Publications by authors named "Dave Lal"
Introduction: Von Hippel-Lindau (VHL) is a diagnosis that leads to increased risk of tumor development over the course of a patient's lifetime. Patients with VHL undergo screening for multiple tumor types, including pheochromocytomas (PCCs). There is variability among the different international guidelines regarding the age to begin PCC screening, with most suggesting 5 years for screening initiation.
View Article and Find Full Text PDFEsophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia.
J Pediatr Gastroenterol Nutr
December 2024
Objectives: Survival rates in children born with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) have improved; however, morbidity associated with the disease remains high. This study aimed to assess the prevalence of gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), fungal esophagitis, esophageal strictures, and long-term outcomes in children with EA/TEF.
Methods: We conducted a retrospective chart review on patients with EA/TEF who were seen at Children's Wisconsin from January 2003 to January 2023.
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%).
Background: The International Neuroblastoma Risk Group (INRG) classifier utilizes a staging system based on pretreatment imaging criteria in which image-defined risk factors (IDRFs) are used to evaluate the extent of locoregional disease. Children's Oncology Group (COG) study ANBL0531 prospectively examined institutional determination of IDRF status and compared that to a standardized central review.
Methods: Between 9/2009-6/2011, patients with intermediate-risk neuroblastoma were enrolled on ANBL0531 and had IDRF assessment at treating institutions.
Neuroblastoma, the most common extracranial solid tumor in children under the age of 5, has been described as early as the 19th century, and its complexity has continued to intrigue researchers, as well as medical and surgical specialists. At one end of the phenotypic spectrum, neuroblastoma is self-limiting with minimal to no intervention required, while on the opposite end exists the challenge of refractory disease despite aggressive management and toxic systemic treatments. The goal of this review is to describe a comprehensive surgical perspective and contemporary approach to neuroblastoma.
View Article and Find Full Text PDFImportance: The indications, safety, and efficacy of chemical venous thromboembolism prophylaxis (cVTE) in pediatric trauma patients remain unclear. A set of high-risk criteria to guide cVTE use was recently recommended; however, these criteria have not been evaluated prospectively.
Objective: To examine high-risk criteria and cVTE use in a prospective multi-institutional study of pediatric trauma patients.
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.
Article Synopsis
- The study aimed to evaluate the effectiveness of MRI in predicting ovarian cancer in young patients compared to other diagnostic tools like ultrasounds and tumor markers.
- Out of 1,053 patients, 10% were found to have malignancies, revealing MRI's sensitivity and specificity to be 60% and 94% respectively, while ultrasound was less sensitive but more specific.
- The results suggest that MRI shows better sensitivity in ambiguous cases compared to ultrasound, and both MRI and tumor markers tend to agree, indicating that a combined approach could optimize preoperative assessment.
Importance: Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health.
Objective: To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.
Design, Setting, And Participants: Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up.
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: The prevalence and natural history of patent processus vaginalis (PPV) are unknown. An interim analysis was performed of a multi-institutional, prospective, observational study in neonates undergoing laparoscopic pyloromyotomy during which bilateral inguinal canals were evaluated.
Methods: Infants under 4 months undergoing laparoscopic pyloromyotomy were enrolled at 8 children's hospitals.
Background/purpose: Controversy persists regarding the ideal surgical approach for repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). We examined complications and outcomes of infants undergoing thoracoscopy and thoracotomy for repair of Type C EA/TEF using propensity score-based overlap weights to minimize the effects of selection bias.
Methods: Secondary analysis of two databases from multicenter retrospective and prospective studies examining outcomes of infants with proximal EA and distal TEF who underwent repair at 11 institutions was performed based on surgical approach.
Study Objective: Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses DESIGN: Prospective cohort study from 2018 to 2021 SETTING: Eleven children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE: Diagnostic accuracy of FS pathology RESULTS: Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology.
View Article and Find Full Text PDFEnteric duplication cysts are rare congenital anomalies defined by the location along the gastrointestinal tract from which they communicate as well as the epithelial lining they contain. Enteric duplication cysts in communication with the pancreas are an even rarer subset that are often difficult to diagnose due to nonspecific presenting symptoms. In a pediatric patient with a history of recurrent pancreatitis episodes, a pancreatic duplication should be on the differential.
View Article and Find Full Text PDFIntroduction: Disparities in surgical management have been documented across a range of disease processes. The objective of this study was to investigate sociodemographic disparities in young females undergoing excision of a breast mass.
Methods: A retrospective study of females aged 10-21 y who underwent surgery for a breast lesion across eleven pediatric hospitals from 2011 to 2016 was performed.
Introduction: Infants with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) undergo screening for tethered cord syndrome (TCS) via ultrasound and magnetic resonance imaging. Existing literature lacks data to guide optimal timing of screening and magnetic resonance imaging (MRI) is often delayed until 3-6 mo of age, when it is frequently forgotten. Detethering surgery has a high rate of success in patients with TCS and is often performed prophylactically due to potential irreversible deficits.
View Article and Find Full Text PDFImportance: The ability of computed tomography (CT) to distinguish between benign congenital lung malformations and malignant cystic pleuropulmonary blastomas (PPBs) is unclear.
Objective: To assess whether chest CT can detect malignant tumors among postnatally detected lung lesions in children.
Design, Setting, And Participants: This retrospective multicenter case-control study used a consortium database of 521 pathologically confirmed primary lung lesions from January 1, 2009, through December 31, 2015, to assess diagnostic accuracy.
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.
Importance: The factors associated with the failure of nonoperative management of appendicitis and the differences in patient-reported outcomes between successful and unsuccessful nonoperative management remain unknown.
Objectives: To investigate factors associated with the failure of nonoperative management of appendicitis and compare patient-reported outcomes between patients whose treatment succeeded and those whose treatment failed.
Design, Setting, And Participants: This study was a planned subgroup secondary analysis conducted in 10 children's hospitals that included 370 children aged 7 to 17 years with uncomplicated appendicitis enrolled in a prospective, nonrandomized clinical trial between May 1, 2015, and October 31, 2018, with 1-year follow-up comparing nonoperative management with antibiotics vs surgery for uncomplicated appendicitis.
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: Anastomotic stricture is the most common complication after esophageal atresia (EA) repair. We sought to determine if postoperative acid suppression is associated with reduced stricture formation.
Methods: A prospective, multi-institutional cohort study of infants undergoing primary EA repair from 2016 to 2020 was performed.