Surgery for Children with Neuroblastoma at The Children’s Hospital of Philadelphia


>>A SUCCESSFUL SURGERY IS
IMPORTANT IN TERMS OF TUMOR BURDEN, BUT ALSO A SUCCESSFUL
SURGERY IN WHICH THE PATIENT RECOVERS QUICKLY CAN FACILITATE
THE ADMINISTRATION OF THE NEXT CYCLE OF CHEMOTHERAPY
AND A SMOOTH TRANSITION ON INTO THE OTHER PHASES
OF THAT PATIENT’S TREATMENT.>>THE MAJORITY OF PATIENTS
WITH NEUROBLASTOMA EVENTUALLY REQUIRE SURGERY. SURGERY IS AN INTEGRAL PART
OF THE CARE OF MOST PATIENTS WITH NEUROBLASTOMA. THE OPERATION ITSELF
TENDS TO BE QUITE DIFFICULT BECAUSE THE TUMOR HAS A
TENDENCY NOT TO INVADE OTHER STRUCTURES, BUT TO WRAP
ITSELF AROUND VITAL ORGANS AND STRUCTURES, SUCH AS
BLOOD VESSELS AND NERVES. AND SO IT CAN BE QUITE
DIFFICULT SOMETIMES TO REMOVE THE TUMOR WHILE
PRESERVING THOSE STRUCTURES.>>SURGICAL CARE OF CHILDREN
WITH CANCER IS GETTING BETTER AND BETTER,
AND THAT’S BECAUSE OF INNOVATIONS, AND THAT’S
BECAUSE OF THE SURGICAL SPECIALISTS WE HAVE HERE
WHO CAN PROVIDE THAT CARE, EXCISE THAT TUMOR, AND
PRESERVE AS MUCH NORMAL FUNCTION AS POSSIBLE.>>WE WANT TO REMOVE AS MUCH
OF THE TUMOR AS POSSIBLE, BUT WE ALSO WANT TO
PRESERVE ALL NORMAL ORGANS. THE PRINCIPAL STRUCTURES
THAT WE ENCOUNTER DIFFICULTY WITH INCLUDE THE AORTA,
THE INFERIOR VENA CAVA — ALL THE BRANCHES OF THE AORTA
IN THE ABDOMEN CAN SOMETIMES BE ENGULFED BY THE TUMOR. AND SOMETIMES IT’S
STRAIGHTFORWARD TO SEPARATE THE TUMOR FROM
THOSE STRUCTURES. OTHER TIMES IT’S
QUITE DIFFICULT. THE SECOND MOST COMMON
TUMOR THAT WE OPERATE ON IN CHILDREN IS WILMS’ TUMOR,
WHICH IS A RELATIVELY COMMON TUMOR OF THE KIDNEYS. THIS OFTEN REQUIRES
A NEPHRECTOMY, A REMOVAL OF THE KIDNEY. SOMETIMES A PATIENT MIGHT
BE A CANDIDATE FOR A PARTIAL NEPHRECTOMY, WHERE WE REMOVE
THE TUMOR AS WELL AS A VERY SMALL PART OF THE KIDNEY TO
TRY TO PRESERVE AS MUCH OF THE KIDNEY AS POSSIBLE. ONE OF THE OTHER MORE
COMMON TUMORS THAT WE SEE IN CHILDREN IS HEPATOBLASTOMA,
AND THAT IS AN OPERATION THAT OFTEN REQUIRES REMOVING
A PORTION OF THE LIVER, OR A HEPATECTOMY. IN RARE CASES, IF THE
TUMOR IS QUITE EXTENSIVE, THE PATIENT REQUIRES
A LIVER TRANSPLANT. AND IN THAT SITUATION, WE
INVOLVE THE LIVER TRANSPLANT SURGEONS.>>WE HAVE THE CLINICAL
VOLUME THAT HELPS PEOPLE TO HONE THEIR SKILLS AND
BASICALLY GET BETTER. THE RESULTS HERE
ARE FANTASTIC. THE COLLABORATION WITHIN
THE SURGERY DEPARTMENT IS TREMENDOUS. THERE IS NO THRESHOLD,
BASICALLY, TO CALL A COLLEAGUE TO
