Publications by authors named "Sara A Mansfield"
Background: Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches to standardize perioperative care. This is the first prospective, multi-institutional study to evaluate ERAS in pediatric patients undergoing abdominal tumor resections.
Methods: All patients >1-month-old undergoing abdominal tumor resection at one of three children's hospitals between 2020 and 2022 were eligible.
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
- The diagnosis and management of biliary dyskinesia in children and adolescents is inconsistent, prompting a systematic review by the American Pediatric Surgical Association to create evidence-based recommendations.
- The review focused on key areas such as diagnostic criteria, the need for cholecystectomy, and outcomes from surgical vs. non-surgical management, but found that diagnostic criteria are unclear and reliable predictors of treatment success are lacking.
- Pediatric-specific guidelines are needed to clarify this condition, improve diagnostic processes, and determine effective management, along with calls for more prospective studies to identify which patients could benefit from surgery.
With an annual cumulative occurrence of approximately 15,000 in North America, all childhood cancers are rare. Very rare cancers as defined by both the European Cooperative Study Group for Rare Pediatric Cancers and the Children's Oncology Group fall into two principal categories: those so uncommon (fewer than 2 cases/million) that their study is challenging even through cooperative group efforts (e.g.
View Article and Find Full Text PDFVery rare tumors are usually divided into two groups: One includes tumors that are rare among both children and adults; the other one encompasses tumors that frequently occur in adults but are rarely observed in children. In this review, we focus on adrenocortical tumors, neuroendocrine tumors of the appendix, pheochromocytoma and paraganglioma, pancreatoblastoma and solid pseudopapillary tumors of the pancreas, with special attention to the role of surgery as main curative intervention or as part of the multimodal treatment.
View Article and Find Full Text PDFObjective: Treatment of neonates with anorectal malformations (ARMs) can be challenging due to variability in anatomic definitions, multiple approaches to surgical management, and heterogeneity of reported outcomes. The purpose of this systematic review is to summarize existing evidence, identify treatment controversies, and provide guidelines for perioperative care.
Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee (OEBP) drafted five consensus-based questions regarding management of children with ARMs.
Objective: The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted a systematic review to describe the epidemiology of venous thromboembolism (VTE) in pediatric surgical and trauma patients and develop recommendations for screening and prophylaxis.
Methods: The Medline (Ovid), Embase, Cochrane, and Web of Science databases were queried from January 2000 through December 2021. Search terms addressed the following topics: incidence, ultrasound screening, and mechanical and pharmacologic prophylaxis.
Background: Significant variation in management strategies for lymphatic malformations (LMs) in children persists. The goal of this systematic review is to summarize outcomes for medical therapy, sclerotherapy, and surgery, and to provide evidence-based recommendations regarding the treatment.
Methods: Three questions regarding LM management were generated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Introduction: Enhanced recovery after surgery (ERAS) is an evidence-based, multi-modal approach to decrease surgical stress, expedite recovery, and improve postoperative outcomes. ERAS is increasingly being utilized in pediatric surgery. Its applicability to pediatric patients undergoing abdominal tumor resections remains unknown.
View Article and Find Full Text PDFBackground: The role of hepatectomy for metastatic disease in children is controversial. Rationales include potential cure, obtaining a diagnosis, and guiding chemotherapy decisions. This study examines the safety and utility of hepatic metastasectomy for children at a single institution.
View Article and Find Full Text PDFBackground: The utility of repeated surgical interventions in hepatoblastoma to achieve no evidence of disease (NED) is not well-defined. We examined the effect of aggressive pursuit of NED status on event-free (EFS) and overall survival (OS) in hepatoblastoma with subgroup analysis of high-risk patients.
Methods: Hospital records were queried for patients with hepatoblastoma from 2005 to 2021.
Purpose: There is still debate over the safest route for the placement of long-term central venous access devices. The aim of this study was to review a large, single-institution experience to determine the impact of access location on peri-operative complications.
Methods: The records of patients undergoing subcutaneous port (SQP) and tunneled catheter insertion over a seven-year period were reviewed.
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.
Article Synopsis
- Despite some advancements, there is still a significant gap in diversity and minority representation among pediatric surgeons compared to the diverse backgrounds of their patient populations.
- The underrepresentation of minorities occurs at all stages of pediatric surgery training, from medical school to fellowship programs.
- This paper emphasizes the importance of diversity, reviews current demographic trends, and suggests evidence-based strategies to enhance minority representation in the pediatric surgery workforce for better patient care.
Purpose: We developed an algorithm to decrease opioid prescriptions for pediatric oncology patients at discharge following surgery, based on a retrospective analysis to decrease variability and over-prescribing. The aim of this study was to prospectively test the algorithm.
Methods: Opioid-naïve patients undergoing surgery for tumor resection at a single institution were included.
Purpose: Image-defined risk factors (IDRFs) are associated with surgical risks in neuroblastoma. We sought to evaluate the impact of neoadjuvant therapy on IDRFs and associated ability to achieve gross total resection (GTR) of locoregional disease in patients with high-risk neuroblastoma.
Methods: We retrospectively reviewed charts of patients treated on four consecutive high-risk neuroblastoma protocols over a 20-year period at a single institution.
Purpose: We sought to determine the benefits of epidural anesthesia (EA) in pediatric surgical patients.
Methods: This study is a single-institution retrospective review of EA for pediatric patients undergoing thoracotomy or laparotomy from 2015 to 2020. Patients with recent or chronic opioid use were excluded.
Objective: To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development, and (3) patient-reported quality of life in children with sarcoma of the chest wall.
Summary Of Background Data: Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery, and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence.
Vascular tumors are a rare subset of vascular anomalies. These are classified based on their malignant potential or local destruction potential. Classification has been historically difficult and treatment recommendations are based on case series.
View Article and Find Full Text PDFComplete surgical resection of pulmonary metastatic disease in patients with osteosarcoma is crucial to long-term survival. Open thoracotomy allows palpation of nodules not identified on imaging but the impact on survival is unknown. The objective of this study was to compare overall survival (OS) and pulmonary disease-free survival (DFS) in children who underwent thoracotomy vs thoracoscopic surgery for pulmonary metastasectomy.
View Article and Find Full Text PDFPurpose: The aim of this study was to evaluate outcomes based on surgical approach for retroperitoneal lymph node dissection (RPLND) in patients with paratesticular rhabdomyosarcoma (PT-RMS).
Methods: Patients undergoing RPLND for PT-RMS over 10 years at a single institution were retrospectively reviewed. Length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), lymph node yield, and time to chemotherapy were assessed.
Background: Image-guided percutaneous core needle biopsy (PCNB) is increasingly utilized to diagnose solid tumors. The objective of this study is to determine whether PCNB is adequate for modern biologic characterization of neuroblastoma.
Procedure: A multi-institutional retrospective study was performed by the Pediatric Surgical Oncology Research Collaborative on children with neuroblastoma at 12 institutions over a 3-year period.