# Sarcoma (Ewing/Rhabdo) — GCMD Library living collection Also covered as: osteosarcoma · synovial sarcoma · ovarian torsion · rhabdomyosarcoma · alveolar rhabdomyosarcoma · soft tissue sarcoma · alveolar soft part sarcoma · undifferentiated sarcoma Experts: Dr. Todd Ponsky, Dr. Rod Gerardo, Dr. Ellen Encisco, Dr. Jose Campos Updated: n/a · 13 episodes · 254 cited statements ## Episodes ### Diagnosis & Workup - [Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545) — video · 1:05 · [machine version](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545.md) ### Evidence & Research - [Nonmetastatic Nonrhabdomyosarcoma Soft Tissue Sarcoma](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326) — video · 3:50 · [machine version](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326.md) - [Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417) — video · [machine version](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417.md) - [Update Course Rewind: Thoracotomy vs VATS for Lung Metastases](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632) — video · 9:40 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632.md) - [Bailey Roberts, MD - Best of the Best in Pediatric Surgery 2024](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011) — video · 8:39 · [machine version](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011.md) - [Heat 2 Winner: Matthew Urichuk, PhD - Best of the Best in Pediatric Surgery 2024](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013) — video · 1:52 · [machine version](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013.md) - [Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335) — video · 1:14 · [machine version](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335.md) ### Case-Based Learning - [Update Course Rewind: Chest Wall Reconstruction 2024](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839) — video · 5:32 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839.md) ### In-Depth Reviews - [Ovarian Teratoma - Ovarian Torsion - Soft Tissue Sarcoma: Update Course 2015](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672) — video · 34:37 · [machine version](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672.md) - [Soft Tissue Sarcoma Rapid Fire: Update Course 2015](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980) — video · 8:27 · [machine version](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980.md) - [Compiled Hayes Jordan Rapid Fire Sessions: Update Course 2015](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995) — video · 33:36 · [machine version](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995.md) - [Wilms Tumor: Audio Chapter](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 1:04:03 · [machine version](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md) - [Update Course Rewind: 2021 Top Ten Key Takeaways](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578) — video · 16:02 · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578.md) ## Chapters - [0:00](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=0) Introduction and study question (Ep 1) - [0:44](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=44) Study design and patient groups (Ep 1) - [1:53](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=113) Study findings (Ep 1) - [2:56](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=176) Conclusions and commentary (Ep 1) - [0:00](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=0) Ovarian Teratomas and Germ Cell Tumors: Staging and Treatment Updates (Ep 2) - [5:58](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=358) Surgical Technique Discussion for Ovarian Masses (Ep 2) - [12:40](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=760) Ovarian Torsion: Preservation Strategies and Timing (Ep 2) - [18:16](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1096) Ovarian Torsion: Ultrasound Reliability and Surgical Decision-Making (Ep 2) - [25:26](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1526) Rhabdomyosarcoma: Staging, Grouping, and Sentinel Node Requirements (Ep 2) - [31:00](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1860) Non-Rhabdo Soft Tissue Sarcomas: Grade-Based Treatment (Ep 2) - [0:00](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0) Rhabdomyosarcoma staging and prognostic factors (Ep 3) - [2:06](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=126) Case examples and sentinel lymph node biopsy requirement (Ep 3) - [4:31](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=271) Lymphatic mapping rationale in rhabdomyosarcoma (Ep 3) - [4:54](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294) Non-rhabdomyosarcoma treatment paradigm (Ep 3) - [6:54](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414) Key surgical principles and Q&A (Ep 3) - [0:00](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=0) Ovarian Germ Cell Tumors: Case Presentation and Staging Updates (Ep 4) - [5:14](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=314) Ovarian Teratoma Management: Surgical Approach and Technique (Ep 4) - [11:52](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=712) Ovarian Torsion: Preservation Strategies and Timing (Ep 4) - [17:28](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1048) Ovarian Torsion: Operative Timing and Oophoropexy Debate (Ep 4) - [25:07](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1507) Rhabdomyosarcoma: Staging, Grouping, and Sentinel Node Requirements (Ep 4) - [29:40](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1780) Non-Rhabdomyosarcoma Soft Tissue Sarcomas: Grade-Based Treatment (Ep 4) - [0:00](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=0) Introduction and Differential Diagnosis of Pediatric Renal Masses (Ep 5) - [4:50](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=290) Initial Workup and Indications for Primary Surgery vs. Biopsy (Ep 5) - [8:53](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=533) Preoperative Chemotherapy Indications and Biopsy Technique (Ep 5) - [15:25](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=925) COG Staging System: Abdominal and Disease Stage (Ep 5) - [23:02](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1382) Treatment Based on Stage and Management of Pulmonary Metastases (Ep 5) - [28:51](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1731) COG vs. SIOP Treatment Philosophies (Ep 5) - [36:03](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2163) Surgical Technique: Positioning, Incision, and Resection Principles (Ep 5) - [41:16](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2476) Surgical Margins, Spillage, and Adherent Structures (Ep 5) - [45:56](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2756) Management of IVC Tumor Thrombus (Ep 5) - [52:29](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3149) Pathologic Variants and Risk Stratification (Ep 5) - [57:36](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3456) Bilateral Wilms Tumor Management (Ep 5) - [63:44](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3824) Closing Remarks (Ep 5) - [0:12](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=12) Takeaway #10: Medical Management of Uncomplicated Appendicitis (Ep 6) - [1:45](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=105) Takeaway #9: Surgical Approach to Osteosarcoma