The practice of Pediatric Surgical Oncology is challenging and needs specialized training. In the modern era where Pediatric Cancers are potentially curable; the focus is to formulate treatment plans which have minimum complications, with an emphasis on “Organ Preservation” without compromising oncological outcomes. This is made possible with the help of multidisciplinary pediatric solid tumor team.
The child is assessed at presentation by a team of pediatric oncologists and surgeon; and after discussion with radiologists, pathologists and radiation oncologists, we are able to develop a cohesive, integrated and thoughtful approach to his or her care. The use of neo-adjuvant chemotherapy to shrink large tumors, and adjuvant radiotherapy after surgery in select cases; helps in decreasing the morbidity of cancer surgery in children. Organ preserving surgeries include limb salvage surgery for bone and soft tissue sarcomas of the extremities, nephron sparing surgery for bilateral Wilms’ (kidney) tumors, gross total resection of neuroblastoma encasing major abdominal vessels and fertility preserving surgeries to move the ovaries away from the radiation field (oopheropexy). A team of skilled plastic surgeons help us to reconstruct those body parts which need to be sacrificed for better tumor control; especially for the face, ear, nose, chest wall and limbs. Use of minimally invasive techniques like laparoscopy, thoracoscopy and robotic surgery where applicable, facilitate early recovery and decreased hospital stay. The aim is to achieve a good cosmetic and functional outcome after surgery so that the child can lead a normal life once his/ her cancer is cured.
The doctors and nursing staff of the pediatric surgical operating room are well trained and sensitive to the special needs of children with cancer. Induction of anesthesia is made pleasant by an experienced anesthesiologist and one parent is allowed to accompany the child into the operating room in order to alleviate his/ her anxiety. Post operative pain is well managed with the help of epidural analgesia in the Surgical Intensive Care Unit. Use of patient controlled analgesia in older children gives them more confidence.
Fear of needle pricks is another challenge faced by the team treating pediatric oncology patients. To ease this apprehension, we place central vascular access devices like PICC line, Hickman Catheter and Chemoport. These devices can be used for administering chemotherapy, blood sampling, IV medications as well as transfusion of blood and blood products; thus improving the compliance and making the child’s treatment comfortable.
Here is a list of common pediatric solid tumors which need surgery
Cancers like Leukemia, Lymphoma may also need biopsy of node, bone marrow biopsy,PORT/PICC line insertion and other adjuvant procedures.