In this video, surgical oncologists discuss surgery for children with neuroblastoma. These operations tend to be quite difficult because of the nature of these tumors, which often wrap themselves around delicate structures in the body. At The Children's Hospital of Philadelphia, surgical oncologists aim to remove as much of the tumor as possible, while preserving all normal organ functioning.
Surgery for Children with Neuroblastoma at CHOP
Rochelle Bagatell, MD: 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.
Peter Mattei, MD: 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.
N. Scott Adzick, MD: 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.
Peter Mattei, MD: 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.
N. Scott Adzick, MD: 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.
Peter Mattei, MD: 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.
Rochelle Bagatell, MD: 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.
Peter Mattei, MD: 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.
Yakob Habtesion: 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."
Rahel Berhane: 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."
Yakob Habtesion: 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.
Peter Mattei, MD: 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.