Lung Metastases (Ep 6) - [3:08](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=188) Takeaway #8: Flourish Device for Esophageal Atresia (Ep 6) - [4:43](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283) Takeaway #7: Indocyanine Green Applications in Pediatric Surgery (Ep 6) - [6:06](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=366) Takeaway #6: Timing of Colorectal Procedures (Ep 6) - [7:42](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=462) Takeaway #5: Pain Management for Pectus Repair (Ep 6) - [9:29](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=569) Takeaway #4: Button Battery Ingestion Management (Ep 6) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - The study evaluated 169 biopsies in 141 patients over a 10-year period at a single institution. — Sophia Schermerhorn (clinical) [Ep 13 · 0:13](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=13) - Nearly 90% of the biopsies were core-needle biopsies. — Sophia Schermerhorn (clinical) [Ep 13 · 0:19](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=19) - All biopsies were performed with image guidance, most commonly CT, sometimes combined with fluoroscopy and ultrasound. — Sophia Schermerhorn (clinical) [Ep 13 · 0:22](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=22) - All biopsies were performed by interventional radiologists. — Sophia Schermerhorn (clinical) [Ep 13 · 0:28](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=28) - 97.9% of biopsies were diagnostic. — Sophia Schermerhorn (clinical) [Ep 13 · 0:33](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33) - Only 3 patients required repeat biopsy. — Sophia Schermerhorn (clinical) [Ep 13 · 0:33](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33) - There was one patient with transient sciatic nerve paresis, which resolved. — Sophia Schermerhorn (clinical) [Ep 13 · 0:40](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=40) - The complication rate was 0.7%. — Sophia Schermerhorn (clinical) [Ep 13 · 0:43](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=43) - The approach provided sufficient tissue for histology, immunostains, and molecular studies. — Sophia Schermerhorn (clinical) [Ep 13 · 0:46](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46) - Immunostains and molecular studies are increasingly essential for modern risk stratification and targeted therapy. — Sophia Schermerhorn (clinical) [Ep 13 · 0:46](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46) - Image-guided percutaneous biopsy should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. — Sophia Schermerhorn (opinion) [Ep 13 · 0:56](https://team.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=56) - Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024 — Sophia Schermerhorn (clinical) [Ep 12 · 0:05](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=5) - PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology — Sophia Schermerhorn (clinical) [Ep 12 · 0:07](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=7) - The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers — Sophia Schermerhorn (clinical) [Ep 12 · 0:20](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=20) - Among 33 patients studied, about 2/3 had relapse limited to the lungs — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:32](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32) - Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:32](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32) - Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation — Sophia Schermerhorn (clinical) [Ep 12 · 0:39](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39) - Patients with solitary pulmonary nodule had the highest overall three-year survival at 73% — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:39](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39) - Three-year survival for patients with multiple nodules was 40% — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:50](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50) - Three-year survival for patients with extrapulmonary disease was 23% — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:50](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50) - Solitary pulmonary relapse may represent a biologically more favorable type of recurrence — Sophia Schermerhorn (opinion) [Ep 12 · 0:57](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57) - Solitary pulmonary relapse is more amenable to achieving meaningful local control — Sophia Schermerhorn (opinion) [Ep 12 · 0:57](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57) - Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma — Sophia Schermerhorn (opinion) [Ep 12 · 0:57](https://team.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57) - In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers — Chiro Esposito (epidemiological) [Ep 7 · 3:34](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214) - ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice — Chiro Esposito (clinical) [Ep 7 · 0:23](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=23) - For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization — Chiro Esposito (clinical) [Ep 7 · 7:15](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=435) - If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult — Chiro Esposito (clinical) [Ep 7 · 7:51](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471) - For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively — Chiro Esposito (clinical) [Ep 7 · 7:51](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471) - ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy — Chiro Esposito (clinical) [Ep 7 · 4:40](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=280) - For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line — Chiro Esposito (clinical) [Ep 7 · 9:34](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574) - In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG — Chiro Esposito (clinical) [Ep 7 · 9:34](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574) - For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels — Chiro Esposito (clinical) [Ep 7 · 17:30](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050) - Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases — Chiro Esposito (clinical) [Ep 7 · 17:30](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050) - In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles — Chiro Esposito (clinical) [Ep 7 · 19:10](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1150) - The spermatic bundle contains three to four lymphatic vessels — Chiro Esposito (clinical) [Ep 7 · 17:30](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050) - There is no maximum dose limit for ICG based on adult surgery studies — Chiro Esposito (clinical) [Ep 7 · 21:53](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1313) - ICG vial remains usable for six hours after preparation — Chiro Esposito (clinical) [Ep 7 · 21:24](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284) - No adverse effects of ICG were observed in the presenter's experience — Chiro Esposito (clinical) [Ep 7 · 21:24](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284) - ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system — Chiro Esposito (clinical) [Ep 7 · 1:20](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=80) - The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images — Chiro Esposito (clinical) [Ep 7 · 5:40](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=340) - For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning — Chiro Esposito (clinical) [Ep 7 · 8:42](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=522) - ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes — Chiro Esposito (opinion) [Ep 7 · 3:34](https://team.