Development of a template for operative reporting of pediatric cancer surgery in limited‐resource settings by using a modified Delphi method

BackgroundWilms tumour (WT) is one of the common and curable cancer types targeted by the Global Initiative for Childhood Cancer. Tumour excision is essential for cure. This analysis focuses on surgical outcomes of patients with WT in sub‐Saharan Africa.MethodsWe implemented a risk‐stratified WT treatment guideline as a multicentre, prospective study across eight hospitals and six countries. Eligibility criteria were age 6 months to 16 years, unilateral WT, surgery performed after preoperative chemotherapy and diagnosed between 1 January 2021 and 31 December 2022. Data collection included a specific surgical case report form (CRF).ResultsThe study registered 230 patients, among whom 164 (71.3%) had a nephrectomy. Ninety‐eight percent of patients had a completed surgical CRF. Out 164 patients, 50 (30.5%) had distant metastases. Median tumour diameter at surgery was 11.0 cm. Lymph node sampling was done in 122 (74.3%) patients, 34 (20.7%) had intraoperative tumour rupture, and for 18 (10.9%), tumour resection involved en bloc resection of another organ. Tumour size at surgery was significantly correlated with tumour rupture (p < .01). With a median follow‐up of 17 months (range: 2–33), 23 (14.0%) patients have relapsed. Twenty‐two (13.4%) patients abandoned treatment post nephrectomy. Two‐year event‐free survival was 60.4% ± 4.7% with treatment abandonment as an event.ConclusionSurvival post nephrectomy is challenged by treatment abandonment, treatment‐related mortality and relapse. Large tumours after preoperative chemotherapy were associated with a higher risk of tumour rupture. Earlier diagnosis and access to radiotherapy are expected to improve survival.

Surgical aspects and outcomes after nephrectomy for Wilms tumour in sub‐Saharan Africa: A report from Wilms Africa Phase II—CANCaRe Africa

Appeadu‐Mensah,

Mdoka,

Alemu

et al. 2024

Childhood cancer surgery in low‐ and middle‐income countries

Pio,

Loh,

Harrison

et al. 2024

This report summarizes the status of pediatric surgical oncology services in low‐ and middle‐income countries. Factors such as surgical capacity and enablers, and barriers to providing pediatric surgical oncology services are discussed. A review of the literature was conducted to examine the evidence for the capacity of low‐ and middle‐income countries to provide childhood cancer surgery services, focusing on general surgery. Unpublished, ongoing work and initiatives of international organizations are also described.

An assessment of narrative operative reports for Wilms tumor resection using consensus component criteria

Morrison,

Rajesh,

Davidoff

et al. 2024

IntroductionPrecision in surgical documentation is essential to avoid miscommunication and errors in patient care. Synoptic operative reports are more precise than narrative operative reports, however they have not been widely implemented in pediatric surgical oncology. To assess the need for implementation of synoptic operative reports in pediatric surgical oncology, we examined the completeness of narrative operative reports in patients undergoing resection of Wilms tumor.MethodsWe conducted a retrospective review of narrative operative reports for resection of Wilms tumor at a single pediatric oncology center from January 2022 through July 2023. Primary outcomes were the presence or absence of 11 key operative report components. Inclusion rates were calculated as simple percentages. Unilateral and bilateral operations were considered.ResultsThirty‐five narrative reports for Wilms tumor resection were included. The most consistently documented operative report components were estimated blood loss, indication for surgery, intraoperative complications, and specimen naming (100% documentation rates). Documentation of lymph node sampling was present in 94.3% of reports. The least consistently documented components were assessment of intraoperative tumor spillage, completeness of resection, metastatic disease, and assessment of vascular involvement (each ≤40% documentation rate). All 11 key components were documented in three reports.ConclusionsEven at a large tertiary pediatric oncology referral center, narrative operative reports for pediatric Wilms tumor resection were found to be frequently missing important components of surgical documentation. Often, these were omissions of negative findings. Utilization of synoptic operative reports may be able to reduce these gaps.