256)
- Positive surgical margins or tumor rupture (intraoperative or microscopic) automatically makes the patient stage 3. — Peter Ehrlich (guideline) [Ep 2 · 41:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2484)
- Taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided. — Peter Ehrlich (guideline) [Ep 2 · 42:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2551)
- Very low-risk patients (stage I, <550g, <2 years, favorable histology) can be treated with surgery alone; 90-95% are cured without chemotherapy, and those who relapse have 100% survival with delayed chemotherapy. — Peter Ehrlich (clinical) [Ep 2 · 43:32](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2612)
- IVC tumor extension is not a negative prognostic factor if the tumor is completely resected. — Peter Ehrlich (clinical) [Ep 2 · 46:14](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2774)
- If IVC tumor thrombus extends into the renal vein but is not adherent and comes out in one piece, it is considered stage 2. — Peter Ehrlich (guideline) [Ep 2 · 46:38](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2798)
- Major complication rates (including mortality, blood transfusions, ICU stay) increase significantly when tumor extends beyond the infrahepatic IVC to the hepatic veins or atrium, with 26-30% major morbidity in primary resection cases. — Peter Ehrlich (clinical) [Ep 2 · 47:43](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2863)
- Loss of heterozygosity at both 1p and 16q occurs in 5-7% of patients and is associated with significantly worse outcomes regardless of stage. — Peter Ehrlich (clinical) [Ep 2 · 54:41](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3281)
- Stage 1-2 patients with loss of heterozygosity at 1p and 16q have approximately 10% lower overall survival than those without these genetic changes. — Peter Ehrlich (epidemiological) [Ep 2 · 55:23](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3323)
- Stage 3-4 patients with loss of heterozygosity at 1p and 16q have approximately 18% lower overall survival and receive 5-drug regimen M chemotherapy. — Peter Ehrlich (clinical) [Ep 2 · 55:45](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3345)
- Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 2 · 57:46](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3466)
- Event-free survival for unilateral Wilms tumor is approximately 88% with overall survival of 95%. — Peter Ehrlich (epidemiological) [Ep 2 · 58:51](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3531)
- Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% with overall survival of only 80%. — Peter Ehrlich (epidemiological) [Ep 2 · 58:51](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3531)
- In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. — Peter Ehrlich (clinical) [Ep 2 · 60:31](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3631)
- Open biopsy to determine favorable vs. unfavorable histology in Wilms tumor is not very accurate initially. — Peter Ehrlich (clinical) [Ep 2 · 61:02](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3662)
- In a recent COG bilateral Wilms study of 250 patients, only one patient who met enrollment criteria turned out to have rhabdoid tumor instead of Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 2 · 61:12](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3672)
- Discordant pathology occurs in up to 20% of bilateral Wilms tumor patients when both kidneys are biopsied. — Peter Ehrlich (epidemiological) [Ep 2 · 62:14](https://origin-library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3734)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025 — Jill Knepprath summarizing a resource [Ep 19 · 0:14](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=14)
- The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes — Jill Knepprath summarizing a resource [Ep 19 · 0:19](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=19)
- Factors studied included the number of metastases, the size of the metastases, and different biological markers — Jill Knepprath summarizing a resource [Ep 19 · 0:30](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=30)
- There was no difference in survival based on the number of metastases — Jill Knepprath summarizing a resource [Ep 19 · 0:36](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=36)
- Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival — Jill Knepprath summarizing a resource [Ep 19 · 0:41](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=41)
- Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival — Jill Knepprath summarizing a resource [Ep 19 · 0:41](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=41)
- In multivariable models, neither the size nor the number of nodules had any effect on survival — Jill Knepprath summarizing a resource [Ep 19 · 0:49](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=49)
- 1q gain was associated with worse event-free survival — Jill Knepprath summarizing a resource [Ep 19 · 0:55](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=55)
- 1q gain was associated with worse overall survival — Jill Knepprath summarizing a resource [Ep 19 · 0:55](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=55)
- 1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases — Jill Knepprath summarizing a resource [Ep 19 · 1:04](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=64)
- Risk stratification for Wilms tumor has evolved many times over the years. — Jill Knepprath summarizing a resource [Ep 20 · 0:00](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=0)
- The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025. — Jill Knepprath summarizing a resource [Ep 20 · 0:09](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=9)
- The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification. — Jill Knepprath summarizing a resource [Ep 20 · 0:19](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=19)
- The new model changes some of the older features or gets rid of them altogether. — Jill Knepprath summarizing a resource [Ep 20 · 0:27](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=27)
- Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement. — Jill Knepprath summarizing a resource [Ep 20 · 0:32](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=32)
- Tumor nephrectomy weight is no longer included in the risk stratification. — Jill Knepprath summarizing a resource [Ep 20 · 0:41](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=41)
- The model modified how histology and age are used to stratify certain patients. — Jill Knepprath summarizing a resource [Ep 20 · 0:43](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=43)