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214) - Since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma. — Todd Ponsky (opinion) [Ep 1 · 3:26](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=206) - Re-excision can have high morbidity because it may require taking significantly more tissue. — Todd Ponsky (clinical) [Ep 1 · 3:39](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=219) - 80% of ovarian masses are teratomas — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 1:25](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=85) - In the year 2000, girls with ovarian germ cell tumors have almost 100% survival — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 1:50](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=110) - Stage one ovarian tumors limited to the ovary now receive only oophorectomy without chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 2 · 2:14](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=134) - Microscopic residual and lymph node involvement in ovarian tumors require chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 2 · 2:26](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=146) - 25% of girls with ovarian germ cell tumors will be missed if peritoneal cytology and washings are not performed — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 3:16](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=196) - If staging procedures are omitted from the operative report, oncologists will treat ovarian tumors as stage 2 — Andrea Hayes-Jordan (clinical) [Ep 2 · 3:54](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=234) - Gliomatosis peritonei is a benign disease appearance associated with ovarian teratomas with nearly 100% survival — Andrea Hayes-Jordan (clinical) [Ep 2 · 4:41](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=281) - In bilateral ovarian disease, tumors larger than 10 cm should definitely be biopsied — Andrea Hayes-Jordan (guideline) [Ep 2 · 5:37](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=337) - If an ovarian tumor is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum — Dan (clinical) [Ep 2 · 7:11](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=431) - 15% of ovarian tumors in adolescents are epithelial tumors with different staging criteria than germ cell tumors — Dan (epidemiological) [Ep 2 · 7:19](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=439) - If alpha-fetoprotein and beta-HCG levels are normal preoperatively, there is some comfort about draining a cyst without contamination — Andrea Hayes-Jordan (clinical) [Ep 2 · 8:07](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=487) - The salvage rate for recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective — Dan (clinical) [Ep 2 · 12:15](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=735) - Ovarian torsion is an urgent but not emergent situation if the goal is to preserve the ovary — Andrea Hayes-Jordan (guideline) [Ep 2 · 13:40](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820) - Many black-colored ovaries from torsion have viable follicles and ovarian preservation should be the goal — Andrea Hayes-Jordan (clinical) [Ep 2 · 13:40](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820) - 76% of ovaries removed for torsion had normal ovarian tissue, only 13% had no ovarian tissue, and only 11% were completely necrotic — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 15:44](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=944) - Pain after oophoropexy is usually short-lived and resolves in about a week — Andrea Hayes-Jordan (clinical) [Ep 2 · 16:34](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=994) - The ability to preserve ovarian function after torsion is related to age, with pediatric patients having more active follicles than older adults — Andrea Hayes-Jordan (clinical) [Ep 2 · 16:58](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1018) - Ultrasound Doppler for ovarian torsion has sensitivity and specificity in the 50-60% range — Andrea Hayes-Jordan (clinical) [Ep 2 · 21:03](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1263) - Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdo sarcomas — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 25:58](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1558) - Abdominal, pelvic, and retroperitoneal rhabdomyosarcomas have the worst survival while orbital rhabdomyosarcomas have the best survival — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 26:22](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1582) - Even small tumors in the extremity or abdomen can only achieve stage 2 at best (not stage 1) in rhabdomyosarcoma staging — Andrea Hayes-Jordan (clinical) [Ep 2 · 27:04](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1624) - Surgical extent determines clinical group in rhabdomyosarcoma: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only — Andrea Hayes-Jordan (guideline) [Ep 2 · 27:15](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1635) - Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis while group 3 patients do more poorly — Andrea Hayes-Jordan (clinical) [Ep 2 · 27:27](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1647) - Inability to resect a large rhabdomyosarcoma is a biologic determination, not a reflection of surgical skill, and aggressive resection with high morbidity will not improve outcome — Andrea Hayes-Jordan (opinion) [Ep 2 · 27:44](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1664) - Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas — Andrea Hayes-Jordan (guideline) [Ep 2 · 29:15](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1755) - For rhabdomyosarcoma, completion node dissection is not performed for positive sentinel nodes; radiation therapy is given instead — Andrea Hayes-Jordan (guideline) [Ep 2 · 29:31](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1771) - Sentinel lymph node mapping for rhabdomyosarcoma should be performed at the time of re-excision if initial excisional biopsy had positive margins — Andrea Hayes-Jordan (guideline) [Ep 2 · 30:10](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1810) - 40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive — Andrea Hayes-Jordan (epidemiological) [Ep 2 · 30:36](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1836) - Histologic grade is now critical in non-rhabdo soft tissue sarcomas, not just the diagnosis — Andrea Hayes-Jordan (guideline) [Ep 2 · 31:00](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1860) - Low-grade soft tissue sarcomas require only resection with observation, no chemotherapy or radiation — Andrea Hayes-Jordan (guideline) [Ep 2 · 31:27](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1887) - Low-grade soft tissue sarcomas with positive margins receive adjuvant radiation therapy — Andrea Hayes-Jordan (guideline) [Ep 2 · 