Publications by authors named "Barrie S Rich"
Article Synopsis
- Pediatric breast masses in children and adolescents are mostly benign, but rare malignant cases require quick identification and treatment to protect developing breast tissue.
- Evaluation starts with a detailed history and physical exam, followed by ultrasound for further characterization, and in some cases, observation is adequate instead of surgery.
- Pediatric surgeons play a key role in managing these cases, and an established algorithm recommends careful diagnosis and treatment, with a multidisciplinary approach for malignant lesions.
Article Synopsis
- Surgical biopsy (SB) has traditionally been used for diagnosing pediatric solid tumors, but newer image-guided techniques like core needle biopsy (CNB) show promise due to lower risks and similar diagnostic accuracy.
- A systematic review of studies from 2010 to 2023 included 27 studies with nearly 2,500 pediatric patients and compared complication rates and diagnostic efficacy of CNB versus SB across various tumor types.
- Results indicated that while CNB had a 90.8% diagnostic success rate and much lower complication rate (2.9%) compared to SB (21.4% complication rate), the overall diagnostic success was notably higher for SB (98.8%).
Germ cell tumors (GCT) are a complex, heterogeneous collection of tumors that may present in either gonadal or extragonadal sites. They consist of a variety of benign and malignant histologies that can occur at several locations throughout the body. An important component of treatment is surgical resection, and while the key components of resection are site specific, the universal goals of GCT resection include the complete resection of tumor without violating the tumor capsule, while preserving function of surrounding organs, minimizing morbidity, and assessing for regional spread.
View Article and Find Full Text PDFPurpose: Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non-RCR).
Patients And Methods: This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi-square tests were conducted for differences among groups.
Pediatric and adolescent ovarian lesions are common and are frequently managed by both pediatric surgeons and pediatric and adolescent gynecologists. During the 2023 American Academy of Pediatric Section on Surgery meeting, an educational symposium was delivered focusing on various aspects of management of pediatric and adolescent benign and malignant masses, borderline lesions, and fertility options for children and adolescents undergoing cancer therapies. This article highlights the discussion during this symposium.
View Article and Find Full Text PDFIntroduction: Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy.
Methods: Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed.
Background: Undifferentiated embryonal sarcoma of the liver (UESL) is a rare tumor for which there are few evidence-based guidelines. The aim of this study was to define current management strategies and outcomes for these patients using a multi-institutional dataset curated by the Pediatric Surgical Oncology Research Collaborative.
Methods: Data were collected retrospectively for patients with UESL treated across 17 children's hospitals in North America from 1989 to 2019.
Purpose: Malignant peritoneal and pleural mesothelioma are rare in young patients, with a paucity of data regarding clinical characteristics and outcomes. We aimed to describe the clinical characteristics, treatment strategies, and outcomes for pediatric and adolescent/young adult (AYA) patients.
Methods: The National Cancer Database (NCDB) was queried for malignant peritoneal and pleural mesothelioma in pediatric and AYA patients (ages 0-39) from 2004 to 2019.
Performance of the appropriate operation is highly important to ensure that any patient with a suspected ovarian germ cell tumor receives optimal therapy that prioritizes cure while simultaneoulsy minimizing risk of short and long-term toxicities of treatment. The following critical elements of any operative procedure performed for a suspected pediatric or adolescent ovarian germ cell tumor are reviewed: 1. Complete resection of the tumor via ipsilateral oophorectomy while avoiding tumor rupture and spillage, and 2.
View Article and Find Full Text PDFBackground: Lymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT.
Methods: Records of patients 0-20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed.
Background: Nephrogenic rests (NR) may represent precursor lesions for Wilms tumor (WT), but their clinical course is not fully understood and no guidelines for treatment exist. This study sought to evaluate the outcomes of pediatric patients with NRs related to traditional chemotherapy and surgery.
Methods: A PRISMA-P-compliant literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, COCHRANE, and SCOPUS from inception to June 2021.
Background: Operating rooms generate significant greenhouse gas emissions. Our objective was to assess current institutional climate-smart actions and pediatric surgeon perceptions regarding environmental stewardship efforts in the operating room.
Methods: A survey was distributed to members of the American Pediatric Surgical Association in June 2022.
Article Synopsis
- This study aimed to analyze how children with Wilms tumor and inferior vena caval (IVC) thrombus are managed and the outcomes of those treatments in a modern cohort.
- The research involved reviewing data from 124 patients across 19 North American medical centers between 2009 and 2019, with findings showing that 81% of patients had favorable tumor histology and a high rate of successful outcomes after neoadjuvant chemotherapy.
