Abdelhafeez Abdelhafeez, Loh Amos, Harison Derek, Ahmad Alia, Velasquez Herrera Thelma Beatriz, Qureshi Bilal Mazhar, Malik Faizan, Renner Lorna, Vujanic Gordan, Parkes Jeannette, Galluzzo Laura, Nightingale Michael, Lucas John T, Kambugu Joyce, Cox Sharon, Abib Simone de Campos Vieira, Lakhoo Kokila
Department of Surgery, Division of Pediatric Surgery, University of Rochester Medical Center, Golisano Children's Hospital, Rochester, New York, USA.
Department of Paediatric Surgery, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, KK Women's and Children's Hospital, Singapore, Singapore.
Pediatr Blood Cancer. 2025 Dec;72(12):e32031. doi: 10.1002/pbc.32031. Epub 2025 Sep 7.
Local control strategies in pediatric oncology are guided by disease-specific considerations. Effective communication of the goals of surgical procedure and associated intraoperative events plays a crucial role in shaping subsequent treatment decisions. However, accurately and comprehensively documenting these findings remains challenging, with considerable variability across different tumor types. This investigation aims to achieve a consensus on critical intraoperative oncologic observations pertaining to pediatric solid tumors, thereby facilitating the enhancement of surgical reporting and the optimization of subsequent treatment strategies.
An expert panel comprising childhood cancer specialists from diverse disciplines and geographical regions participated in a Delphi consensus process. After reviewing relevant literature and engaging in multiple voting rounds, the panel identified essential tumor-specific intraoperative documentation elements.
A Delphi panel of 16 experts from diverse geographical locations completed two rounds of voting with a 94% participant retention rate and achieved consensus on 15 key statements. Essential documentation components included completeness of resection, evaluation of locoregional spread, and vascular involvement, with tumor-specific variations. For instance, neuroblastoma required documentation of resection percentage, while sarcoma emphasized biopsy tract resection and plane of resection. Ovarian germ cell tumors necessitated ascitic fluid sampling and contralateral ovary evaluation. Additionally, the presence of tumor thrombus was highlighted as particularly relevant in renal, liver, and adrenocortical carcinomas. Despite recognizing the significance of these findings, the panel noted deficiencies in operative reports, including omissions of documentation of tumor spillage, lymph node sampling, and residual disease, underscoring the need for improved documentation to support multidisciplinary decision-making.
This study highlights the critical role of precise intraoperative documentation in guiding multidisciplinary care for pediatric solid tumors. The variability across tumor types underscores the need for tailored documentation guidelines. While a standardized synoptic operative report could improve consistency and communication, a hybrid model combining universal elements with tumor-specific details may offer an effective solution for comprehensive and adaptable reporting.
儿科肿瘤学中的局部控制策略以疾病特异性考量为指导。手术操作目标及相关术中事件的有效沟通在形成后续治疗决策中起着关键作用。然而，准确且全面地记录这些发现仍然具有挑战性，不同肿瘤类型之间存在相当大的差异。本研究旨在就小儿实体瘤相关的关键术中肿瘤学观察结果达成共识，从而促进手术报告的完善以及后续治疗策略的优化。
一个由来自不同学科和地理区域的儿童癌症专家组成的专家小组参与了德尔菲共识过程。在回顾相关文献并进行多轮投票后，该小组确定了肿瘤特异性术中记录的基本要素。
一个由来自不同地理位置的16名专家组成的德尔菲小组完成了两轮投票，参与者保留率为94%，并就15项关键陈述达成了共识。基本记录内容包括切除的完整性、局部区域扩散的评估以及血管受累情况，存在肿瘤特异性差异。例如，神经母细胞瘤需要记录切除百分比，而肉瘤则强调活检道切除和切除平面。卵巢生殖细胞肿瘤需要进行腹水采样和对侧卵巢评估。此外，肿瘤血栓的存在在肾、肝和肾上腺皮质癌中被特别强调。尽管认识到这些发现的重要性，但该小组指出手术报告中存在不足之处，包括遗漏肿瘤溢出、淋巴结采样和残留疾病的记录，强调需要改进记录以支持多学科决策。
本研究强调了精确的术中记录在指导小儿实体瘤多学科治疗中的关键作用。肿瘤类型之间的差异凸显了制定针对性记录指南的必要性。虽然标准化的概要手术报告可以提高一致性和沟通效果，但将通用要素与肿瘤特异性细节相结合的混合模式可能为全面且适应性强的报告提供有效的解决方案。