31:34](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1894) - Unresectable soft tissue sarcomas should receive both preoperative radiation and chemotherapy (previously only chemotherapy was recommended) — Andrea Hayes-Jordan (guideline) [Ep 2 · 31:49](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1909) - Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma — Andrea Hayes-Jordan (clinical) [Ep 2 · 32:07](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1927) - Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, which are primarily treated with surgery and radiation — Andrea Hayes-Jordan (clinical) [Ep 2 · 32:25](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1945) - A 5 cm tumor in a child less than 3 years old is equivalent to a 3 cm tumor in a larger patient, so 3 cm should be the cutoff for excision versus biopsy in toddlers — Andrea Hayes-Jordan (clinical) [Ep 2 · 32:51](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1971) - Low-grade non-rhabdo sarcomas with negative margins can be cured with surgery alone without chemotherapy — Andrea Hayes-Jordan (clinical) [Ep 2 · 33:22](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2002) - Core needle biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained — Andrea Hayes-Jordan (guideline) [Ep 2 · 34:07](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2047) - Half of soft tissue sarcomas are rhabdomyosarcomas, and the other half are non-rhabdomyosarcomas. — Andrea (epidemiological) [Ep 3 · 0:00](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0) - Prognosis in rhabdomyosarcoma varies depending on site, with abdominal, pelvic, and retroperitoneal tumors having the worst survival and orbital rhabdomyosarcomas having the best survival. — Andrea (clinical) [Ep 3 · 0:25](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=25) - Stage 1 rhabdomyosarcoma includes favorable sites (vaginal and paratesticular), while stages 2, 3, and 4 are unfavorable sites with various amounts of disease. — Andrea (clinical) [Ep 3 · 0:50](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=50) - Even a small tumor in the extremity or abdomen can only achieve stage 2 at best. — Andrea (clinical) [Ep 3 · 1:02](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=62) - Clinical grouping in rhabdomyosarcoma depends on surgical extent: group 1 is complete removal, group 2 is microscopic residual, and group 3 is biopsy only. — Andrea (clinical) [Ep 3 · 1:14](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=74) - Group 1 and 2 rhabdomyosarcoma patients have an excellent prognosis, while group 3 patients do more poorly. — Andrea (clinical) [Ep 3 · 1:30](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=90) - A large tumor that a surgeon cannot resect is a biologic determination, and attempting resection with high morbidity will not improve the patient's outcome. — Andrea (opinion) [Ep 3 · 1:45](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=105) - Five centimeters is the cutoff for low-risk versus high-risk patients in soft tissue sarcoma. — Andrea (clinical) [Ep 3 · 2:09](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=129) - Sentinel lymph node biopsies are now required for all rhabdomyosarcoma patients with trunk or extremity tumors. — Andrea (guideline) [Ep 3 · 3:18](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=198) - In rhabdomyosarcoma, completion node dissection is not performed after sentinel lymph node biopsy; patients receive radiation therapy instead. — Andrea (guideline) [Ep 3 · 3:34](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=214) - Alveolar rhabdomyosarcoma patients should receive chemotherapy after biopsy, which typically reduces the tumor to approximately 1 centimeter, making resection with negative margins easier. — Andrea (clinical) [Ep 3 · 3:53](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=233) - Sentinel lymph node mapping should be performed at the time of re-excision in rhabdomyosarcoma. — Andrea (guideline) [Ep 3 · 4:07](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=247) - Forty to fifty percent of biopsied lymph nodes are positive in rhabdomyosarcoma. — Andrea (epidemiological) [Ep 3 · 4:39](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279) - Clinically negative lymph nodes may be positive in rhabdomyosarcoma, which is why sentinel node biopsy is performed. — Andrea (clinical) [Ep 3 · 4:39](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279) - Positive lymph nodes in rhabdomyosarcoma have a worse prognosis and require radiation therapy. — Andrea (clinical) [Ep 3 · 4:39](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279) - In non-rhabdomyosarcoma soft tissue sarcoma, histological grade is now critical for treatment planning. — Andrea (guideline) [Ep 3 · 4:54](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294) - Large soft tissue sarcoma tumors should be biopsied first and treated with chemotherapy before resection. — Andrea (guideline) [Ep 3 · 4:54](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294) - Soft tissue sarcomas have been identified as chemotherapy-sensitive or chemotherapy-insensitive, which changes treatment approach. — Andrea (clinical) [Ep 3 · 5:13](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=313) - Low-grade soft tissue sarcoma tumors require only resection and observation, with no need for radiation or chemotherapy. — Andrea (guideline) [Ep 3 · 5:21](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=321) - If a low-grade soft tissue sarcoma is resected with positive margins, the patient will receive adjuvant radiation therapy. — Andrea (guideline) [Ep 3 · 5:38](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=338) - Unresectable large soft tissue sarcomas should be treated with preoperative radiation therapy and preoperative chemotherapy (previously only chemotherapy was recommended). — Andrea (guideline) [Ep 3 · 5:52](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=352) - Small soft tissue sarcoma tumors less than 5 centimeters should be resected with attempts to achieve negative margins. — Andrea (guideline) [Ep 3 · 6:10](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370) - Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma. — Andrea (clinical) [Ep 3 · 6:10](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370) - Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, all of which are high-grade tumors. — Andrea (clinical) [Ep 3 · 6:28](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388) - For chemotherapy-insensitive soft tissue sarcomas, the surgeon and radiation therapist are the primary treaters. — Andrea (clinical) [Ep 3 · 6:28](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388) - High-risk soft tissue sarcoma patients receive preoperative radiation and chemotherapy. — Andrea (guideline) [Ep 3 · 6:48](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=408) - Sentinel lymph node biopsy should always be performed if lymph nodes are clinically negative by imaging. — Andrea (guideline) [Ep 3 · 7:15](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435) - Positive lymph nodes receive radiation to the lymph node basin, and completion node dissection is not required. — Andrea (guideline) [Ep 3 · 7:15](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435) - Non-rhabdomyosarcoma tumors with negative margins after resection do not need chemotherapy if they