Nephron-Sparing Surgery for Patients With Wilms Tumor, a Surgical Delphi Study Consensus Statement.

Background And Aim: Current pediatric renal tumor treatment protocols allow for nephron-sparing surgery (NSS) for unilateral disease only under strict conditions. Oncological guidelines do not account for surgical feasibility, however, possibly reducing the utilization of NSS. To potentially change this, a definition of surgical feasibility is required.

Evidence-Based Surgical Guidelines for Treating Children With Rhabdomyosarcoma.

Background: Surgery remains the cornerstone of treatment for rhabdomyosarcoma (RMS) in children. However, there is considerable variation in surgical management practices worldwide, highlighting the need for standardized Clinical Practice Guidelines (CPG).

Methods: The CPG development involved assembling a multidisciplinary group, prioritizing 10 key topic areas, conducting evidence searches, and synthesizing findings.

Surgery and the first 8000 days of life: a review.

The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2-21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.

Treatment of penetrating injuries of the retrohepatic vena cava: systematic review protocol.

Injuries to the retrohepatic segment of the inferior vena cava require complex procedures, as exposure without prior vascular control can lead to uncontrollable and fatal bleeding. To achieve such control, the classic techniques of hepatic vascular exclusion and the implantation of an atriocaval shunt have been described, and more recently, endovascular strategies have been reported. However, there is no consensus in the literature regarding which of these strategies is associated with lower mortality.

Use of etomidate in endotracheal intubations in the emergency room during the COVID-19 pandemic: a randomized clinical trial.

Purpose: Shock, cardiovascular problems, and respiratory failure constitute the main causes of death in patients cared in medical emergency rooms. Patients commonly require orotracheal intubation (OTI), a fact that has been intensified by diseases that generate important and fatal hemodynamic and respiratory problems in the affected patient.

Methods: Although etomidate (ETO) is a highly used anesthetic for OTI, its use remains controversial in several scenarios.

Childhood cancer surgery in low- and middle-income countries.

This report summarizes the status of pediatric surgical oncology services in low- and middle-income countries. Factors such as surgical capacity and enablers, and barriers to providing pediatric surgical oncology services are discussed. A review of the literature was conducted to examine the evidence for the capacity of low- and middle-income countries to provide childhood cancer surgery services, focusing on general surgery.

Global Initiative for Children's Surgery (GICS) Pediatric Trauma Care Initiative: A Call for a Comprehensive Approach to a Global Problem.

Introduction: Trauma is a major problem which has a significant health, social, and economic impact. Particularly, pediatric trauma carries substantial mortality and morbidity. This is a great concern for subspecialized general and pediatric surgeons.

Barriers and challenges to achieving equity in global children's surgery: A call to action.

A Call to Action.

Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries.

Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning.

Surgery in Bilateral Wilms Tumor-A Single-Center Experience.

The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT.

Limitations of using the DATASUS database as a primary source of data in surgical research: a scoping review.

Objective: DATASUS is the Brazilian Public Unified Health System (SUS) department responsible for providing health data that are used as a primary source of data in several studies on surgery and surgical specialties although its main limitations have not been previously reviewed. The objective of this work is to synthesize information from studies on surgery that used DATASUS systems as a data source and to identify the main gaps in this platform.

Methods: a scoping review was conducted according to the PRISMA-ScR method to identify papers on surgery, and other surgical specialties, that used the DATASUS platform as a primary data source.

Development of a template for operative reporting of pediatric cancer surgery in limited-resource settings by using a modified Delphi method.

Purpose: A comprehensive operative report for cancer surgery is crucial for accurate disease staging, risk stratification, and therapy escalation/de-escalation, which affects the outcome. Narrative operative reports may fail to include some critical findings. Furthermore, standardized operative reports can form the basis of a local registry, which is often lacking in limited-resource settings (LRSs).

Delivery of essential pediatric congenital surgical care within Brazil's universal health coverage system: a national survey of pediatric surgeons.

Objective: In this study, we assess the delivery of congenital pediatric surgical care under Brazil's system of universal health coverage and evaluate differences in delivery between public and private sectors.

Methods: A cross-sectional national survey of pediatric surgeons in Brazil was conducted. Participants were asked which of 23 interventions identified through the they perform and to report barriers faced while providing surgical care.

Surgically Amenable Childhood Cancers: An Overview of the Burden and Challenges of Management in Low- and Middle-Income Countries.

The World Health Organization's Global Initiative for Childhood Cancer was launched to decrease the disparities in childhood cancer outcomes and improve treatments for childhood cancer in resource-limited settings. Low-grade glioma, retinoblastoma, and Wilms tumors are among the index cancers included in this global initiative, as these cancers represent a large percentage of childhood tumors and are curable with cost-effective, evidence-based interventions. Herein, we discuss the global childhood tumor burden, the status of pediatric cancer surgery capacity and services around the world, and the strategic considerations for building pediatric surgical oncology capacity.

A debriefing tool to acquire non-technical skills in trauma courses.

Objective: The study reports the use of a nominal group technique (NGT) to evaluate the PEARLS Healthcare debriefing tool as a tool to foster non-technical skills in trauma simulation courses. Additionally, it introduces a debriefing card to be used in trauma courses.

Design: A nominal group technique was used to evaluate the main strategies for PEARLS.

Prognostic factors in treatment of traumatic femoropopliteal arterial injuries at a Brazilian trauma center.

Background: Despite significant improvements in outcomes, traumatic arterial limb injuries remain a significant cause of limb loss and mortality.

Objectives: This study sought to identify predictors of mortality and major amputation in patients undergoing revascularization after femoropopliteal arterial trauma.

Methods: This was a retrospective review of a trauma registry from an urban trauma center in Brazil.

Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings.

Background: Survival of Wilms tumor (WT) is > 90% in high-resource settings but < 30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes.

Objective: Provide resource-sensitive recommendations for the surgical management of WT.

Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries.

Background: Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life.

Methods: Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals.

Management of Pediatric Tumors With Vascular Extension.

Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible.

Diagnostic Errors in Wilms' Tumors: Learning From Our Mistakes.

This study aimed to analyze clinical characteristics and image findings in patients initially diagnosed with renal masses and treated on the Société Internationale d'Oncologie Pédiatrique (SIOP) 2001 protocol for Wilms tumor (WT) that eventually were diagnosed with different pathologies. We reviewed the preoperative symptoms, laboratory tests, and images of patients who were initially treated for WT and proved to have other diagnoses. Data from these patients were compared to those of the last 10 patients with WT and the last 10 patients with neuroblastoma (NBL) treated at a single institution.

Lessons Learned From Treating 114 Inferior Vena Cava Injuries at a Limited Resources Environment - A Single Center Experience.

Background: The inferior vena cava is the most frequently injured vascular structure in penetrating abdominal trauma. We aimed to review inferior vena cava injury cases treated at a limited resources facility and to discuss the surgical management for such injures.

Methods: This was a retrospective study of patients with inferior vena cava injuries who were treated at a single center between January 2011 and January 2020.

Comparative angiotomographic study of swine vascular anatomy: contributions to research and training models in vascular and endovascular surgery.

Background: Medium and large animal models allow researchers to evaluate the efficacy and safety of cardiovascular procedures in systems that resemble human anatomy and can be used to simulate scenarios for training purposes. Although porcine models have been used extensively, many physiological and anatomical features remain unknown or only superficially described.

Objectives: To describe the normal porcine vascular anatomy on computed tomography scans, compare it to human vascular anatomy, and discuss the application of porcine models for open and endovascular procedures.