Surgery for Children with Solid Tumors – The Children’s Hospital of Philadelphia


>>THERE’S NO OTHER
HOSPITAL IN THE U.S., AT LEAST, THAT DOES MORE
NEUROBLASTOMA THAN CHOP. THEY SEE THE MOST
VOLUME THAN ANY, SO WE DECIDED TO ALSO GO
INTERVIEW THE DOCTORS OVER THERE. AND AS SOON AS WE
COMPLETED THE INTERVIEW, WE KNEW WE WANTED TO
TAKE HIM TO PHILADELPHIA.>>FOR A CHILD AND FOR
A FAMILY FACING CANCER, WE HAVE EVERY SURGICAL
RESOURCE IMAGINABLE AT THE CHILDREN’S HOSPITAL
OF PHILADELPHIA. WHEN YOU THINK ABOUT IT,
WE HAVE AN ARRAY OF PEDIATRIC SURGICAL SPECIALISTS. SEVENTY-FIVE IN NUMBER,
MORE THAN ANY CENTER IN THE WORLD THAT CAN
PROVIDE ANY EXPERTISE THAT A CHILD WITH CANCER NEEDS.>>THE NICE THING ABOUT A
PLACE LIKE CHOP IS THAT WE HAVE EXPERTS IN REALLY
JUST ABOUT EVERY AREA OF PEDIATRIC SUBSPECIALTY. AND SO IF PATIENTS COME WITH
A PROBLEM THAT IS UNUSUAL OR UNCOMMON, WE KNOW THAT
WE CAN FIND THE EXPERTISE.>>I CAN THINK OF EIGHT TO
10 DIFFERENT TECHNIQUES THAT WE’VE DEVELOPED HERE
IN RESPONSE TO CHALLENGING SITUATIONS OR PROBLEMS. THE WHOLE FIELD OF
LIMB-SPARING SURGERY HAS BEEN AROUND FOR A LONG TIME,
BUT WITHIN THE UMBRELLA OF THAT FIELD THERE ARE
MANY DIFFERENT NUANCES AND VARIATIONS THAT HAVE BEEN
DEVELOPED HERE AT CHOP OVER THE YEARS.>>THE RIGHT APPROACH TO
SURGERY ON THE BRAIN IS A LITTLE BIT DIFFERENT
THAN OTHER SURGERIES BECAUSE THE FUNCTION IS NOT
QUITE AS WELL DEFINED, THE WHOLE
MIND-BRAIN BARRIER. SO A GREAT CONCERN IS ALWAYS
TO BE AGGRESSIVE WITHOUT BEING RECKLESS. YOU WANT TO REMOVE AS MUCH
TUMOR AS YOU CAN AND LEAVING THEM NEUROLOGICALLY INTACT.>>THE MAJORITY OF PATIENTS
WITH NEUROBLASTOMA EVENTUALLY REQUIRE SURGERY. SURGERY IS AN INTEGRAL PART
OF THE CARE OF MOST PATIENTS WITH NEUROBLASTOMA. MOST OF THE TIME IS SPENT
PAINSTAKINGLY REMOVING THE TUMOR, LITERALLY
MILLIMETER BY MILLIMETER. AND SOMETIMES IT MEANS
SEPARATING IT VERY CAREFULLY FROM THESE VERY
DELICATE STRUCTURES. WE ALWAYS HAVE TO TAKE OUR
TIME AND BE VERY CAREFUL.>>A SURGEON HAS TO HAVE
A GREAT DEAL OF TECHNICAL EXPERTISE IN ORDER TO
BE ABLE TO CARRY OUT, FOR EXAMPLE, A LIMB
SALVAGE PROCEDURE. I THINK WHAT SETS THE TEAM
AT CHOP APART IS AN ABILITY TO UNDERSTAND
THE CHEMOTHERAPY, THE RADIATION
CONSIDERATIONS, AND ALL THE OTHER ASPECTS
THAT GO INTO THE ENTIRETY OF A PATIENT’S CARE. PATIENTS COME FROM A VERY
LONG WAY TO TAKE ADVANTAGE OF THE EXPERTISE AND THE
VOLUME THAT WE HAVE HERE AT CHOP.>>VOLUME IS CRITICAL IN A
SURGICAL PROGRAM FOR THE SIMPLE REASON THAT THE MORE
EXPERIENCE SOMEBODY HAS IN ALL THE VARIETIES OF
THAT CLINICAL PRESENTATION, THE BETTER OFF THE PATIENT
IS GOING TO BE IN TERMS OF THAT SURGEON BEING
ABLE TO ANTICIPATE, AS WELL AS TO DEAL
WITH THE UNEXPECTED. IF YOU’RE DOING 100
OPERATIONS FOR BRAIN TUMORS A YEAR, THE VARIETY AND
THE DIFFERENCES OF CLINICAL EXPERIENCE THAT YOU’RE GOING
TO HAVE AND BE ABLE TO BRING TO THIS INDIVIDUAL PATIENT
IS GOING TO BE MUCH RICHER AND MUCH MORE POWERFUL.>>THE FACT THAT WE SEE SO
MANY CHILDREN WITH RARE, UNCOMMON,
DIFFICULT TUMORS, I THINK, LEADS TO THIS OR HELPS
FOSTER SUPPORT THIS ENVIRONMENT OF INNOVATION. TRYING TO FIND NEW
AND BETTER WAYS.>>FOR MOST PATIENTS AND
PARENTS WHOSE CHILD IS ABOUT TO UNDERGO A MAJOR OPERATION
UNDER GENERAL ANESTHESIA, IT’S OFTEN THE ANESTHESIA
THAT IS THE SCARIEST PART FOR THOSE PATIENTS. AND SO WE TRY TO ADDRESS
THAT IN A PROACTIVE WAY AHEAD OF TIME. WE REASSURE THEM THAT
GENERAL ANESTHESIA IS VERY SAFE FOR PATIENTS,
ESPECIALLY YOUNG PATIENTS. BUT WE ALSO REASSURE THEM THAT
IT IS A VERY SERIOUS BUSINESS.>>WE’RE FORTUNATE TO HAVE
AN ANESTHESIA PAIN PROGRAM HERE AT CHOP, WHICH I
BELIEVE IS VERY UNIQUE AND HUGELY VALUABLE AFTER
THIS TYPE OF SURGERY. OUR ANESTHESIA TEAM IS
LOOKING FOR CATHETERS OR REGIONAL BLOCKS OR
POSTOPERATIVE PAIN MANAGEMENT TECHNIQUES THAT
WILL HELP MAKE IT A LESS PAINFUL EXPERIENCE FOR
THE CHILD AFTER SURGERY.

1 thought on “Surgery for Children with Solid Tumors – The Children’s Hospital of Philadelphia

  1. Thank you CHOP for saving my daugher's Life! The care and professionalism of doctors and surgeons were amazing. She is a normal healthy girl 4 years later. Thank you. Your staff hold a special place in my families hearts! Michael

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