are low-grade. — Andrea (guideline) [Ep 3 · 7:25](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=445) - Chemotherapy-insensitive soft tissue sarcomas require aggressive surgical extirpation as much as possible. — Andrea (guideline) [Ep 3 · 7:37](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=457) - Core biopsies are acceptable for soft tissue sarcoma diagnosis if 3 or 4 good cores that are not necrotic are obtained, with the pathologist checking the core before the interventional radiologist finishes. — Andrea (clinical) [Ep 3 · 8:10](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=490) - 80% of ovarian masses in children are teratomas — Andrea Hayes-Jordan (epidemiological) [Ep 4 · 0:37](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=37) - By the year 2000, girls with ovarian germ cell tumors have almost 100% survival — Andrea Hayes-Jordan (epidemiological) [Ep 4 · 1:03](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=63) - Stage 1 ovarian germ cell tumors (limited to ovary) now receive only oophorectomy without chemotherapy — Andrea Hayes-Jordan (guideline) [Ep 4 · 1:22](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=82) - Peritoneal cytology/washings will miss approximately 25% of girls with disease if not performed — Andrea Hayes-Jordan (clinical) [Ep 4 · 2:28](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=148) - If staging procedures are omitted from the operative report, oncologists will treat the patient as stage 2 — Andrea Hayes-Jordan (clinical) [Ep 4 · 3:06](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=186) - Gliomatosis peritonei is a benign disease with 100% survival, typically associated with ovarian teratomas — Andrea Hayes-Jordan (clinical) [Ep 4 · 3:53](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=233) - For bilateral ovarian disease, tumors larger than 10 centimeters should be biopsied, with lower threshold for bilateral oophorectomy on first operation — Andrea Hayes-Jordan (clinical) [Ep 4 · 4:38](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=278) - 15% of ovarian tumors in the teenage age range are actually epithelial tumors with different staging criteria than germ cell tumors — Dan (epidemiological) [Ep 4 · 6:31](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=391) - If a presumed teratoma is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum — Dan (clinical) [Ep 4 · 6:12](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=372) - If preoperative AFP and beta-HCG levels are normal, there is increased comfort (though not 100%) about draining a cystic ovarian mass — Andrea Hayes-Jordan (clinical) [Ep 4 · 7:18](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=438) - The salvage rate for patients with recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective — Dan (clinical) [Ep 4 · 11:28](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=688) - Ovarian torsion should be considered an urgent rather than emergent situation if the goal is ovarian preservation — Andrea Hayes-Jordan (clinical) [Ep 4 · 12:52](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=772) - Many black-colored ovaries from torsion actually contain viable follicles and ovarian preservation should be the goal — Andrea Hayes-Jordan (clinical) [Ep 4 · 13:25](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=805) - 76% of ovaries removed for torsion (that surgeons judged to be dead) contained normal ovarian tissue on pathology; only 11% were completely necrotic — Andrea Hayes-Jordan (clinical) [Ep 4 · 14:56](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=896) - The ability to preserve ovarian function after torsion is related to patient age, with pediatric patients having more active follicles than older adults — Andrea Hayes-Jordan (clinical) [Ep 4 · 16:10](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=970) - The current recommendation is detorsion without complete oophorectomy for ovarian torsion — Andrea Hayes-Jordan (guideline) [Ep 4 · 17:17](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1037) - Ultrasound Doppler has only 50-60% sensitivity and specificity for diagnosing ovarian torsion — Andrea Hayes-Jordan (clinical) [Ep 4 · 20:10](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1210) - Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdomyosarcomas — Andrea Hayes-Jordan (epidemiological) [Ep 4 · 25:10](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1510) - In rhabdomyosarcoma, prognosis varies by site, with abdominal/pelvic/retroperitoneal tumors having the worst survival and orbital tumors having the best — Andrea Hayes-Jordan (clinical) [Ep 4 · 25:27](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1527) - The surgeon determines the clinical group in rhabdomyosarcoma based on surgical extent: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only — Andrea Hayes-Jordan (clinical) [Ep 4 · 26:27](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1587) - Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis; group 3 patients do more poorly — Andrea Hayes-Jordan (clinical) [Ep 4 · 26:39](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1599) - Attempting to resect a large unresectable rhabdomyosarcoma with high morbidity will not improve the patient's outcome; this is a biologic determination, not a reflection of surgical skill — Andrea Hayes-Jordan (opinion) [Ep 4 · 27:01](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1621) - A 4-centimeter mass in the forearm of a 5-year-old is relatively huge and should probably be biopsied rather than resected initially — Andrea Hayes-Jordan (clinical) [Ep 4 · 28:08](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1688) - Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas — Andrea Hayes-Jordan (guideline) [Ep 4 · 28:27](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1707) - For rhabdomyosarcoma, completion lymph node dissection is not performed for positive sentinel nodes; patients receive radiation therapy instead — Andrea Hayes-Jordan (guideline) [Ep 4 · 28:43](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1723) - 40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive — Andrea Hayes-Jordan (epidemiological) [Ep 4 · 29:48](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1788) - For non-rhabdomyosarcoma soft tissue sarcomas, histologic grade is now critical and determines treatment — Andrea Hayes-Jordan (guideline) [Ep 4 · 30:03](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1803) - Low-grade soft tissue sarcomas require only resection and observation; no chemotherapy or radiation unless margins are positive — Andrea Hayes-Jordan (guideline) [Ep 4 · 30:39](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1839) - For unresectable soft tissue sarcomas, preoperative radiation therapy and chemotherapy are now recommended (previously only chemotherapy) — Andrea Hayes-Jordan (guideline) [Ep 4 · 31:01](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1861) - Chemosensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma — Andrea Hayes-Jordan (clinical) [Ep 4 · 31:19](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1879) - Chemoinsensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid, and clear cell sarcoma; surgery and radiation are the primary treatments — Andrea Hayes-Jordan (clinical) [Ep 4 · 31:37](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1897) - A 