Children's Oncology Group's 2023 blueprint for research: Surgery

Abstract

Surgery plays a crucial role in the treatment of children with solid malignancies. A well-conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well-established standards. The long-term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.

Keywords: Wilms tumor; education; germ cell tumor; hepatoblastoma; imaging; neuroblastoma; osteosarcoma; quality assurance; sarcoma; surgery; synoptic operative notes; technology.

FIGURE 1.

A. Axial view from an abdominal CT scan of a child with a retroperitoneal neuroblastoma. The black arrow shows the encased right renal artery. B. 3D rendering from the same study. Again, the black arrow shows the encased right renal artery. The white arrow shows the inferior vena cava, which is not encased. The asterisk shows the hand-held device used to manipulate the image. (Courtesy Chris Goode, Memphis, TN).

FIGURE 2.

Near-infrared images of tumors (Left – paraspinal retroperitoneal neuroblastoma [note heterogenous ICG uptake], Middle – paraspinal neuroblastoma resection bed [note residual ICG uptake that was subsequently resected], Right – hepatocellular carcinoma lung metastasis) following systemic administration of indocyanine green (1.5 mg/kg) given intravenously 24 hours prior to surgery. (Courtesy Hafeez Abdelhafeez, Memphis, TN)

FIGURE 3.

Left: White light view of an orthotopic neuroblastoma in a murine model following intravenous injection of a GD-2-targeted fluorescent tracer. Right: Near-infrared (NIR) image demonstrating tumor-specific uptake. (Courtesy of Marcus Malek, Pittsburgh, PA).