Error Traps and Culture of Safety in Pediatric Surgical Oncology

The June issue of Seminars in Pediatric Surgery, focused on a topic that's important to every pediatric surgeon, improving the healthcare we deliver to children around the world. Follow along with our latest video series as we highlight articles that help enhance the culture of safety from various pediatric surgical subspecialties. And you might recognize a few well-known faces and names along the way. Here's a quick summary of error traps and culture of safety in pediatric surgical oncology with guest video reviewer, Dr. Pablo Daval. The focus of this paper is on technical issues for the practicing surgeon. The field of pediatric surgical oncology is very broad, and we decided to focus on the three more frequent extracranial solid tumors, neuroblastoma, hepatoblastoma, and Wilms tumor. For the three types, the surgeon should know when to perform an upfront reception, and when to delay it until neo-adjuvant chemotherapy has reduced the size and therefore the risks. Avoiding vascular lesions is key in the three types. And for neuroblastoma, the implementation of IRDFs or image-defined risk factors, can help to achieve a better resection. Exposure should be adequate and dissection thorough, and although some cases could be done with minimally invasive surgery, others will require complex approaches. The use of the pretext staging system in hepatoblastoma has proven to have prognostic implications, and it can guide surgery while maintaining the goals of complete resection without post-operative liver failure. For Wilms tumor, the surgeon should avoid intraoperative rupture and vascular lesions and always obtain lymph nodes. In the bilateral tumors, the preservation of as much renal parenchyma as possible is the aim. Surgical planning relies on imaging studies and lately, the use of 3D printed models if available, can add to it. It is almost impossible to summarize everything in this short clip, so I invite you to read our paper. Thanks very much.