5-centimeter tumor in a child less than 3 years old is equivalent to a 3-centimeter tumor in a larger patient, so 3 centimeters should be the cutoff for excision in toddlers — Andrea Hayes-Jordan (clinical) [Ep 4 · 32:03](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1923) - Low-grade non-rhabdomyosarcoma soft tissue sarcomas with negative margins can be cured with surgery alone and do not need chemotherapy — Andrea Hayes-Jordan (clinical) [Ep 4 · 32:34](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1954) - Core biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained, confirmed by pathologist during the procedure — Andrea Hayes-Jordan (clinical) [Ep 4 · 33:19](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1999) - In North America, the preferred approach for resectable Wilms tumor is primary nephrectomy (total nephrectomy and ureterectomy with lymph node sampling). — Peter Ehrlich (guideline) [Ep 5 · 6:23](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383) - Preoperative chemotherapy is recommended if tumor extends into the IVC beyond the infrahepatic vena cava, if tumor is so large it compromises respiratory status, if major liver or bowel resection would be required, if only one functioning kidney exists, or if bilateral tumors are present. — Peter Ehrlich (guideline) [Ep 5 · 7:01](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=421) - The 'claw sign' on CT—normal kidney displaced into a horseshoe pattern around a mass—is a classic feature of Wilms tumor. — Peter Ehrlich (clinical) [Ep 5 · 3:49](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229) - Wilms tumor tends to push structures out of the way rather than growing into them, whereas neuroblastoma grows around structures like blood vessels. — Peter Ehrlich (clinical) [Ep 5 · 4:16](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256) - If a tumor requires major liver or bowel resection, biopsy and preoperative chemotherapy are preferred because complication rates are higher when these organs are resected at the same time as the kidney, and most tumors will respond to chemotherapy. — Peter Ehrlich (clinical) [Ep 5 · 10:24](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=624) - Biopsy with residual gross tumor has always been treated as stage 3 abdominal disease, requiring three-drug chemotherapy plus flank radiation. — Peter Ehrlich (guideline) [Ep 5 · 11:18](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=678) - Evidence suggests higher risk of tumor rupture when tumors reach 13-15 centimeters or larger, which may warrant consideration of preoperative chemotherapy. — Peter Ehrlich (clinical) [Ep 5 · 14:33](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873) - For biopsy, open biopsy provides large tissue sections; large-core needle biopsy (10-20 cores) has proven accurate in several series. Fine needle aspiration or single-pass true-cut biopsy cannot diagnose anaplasia and should not be used. — Peter Ehrlich (guideline) [Ep 5 · 17:19](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1039) - COG stage 1 is tumor limited to kidney, completely resected, no capsular invasion, no rupture or biopsy, vessels of renal sinus not involved, negative margins, and negative regional lymph nodes. — Peter Ehrlich (guideline) [Ep 5 · 20:00](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1200) - COG stage 2 is complete resection with negative margins but tumor extends beyond kidney through capsular penetration, renal sinus invasion, or blood vessel involvement within the nephrectomy specimen outside the primary kidney. — Peter Ehrlich (guideline) [Ep 5 · 20:28](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228) - COG stage 3 includes: biopsy with gross residual tumor, positive lymph nodes, peritoneal surface penetration with implants, positive margins, microscopic residual from intraoperative spill, incomplete resection, piecemeal removal, or renal vein division with tumor present. — Peter Ehrlich (guideline) [Ep 5 · 21:00](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1260) - COG stage 4 is hematogenous metastasis to lung, liver (most common), bone, or brain. Stage 5 is bilateral renal tumor involvement. — Peter Ehrlich (guideline) [Ep 5 · 21:58](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1318) - Stage 1-2 abdominal disease without lung metastases receives two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation, significantly reducing late effects including renal failure, second malignancies, and cardiovascular disease. — Peter Ehrlich (guideline) [Ep 5 · 23:08](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1388) - If a patient has a lung lesion but stage 1-2 abdominal disease after primary nephrectomy with negative lymph nodes, the child avoids abdominal radiation (though still receives chemotherapy for the lung lesion). — Peter Ehrlich (clinical) [Ep 5 · 24:15](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455) - Recent COG data shows approximately 40% of patients with pulmonary metastases who have complete response at 6 weeks can avoid pulmonary radiation without affecting event-free or overall survival, with 80-85% not relapsing. — Peter Ehrlich (clinical) [Ep 5 · 26:24](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1584) - Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer, a significant late effect. — Peter Ehrlich (epidemiological) [Ep 5 · 26:08](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568) - For a single lung lesion remaining at 6 weeks that did not respond to chemotherapy, thoracoscopic biopsy is reasonable because 50-60% of such lesions may not be cancer (could be scar), and if benign, the patient would not need pulmonary radiation. — Peter Ehrlich (clinical) [Ep 5 · 28:09](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1689) - SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with evaluation at 4 and 8 weeks, then resection followed by post-chemotherapy pathology-based risk stratification (low, intermediate, high risk). — Peter Ehrlich (guideline) [Ep 5 · 30:16](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1816) - In SIOP protocols, predominantly blastema component after preoperative chemotherapy is a negative prognostic factor, but blastema percentage does not correlate with outcome in COG primary nephrectomy patients. — Peter Ehrlich (clinical) [Ep 5 · 31:19](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1879) - Outcomes for stage 1 and stage 2 patients are basically identical between COG and SIOP treatment approaches. — Peter Ehrlich (clinical) [Ep 5 · 33:58](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2038) - Some Wilms tumor patients present with low hemoglobin because the tumor ruptures internally and bleeds. — Peter Ehrlich (clinical) [Ep 5 · 34:46](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2086) - Acquired von Willebrand disease occurs in Wilms tumor patients; in most cases it is meaningless, but a few case series report significant intraoperative bleeding until tumor removal. — Peter Ehrlich (clinical) [Ep 5 · 35:11](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111) - Right-sided tumors can cause complications including adrenal vein injury, duodenal injury (due to proximity), superior mesenteric artery injury, and IVC injury due to anatomic distortion. — Peter Ehrlich (clinical) [Ep 5 · 