- More changes are expected in the future as ongoing COG trials produce more results. — Jill Knepprath summarizing a resource [Ep 20 · 0:48](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=48)
- The systematic review and meta-analysis was conducted in Chongqing, China — Cecilia Gigena summarizing a resource [Ep 13 · 0:12](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=12)
- The study aimed to evaluate efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor — Cecilia Gigena summarizing a resource [Ep 13 · 0:12](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=12)
- The analysis included 26 studies — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- Nephron-sparing surgery increased glomerular filtration rate after surgery — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- There were no significant differences in overall survival between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- There were no significant differences in recurrence rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- There were no significant differences in hypertension rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- There were no significant differences in renal dysfunction rates between nephron-sparing surgery and radical nephrectomy — Cecilia Gigena summarizing a resource [Ep 13 · 0:27](https://origin-library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-8077?t=27)
- When performing nephrectomy for Wilms tumor, lymph node sampling is mandatory according to protocols. — The host summarizing the discussion [Ep 1 · 1:54](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=114)
- If histologically negative lymph nodes are not documented during Wilms tumor nephrectomy, they are assumed to be positive, which increases the stage and requires increased chemotherapy. — The host summarizing the discussion [Ep 1 · 2:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=121)
- Failure to sample lymph nodes during Wilms tumor nephrectomy is an identified practice gap by the Cancer Committee and COG publications. — The host summarizing the discussion [Ep 1 · 2:19](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=139)
- The presence of metastatic disease in the lung does not preclude treating the primary tumor with nephrectomy, because this affects whether radiation therapy is required. — The host summarizing the discussion [Ep 1 · 4:07](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=247)
- There is both a local stage and a patient stage for Wilms tumor. — The host summarizing the discussion [Ep 1 · 4:25](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=265)
- On the ACS pediatric surgery blog, a similar question showed that overwhelmingly the presence of lymph node metastases led people to choose biopsy and chemotherapy, which is incorrect. — The host summarizing the discussion [Ep 1 · 4:33](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=273)
- Regardless of pulmonary metastatic disease, if the primary tumor can be removed without removing other organs, nephrectomy should be performed because it decreases radiation therapy requirements. — The host summarizing the discussion [Ep 1 · 4:44](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=284)
- The child will receive stage 4 metastatic chemotherapy regardless, but performing biopsy counts as local spillage and requires radiation therapy to the flank or abdomen. — The host summarizing the discussion [Ep 1 · 5:04](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=304)
- Local disease should be treated differently than systemic disease in Wilms tumor. — The host summarizing the discussion [Ep 1 · 5:17](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=317)
- Oncologists want measurable disease to assess response to chemotherapy. — The host summarizing the discussion [Ep 1 · 5:45](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=345)
- According to Dr. Shamberger, there are radiographic criteria for single lung nodules; if it looks like a metastasis you proceed, but if it does not look like a metastasis you can biopsy it to prove it is not a met and avoid chemotherapy. — The host summarizing the discussion [Ep 1 · 6:54](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=414)
- In SIOP protocols, they perform percutaneous biopsy of the primary tumor and treat with chemotherapy. — Todd Ponsky summarizing the discussion [Ep 1 · 8:01](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481)
- The American College of Surgeons registry data shows improvement with fewer patients receiving nephrectomies without lymph node sampling since educational efforts began. — The host summarizing the discussion [Ep 1 · 9:29](https://origin-library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- Bob Shamberger has made the point that if a Wilms tumor is not responding to chemotherapy, tissue is needed to check for anaplasia. — Dan summarizing the discussion [Ep 4 · 6:56](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=416)
- Most pathologists think anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy. — The host summarizing the discussion [Ep 4 · 7:24](https://origin-library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=444)
- The STEP registry discourages performing STEP procedures in the perinatal period due to difficult outcomes at best — Greg summarizing the discussion [Ep 3 · 26:24](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1584)
- STEP procedures in patients with gastroschisis are not particularly beneficial due to underlying motility disorders — Greg summarizing the discussion [Ep 3 · 26:33](https://origin-library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- Wilms tumor is the second most common intra-abdominal tumor in children and fifth most common tumor in children overall. — The host summarizes what Dr. Andrew Davidoff said [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0)
- The first article examines surgical management, staging and outcomes of Wilms tumors with intravascular extension, using results from the SIOP (International Society of Pediatric Oncology) Renal Tumor Study. — Brittany Levy summarizing the discussion [Ep 12 · 0:34](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=34)
- The study looked at children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection of tumor thrombus was successful versus when it was not. — Brittany Levy summarizing the discussion [Ep 12 · 0:58](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58)
- Dr. Paul Tam states that Wilms tumor has been a great success story for pediatric surgery and pediatric oncology. — Brittany Levy summarizing the discussion [Ep 12 · 1:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74)