HELP OUT IN A CHILD’S CARE. THERE’S NO EGO INVOLVED. IT’S JUST WHAT’S
BEST FOR THE KID. SO THE KID IS RIGHT
HERE, AND THAT’S REALLY A BENCHMARK OF THE CHILDREN’S
HOSPITAL OF PHILADELPHIA.>>WE WORK VERY WELL IN A
COLLABORATIVE FASHION WITH ALL OF OUR SUB-SPECIALISTS,
AND ESPECIALLY WHEN IT COMES TO THE ONCOLOGY CENTER,
THEY’RE VERY GOOD AT ORGANIZING AND BRINGING
TOGETHER EXPERTS IN ALL FIELDS WHENEVER NECESSARY.>>I THINK WHAT’S REALLY
UNIQUE ABOUT THE COORDINATED CARE THAT OUR SURGICAL
ONCOLOGISTS AND PEDIATRIC ONCOLOGISTS ARE ABLE TO
DELIVER HERE AT CHOP IS THAT WE THINK TOGETHER. WE WORK TOGETHER FREQUENTLY. WE THINK ABOUT PROBLEMS
TOGETHER FREQUENTLY, AND WE’RE ABLE TO THINK
ABOUT THE TECHNICAL ASPECTS AS WELL AS THE MEDICAL
ASPECTS TOGETHER. WE’VE BEEN ABLE TO PARTNER
WITH OUR COLLEAGUES SO THAT CARE CAN BE DELIVERED
CLOSE TO THE PATIENT’S HOME. BUT RIGHT AROUND
THE TIME OF SURGERY, WE ALL COME BACK
INTO THE PICTURE, HELP THE PATIENT THROUGH
WHAT CAN POTENTIALLY BE A CHALLENGING SITUATION, AND
THEN COMMUNICATE BACK WHAT’S HAPPENED IN THE
PERIOPERATIVE PERIOD TO THE ONCOLOGY AND SURGERY TEAMS
THAT ARE GOING TO BE TAKING CARE OF THE PATIENT
DOWN THE ROAD.>>SOMETIMES IT IS THE
SURGICAL ASPECT OF THEIR CARE THAT REQUIRES
A PLACE LIKE CHOP, AND SO WE’RE HAPPY TO WORK
TOGETHER WITH ONCOLOGISTS IN THE COMMUNITY, FROM ANY
PART OF THE COUNTRY OR, IN SOME CASES,
ANY PART OF THE WORLD. WE’RE NOT TRYING TO TAKE
THAT PATIENT AWAY FROM THEM. WE JUST WANT TO HELP
IN ANY WAY THAT WE CAN.>>I HAD SEVERAL DOCTORS
ON THE LIST THAT I WANTED TO MEET, BUT AFTER WE MET
WITH DR. MATTEI, HE JUST MADE US
FEEL COMFORTABLE. I’VE NEVER HEARD A
DOCTOR THAT WOULD SAY, “I’M HONORED TO HAVE YOU
CHOSEN ME TO COME HERE TO POSSIBLY DO YOUR
SON’S SURGERY.”>>I REMEMBER HE
CALLED MATTHEW TO HIS HEAD AND HE SAID —
HE CHECKED HIM, AND HE SAID, “I’LL TAKE CARE
OF HIM JUST LIKE MY SON.”>>AFTER ABOUT NINE
HOURS OR 10 HOURS WAITING, WHEN DR. MATTEI FINALLY
COMES AND TELLS YOU, YOU KNOW, 99 PERCENT OF
THE TUMOR IS REMOVED, IT WAS, YOU KNOW,
THE HAPPIEST DAY OF, YOU KNOW, ME AND MY WIFE.>>BECAUSE THERE ARE FEW
THINGS MORE REWARDING THAN HELPING A CHILD WITH CANCER. IT’S A VERY DIFFICULT
OPERATION IN MANY CASES. IT’S VERY CHALLENGING
FROM A TECHNICAL STANDPOINT. IT’S VERY DIFFICULT FROM
AN EMOTIONAL STANDPOINT. BUT, AGAIN, THE REWARDS OF
A JOB WELL DONE ARE GREATER THAN PROBABLY IN ANY OTHER
FIELD THAT I CAN IMAGINE.

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