36:25](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2185) - Wilms tumors can cause intense inflammatory reaction making them adherent to diaphragm or liver; taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided. — Peter Ehrlich (clinical) [Ep 5 · 42:31](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551) - The main factor predicting outcome in stage 3 disease is whether lymph nodes are positive, along with genetic changes including loss of heterozygosity and 1Q gain. — Peter Ehrlich (clinical) [Ep 5 · 32:50](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1970) - Patients with loss of heterozygosity of both 1p and 16q (5-7% of patients) have significantly worse outcomes regardless of stage. Stage 1-2 patients with LOH have about 10% lower overall survival; stage 3-4 patients have 18% lower survival. — Peter Ehrlich (clinical) [Ep 5 · 54:41](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281) - Patients with both 1p and 16q loss of heterozygosity receive augmented therapy: doxorubicin is added for stage 1-2 disease, and five-drug regimen M is used for stage 3-4 disease. — Peter Ehrlich (guideline) [Ep 5 · 55:07](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3307) - IVC tumor extension is not a negative prognostic factor if the tumor is completely resected. — Peter Ehrlich (clinical) [Ep 5 · 46:27](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2787) - Major complication rate for primary surgery with tumor extending beyond infrahepatic IVC is 26-30%, including mortality, increased transfusions, and ICU stay, supporting preoperative chemotherapy for these cases. — Peter Ehrlich (clinical) [Ep 5 · 48:49](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929) - Favorable histology Wilms tumor has three components: blastema, stroma, and epithelial (triphasic tumor). Tumors with only two components are also considered favorable histology. — Peter Ehrlich (clinical) [Ep 5 · 52:39](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3159) - Unfavorable histology is classified as focal anaplasia or diffuse anaplasia based on number of high-power fields showing anaplasia, with different treatments for each. — Peter Ehrlich (clinical) [Ep 5 · 55:58](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3358) - Clear cell sarcoma of the kidney has reasonable treatment outcomes, particularly for low stages. Rhabdoid tumors have poor outcomes except for stage 1; most present at stage 3-4 with terrible outcomes. — Peter Ehrlich (clinical) [Ep 5 · 57:01](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3421) - Renal cell carcinoma in children has no good therapy, particularly for metastatic disease. — Peter Ehrlich (clinical) [Ep 5 · 56:51](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411) - Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor. — Peter Ehrlich (epidemiological) [Ep 5 · 57:46](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3466) - The strategy for bilateral Wilms tumor is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy of at least one kidney (ideally both) to avoid dialysis. — Peter Ehrlich (guideline) [Ep 5 · 58:07](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3487) - Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% compared to 88% for unilateral tumors; overall survival was 80% vs. 95%. — Peter Ehrlich (epidemiological) [Ep 5 · 58:40](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3520) - Maximum tumor response to chemotherapy in most children with Wilms tumor occurs by 12 weeks, and early response at 6 weeks predicts late response. — Peter Ehrlich (clinical) [Ep 5 · 59:37](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577) - In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. In a recent COG study of 250 enrolled patients, only one turned out to have rhabdoid tumor. — Peter Ehrlich (epidemiological) [Ep 5 · 60:31](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3631) - Biopsy is recommended for bilateral tumors in older patients (8-10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely. — Peter Ehrlich (guideline) [Ep 5 · 61:56](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3716) - If biopsying bilateral tumors, both kidneys should be biopsied because there is discordant pathology in up to 20% of patients. — Peter Ehrlich (clinical) [Ep 5 · 62:16](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3736) - A small subset of very young patients (<24 months) with stage 1 favorable histology tumors <550g can be treated with surgery alone without chemotherapy, with >95% overall survival. Those who relapse (about 10%) have 100% salvage with chemotherapy. — Peter Ehrlich (clinical) [Ep 5 · 43:32](https://team.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612) - About 40% of patients can achieve a durable cure response after 5 years with complete metastatic site clearance. — Roshni Dasgupta (clinical) [Ep 8 · 2:08](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=128) - Complete surgical resection of all metastatic tumor sites is an independent positive prognostic factor and affects overall survival, not just disease recurrence. — Roshni Dasgupta (clinical) [Ep 8 · 2:23](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=143) - In patients with metastatic osteosarcoma, even 1-millimeter nodules can contain malignant disease in about 60% of cases. — Roshni Dasgupta (clinical) [Ep 8 · 2:35](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=155) - The bigger the nodule is, the more likely it contains malignancy, but all the way down to 1 millimeter, tumor can be found. — Roshni Dasgupta (clinical) [Ep 8 · 2:47](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=167) - Thoracotomy has historically been standard of care because surgeons can use fingers and hands to feel tiny nodules. — Roshni Dasgupta (clinical) [Ep 8 · 3:13](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=193) - Manual palpation during thoracotomy finds about 30 to 40% more lung nodules than are detected on CT scan, even with thin-cut CT scans. — Roshni Dasgupta (clinical) [Ep 8 · 3:19](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=199) - ICG can be used with thoracotomy to find deeper nodules, though depth of penetration is a limitation. — Roshni Dasgupta (clinical) [Ep 8 · 3:50](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=230) - It is uncertain whether removing tiny 1-millimeter nodules actually provides a survival advantage. — Roshni Dasgupta (opinion) [Ep 8 · 4:15](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=255) - VATS is minimally invasive with shorter length of stay, and repeat thoracoscopy typically encounters fewer adhesions compared to repeat thoracotomy. — Roshni Dasgupta (clinical) [Ep 8 · 4:41](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=281) - VATS often requires some sort of localization process and good interventional radiology support. — Roshni Dasgupta (clinical) [Ep 8 · 4:58](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=298) - In oligometastatic disease (patients with fewer than 4 nodules on each side), there was no difference in mortality between open resection and thoracoscopy. — Roshni Dasgupta (clinical) [Ep 8 · 5:34](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=334) - The survival curves for thoracotomy and thoracoscopy in oligometastatic disease are essentially identical, meaning the optimal operation is unknown. — Roshni