- Dr. Paul Tam suggests improving outcomes by identifying subgroups of patients who are still not doing well and trying to improve care in those particular areas. — Brittany Levy summarizing the discussion [Ep 12 · 1:39](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=99)
- If half of Wilms tumor patients have complete tumor removal and half do not, and there is an outcome difference, then surgeons should still try hard to remove all of the tumor. — Brittany Levy summarizing the discussion [Ep 12 · 1:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114)
- The second article examines efficacy of clinical grade human placental mesenchymal stromal cells in fetal ovine myelomeningocele repair. — Brittany Levy summarizing the discussion [Ep 12 · 2:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=133)
- The article discussed use of mesenchymal stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs given the intervention. — Brittany Levy summarizing the discussion [Ep 12 · 2:40](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=160)
- The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country. — Rod Gerardo summarizing the discussion [Ep 12 · 4:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277)
- Many survey respondents reported receiving fetal training during their pediatric surgery fellowship training, yet when the question was posed differently, many responded that they did not have exposure to fetal surgery during fellowship training. — Brittany Levy summarizing the discussion [Ep 12 · 5:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337)
- Dr. Paul Tam states that fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental. — Brittany Levy summarizing the discussion [Ep 12 · 5:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354)
- Pediatric trauma patients are at high risk for developing venous thromboembolism (VTE). — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 16 · 1:02](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=62)
- The Wita et al. cohort study was conducted from 2019 to 2022 in eight pediatric trauma centers and included patients younger than 18 years old. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 16 · 1:09](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=69)
- Among 460 high-risk pediatric trauma patients, more than half received chemical VTE prophylaxis. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 16 · 1:18](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=78)
- Delaying blood thinners beyond 24 hours of hospital arrival increases the risk of blood clots in pediatric trauma patients. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 16 · 1:25](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=85)
- VTE prophylaxis is safe and effective for pediatric trauma patients and needs to be started within 24 hours of admission. — Lizzie Lee summarizes what Dr. Alex Halpern said [Ep 16 · 1:32](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=92)
- Gillielli et al. reviewed 104 abstracts and 34 full text articles, ultimately including 12 studies in their systematic review of female fertility cryopreservation in childhood cancer. — Alex Halpern summarizing a resource [Ep 16 · 2:04](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=124)
- Ovarian tissue cryopreservation was performed in 501 pediatric cancer patients, with 5.9% undergoing ovarian tissue transplantation. — Alex Halpern summarizing a resource [Ep 16 · 2:16](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=136)
- After ovarian tissue transplantation, 33% of pediatric cancer patients were able to become pregnant. — Alex Halpern summarizing a resource [Ep 16 · 2:27](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=147)
- Ovarian tissue cryopreservation has great advantages for pediatric cancer patients but needs to be studied further. — Alex Halpern summarizing a resource [Ep 16 · 2:33](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=153)
- The Lee et al. systematic review and meta-analysis from Chongqing, China evaluated efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 16 · 3:09](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=189)
- The meta-analysis gathered 26 studies on nephron-sparing surgery for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 16 · 3:23](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=203)
- Nephron-sparing surgery increased glomerular filtration rate after surgery for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 16 · 3:25](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- Nephron-sparing surgery showed no significant differences in overall survival, recurrences, hypertension, or renal dysfunction compared to radical nephrectomy for unilateral Wilms tumor. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 16 · 3:25](https://origin-library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- The North American COG approach often involves immediate surgery, while the European SIOP approach typically starts with chemotherapy before surgery. — Lizzie Lee summarizing the discussion [Ep 15 · 3:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=210)
- Loss of heterozygosity is the loss of genetic diversity in tumor cells and can indicate more aggressive disease in Wilms tumor. — Lizzie Lee summarizing the discussion [Ep 15 · 1:54](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=114)
- Gain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers. — Lizzie Lee summarizing the discussion [Ep 15 · 2:02](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=122)
- According to Children's Oncology Group updates, adverse biologic factors are associated with worse prognosis in stage 2 patients, but not in stage 1 favorable histology Wilms tumor patients. — Lizzie Lee summarizing the discussion [Ep 15 · 3:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=195)
- Genetic markers like loss of heterozygosity at specific chromosomes can indicate a higher risk of cancer recurrence and guide decisions about adding chemotherapy treatments. — Lizzie Lee summarizing the discussion [Ep 15 · 3:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=229)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Aug 31: 25 doctors auto-found from episode dossiers
- Aug 30: 20 doctors auto-found from episode dossiers
- Aug 30: 16 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 29 doctors auto-found from episode dossiers
- Aug 29: 31 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 25 items, 16 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 18 items, 16 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 18 items, 16 dossiers, summaries for 3 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai