Pediatric Surgical Oncology
Survival rates for children with cancer have improved dramatically over the past three decades. This improvement is due to the multi-modal therapy administered to children with cancer. Refinements in chemotherapy and radiation therapy have been particularly helpful.
Multi-agent chemotherapy has significantly improved survival for most solid and hematogeous malignancies. Chemotherapy prior to resection of a tumor has allowed the surgeon to perform less radical operations. Advances in surgical technique, anesthetic monitoring, and postoperative management have also significantly reduced the morbidity and mortality associated with resection of tumors. It should be recognized that less need for radical resection of tumors does no imply there is less involvement from the pediatric surgical oncologist. In fact, early involvement of a surgeon in the care of most children with cancer is warranted. Very few patients are “cured” without some surgical intervention. Some examples are as follows:
- Patients with leukemia will always require access to the central venous system for the administration of chemotherapy.
- Patients with “failure to thrive” from their treatment often require access to the gastrointestinal tract to assist with nutrition.
- Surgeons play a key role in performing biopsy procedures. The correct choice of the biopsy technique and approach requires a thorough understanding of the patient’s disease.
- Resection of tumors requires a special knowledge of the natural history of the patient’s malignancy. The pediatric surgeon oncologist must clearly understand the role of resection and the goals of resection.
The pediatric surgical oncologist must have a good working relationship with the all those involved in the care of the patient and participate in multidisciplinary tumor board discussions to determine the best surgical care for the patient. In addition, the dedicated pediatric surgical oncologist participates in national cooperative groups and stays up-to- date with current treatment protocols and algorithms.
—Nicholas C. Saenz, M.D., Pediatric Surgery