Publications by authors named "Dave R Lal"
Purpose: Early Kasai portoenterostomy (KPE) for infants with biliary atresia (BA) increases the chance of transplant-free survival (TFS). However, early timing of KPE is not consistently achieved in the United States. Clearance of jaundice at three months is predictive of TFS.
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.
Article Synopsis
- Most ovarian masses in children and adolescents are benign, but many undergo unnecessary oophorectomies, which can harm long-term health.
- A study evaluated a preoperative risk stratification algorithm in 11 children's hospitals to help differentiate between benign and malignant ovarian conditions, aiming to reduce unnecessary surgeries.
- Results showed that the percentage of unnecessary oophorectomies significantly decreased from 16.1% to 8.4% after implementing the algorithm, indicating its effectiveness in identifying benign cases.
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.
Importance: 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
- 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.
Article Synopsis
- Anastomotic stricture is a common complication following esophageal atresia repair, and the study aimed to investigate if acid suppression after surgery could reduce the occurrence of these strictures.
- Conducted on a cohort of 156 infants from 2016 to 2020, the study found that 51% developed strictures, with a significant proportion occurring within three months post-repair, and the use of acid suppression did not correlate with a reduction in stricture formation at various time points.
- The analysis revealed that the use of a transanastomotic tube was linked to an increased risk of strictures at hospital discharge and at three months, indicating that this device may contribute to the complications rather than the duration
Background: With increased surgeon comfort using laparoscopy, we hypothesized resection of pediatric ovarian dermoids using laparoscopy would yield a shorter length of stay and no increase in morbidity or recurrence compared to laparotomy.
Methods: A retrospective review was performed amongst eleven pediatric hospitals. Patients aged 2 to 21 who underwent resection of an ovarian dermoid from 2010 to 2020 were included.
Study Objective: To assess the preoperative imaging impression and surgeon diagnostic accuracy for pediatric ovarian mature cystic teratomas (MCTs) DESIGN: Retrospective review SETTING: Eleven pediatric hospitals PARTICIPANTS: Patients ages 2 to 21 who underwent surgical management of an ovarian neoplasm or adnexal torsion with an associated ovarian lesion INTERVENTION: None MAIN OUTCOME MEASURES: Preoperative imaging impression, surgeon diagnosis, tumor markers, and pathology RESULTS: Our cohort included 946 females. Final pathology identified 422 (45%) MCTs, 405 (43%) other benign pathologies, and 119 (12%) malignancies. Preoperative imaging impression for MCTs had a 70% sensitivity, 92% specificity, 88% positive predictive value (PPV), and 79% negative predictive value (NPV).
View Article and Find Full Text PDF