- The results indicated that 93% of patients survived without significant events after two years, with neoadjuvant treatment reducing the need for cardiac surgery, and suggesting that complete removal of thrombus may not always be necessary for successful treatment.
Background: Numerous studies have demonstrated a variety of social inequalities within pediatric and young adult patients with solid tumors. This systematic review examines and consolidates the existing literature regarding disparities in pediatric and young adult solid tumor oncology.
Procedure: A MeSH search was performed on the following databases: MEDLINE, PubMed, OvidSP Cochrane, Central, Embase, Cinhal, and Scopus.
Unique challenges face pediatric surgeons at community-based nonteaching hospitals. Communication and collaboration among and between healthcare providers, hospital administrators, and quaternary referral programs is crucial for the success of these smaller hospitals as they care for children.
View Article and Find Full Text PDFBackground: Intraoperative nerve monitoring (IONM) is a technique used to decrease the possibility of nerve-associated morbidity and damage to nearby neural structures during complex surgical procedures. The use and potential benefits of IONM in pediatric surgical oncology are not well-described.
Methods: An overview of the current literature was performed to elucidate the various techniques that may be useful to pediatric surgeons for resection of solid tumors in children.
Introduction: This study evaluated North American pediatric surgeons' opinions and knowledge of business and economics in medicine and their perceptions of trends in their healthcare delivery environment.
Methods: We conducted an elective online survey of 1119 American Pediatric Surgical Association members. Over 8 mo, we iteratively developed the survey focused on four areas: opinion, knowledge, current practice environment, and trends in practice environment over the past 5 y.
Background: Metabolic and bariatric surgery (MBS) in adolescents has been shown to be safe and effective, but current practice patterns are variable and poorly understood. The aim of this study is to assess current MBS practice patterns among pediatric surgeons in the United States.
Methods: American Pediatric Surgical Association members were surveyed on current bariatric surgery practices.
Article Synopsis
- A study analyzed 1,259 children diagnosed with WT between 2009 and 2019, finding that 7.5% had pleural effusions, which were associated with older age and more advanced cancer stages.
- Despite the presence of pleural effusions, survival rates were still high (86.2% event-free, 91.5% overall), and the occurrence of malignant cells in the fluid was low, suggesting no need to change treatment approaches based on pleural effusion
Article Synopsis
- Inflammatory myofibroblastic tumor (IMT) is a type of intermediate malignancy, and this study involves a large cohort of patients (182) under the age of 39 to better understand the disease.
- The findings showed that the median age of patients is 11 years, with common symptoms including pain and respiratory issues, and a notable 53% of tumors displayed ALK overexpression.
- Surgery was frequently performed (91%), leading to a high 5-year survival rate of 95%, but certain factors like tumor size and respiratory symptoms were linked to recurrence risk, indicating that aggressive surgical approaches may not always be necessary.*
Article Synopsis
- Hepatocellular carcinoma (HCC) in children is rare and has various subtypes, making it challenging to manage and predict outcomes.
- A study involving 262 children identified three main HCC subtypes: conventional HCC (cHCC), fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB-HCC), revealing significant differences in their clinical behaviors and mortality risk factors.
- The findings suggest that cHCC has a higher mortality risk compared to FLC, and factors such as elevated α-fetoprotein levels and tumor unresectability are associated with poorer outcomes, highlighting the need for tailored treatment strategies based on histological characteristics.
Intestinal atresia is a form of congenital bowel obstruction that requires operative repair in the early neonatal period. Duodenal atresia and jejunoileal (JI) atresia are appropriately seen as distinct entities. Both can be suspected with fetal imaging, which can assist with prenatal counseling of families.
View Article and Find Full Text PDFIntroduction: Clinical and radiographic findings often lead to diagnostic laparoscopy for presumed adnexal torsion (AT). To better understand the preoperative factors leading to AT, we evaluated the clinical course of patients with ultrasound findings concerning for AT to assess intraoperative AT rates and predictive factors for AT.
Methods: An institutional review board-approved retrospective review in two hospital centers over a period of 5 y was performed for females (4-18 y) with ultrasound (US) findings concerning for AT (n = 225).
Background: Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients.
Methods: A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions.
Introduction: The topics of sub-specialization and regionalization of care have garnered increased attention among pediatric surgeons. Thyroid surgeries are one such sub-specialty and are commonly concentrated within practices. A national survey was conducted examining current surgeon practices and beliefs surrounding pediatric thyroid surgery.
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