Dasgupta (clinical) [Ep 8 · 5:44](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=344) - The multi-institution study had significant selection bias and institutional selection bias, with patients unlikely to receive thoracoscopy if they had many nodules. — Roshni Dasgupta (epidemiological) [Ep 8 · 6:03](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=363) - Metastatic disease is typically addressed after 4 cycles of chemotherapy, and residual nodules at that point are unlikely to change with additional chemotherapy. — Roshni Dasgupta (clinical) [Ep 8 · 6:34](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=394) - Practice for bilateral lung metastases is highly varied, with options including median sternotomy, staged thoracotomies, or bilateral thoracoscopies. — Roshni Dasgupta (clinical) [Ep 8 · 7:02](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=422) - Most practitioners perform staged procedures for bilateral disease, particularly with thoracotomy, typically 4 to 6 weeks apart to allow a cycle of chemotherapy in between. — Roshni Dasgupta (clinical) [Ep 8 · 7:13](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=433) - Dr. Rothenberg's institution reported almost 20 years ago that survival didn't change when there were only 3 to 4 nodules per side. — Steven Rothenberg (clinical) [Ep 8 · 7:29](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=449) - Because osteosarcoma is a systemic disease, the argument that manual palpation is necessary would logically require bilateral thoracotomy, not unilateral. — Steven Rothenberg (opinion) [Ep 8 · 7:52](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=472) - Even with the best CTs, only 1 to 2 millimeter nodules can be visualized, and some are still missed. — Steven Rothenberg (clinical) [Ep 8 · 8:02](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=482) - There are nodules that can be felt but not seen, and nodules that cannot be felt at all. — Steven Rothenberg (clinical) [Ep 8 · 8:05](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=485) - Dr. Rothenberg's practice is to use thoracoscopy when there are only 3 to 4 nodules per side that are amenable to thoracoscopic resection, in order to reduce morbidity. — Steven Rothenberg (clinical) [Ep 8 · 8:12](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=492) - For bilateral oligometastatic disease, Dr. Rothenberg performs bilateral thoracoscopy. — Steven Rothenberg (clinical) [Ep 8 · 8:23](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=503) - Non-surgical methods such as CyberKnife using fiducials to localize and ablate lesions may be a future approach for lung metastases. — Todd Ponsky (opinion) [Ep 8 · 8:43](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=523) - The Children's Oncology Group is starting a study to answer the question of thoracotomy versus VATS, with enrollment expected to begin late 2021 or early 2022. — Todd Ponsky (guideline) [Ep 8 · 8:56](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=536) - Osteosarcoma most commonly affects adolescents and young adults — Bailey Roberts (epidemiological) [Ep 9 · 1:08](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=68) - Gross metastasis at the time of diagnosis is present about 20% of the time in osteosarcoma — Bailey Roberts (epidemiological) [Ep 9 · 1:11](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71) - The most common site of metastasis in osteosarcoma is in the lung — Bailey Roberts (clinical) [Ep 9 · 1:11](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71) - Overall survival in osteosarcoma worsens from 80% to about 20% for metastatic disease — Bailey Roberts (epidemiological) [Ep 9 · 1:19](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=79) - Recurrence is very common in osteosarcoma, and the most common site of recurrence is in the lungs — Bailey Roberts (clinical) [Ep 9 · 1:25](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=85) - Extracellular vesicles are carriers of amino acids, proteins, mRNA or other forms of cellular communication — Bailey Roberts (clinical) [Ep 9 · 1:38](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=98) - EV content is unique and specific to the cells that released it, and therefore can be traced back to the cell type — Bailey Roberts (clinical) [Ep 9 · 1:45](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=105) - EVs are involved in the metastatic cascade and implicated as potential markers for disease diagnosis and staging — Bailey Roberts (clinical) [Ep 9 · 1:52](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=112) - EVs have been shown to change fibroblasts, inhibit T cell activity, and are involved in establishing a pre-metastatic niche — Bailey Roberts (clinical) [Ep 9 · 1:59](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=119) - K12 is a spontaneous osteosarcoma with low metastatic capability — Bailey Roberts (clinical) [Ep 9 · 2:31](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=151) - K7M2 is a highly metastatic osteosarcoma derived from a spontaneous osteosarcoma that went through two reiterations of harvesting spontaneous lung metastases and reimplanting them into the mouse — Bailey Roberts (clinical) [Ep 9 · 2:35](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=155) - The K7M2 cell line is more aggressive and causes death at a much higher rate than K12 — Bailey Roberts (clinical) [Ep 9 · 2:57](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=177) - Pre-education with K7M2 EVs drastically increases the metastatic burden in the lungs of mice with K7M2 tumors — Bailey Roberts (clinical) [Ep 9 · 3:59](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=239) - Pre-education with K7M2 EVs increased the overall mortality during the five-week study period in mice with K7M2 tumors — Bailey Roberts (clinical) [Ep 9 · 4:18](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=258) - K7M2 EV education led to increased metastatic burden in mice with K12 tumors — Bailey Roberts (clinical) [Ep 9 · 4:44](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=284) - Pre-education with highly metastatic cell line EVs increases the metastasis seen in a normally low metastatic tumor — Bailey Roberts (clinical) [Ep 9 · 5:01](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=301) - No mice with K12 tumors died in the study period — Bailey Roberts (clinical) [Ep 9 · 5:09](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=309) - Extracellular vesicles delivered prior to tumor implantation from highly metastatic K7M2 increase the metastatic burden of K7M2 tumors — Bailey Roberts (clinical) [Ep 9 · 5:14](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=314) - Increased metastatic burden from extracellular vesicles decreases overall survival — Bailey Roberts (clinical) [Ep 9 · 5:24](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=324) - Extracellular vesicles from highly metastatic K7M2 increase the metastatic burden of less metastatic K12 tumors — Bailey Roberts (clinical) [Ep 9 · 5:30](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=330) - All cells in the body release EVs, so we can't just generally target EVs and hope to decrease the establishment of a pre-metastatic niche — Bailey Roberts (clinical) [Ep 9 · 6:27](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=387) - IRF5 is a molecule being explored as a potential immunotherapy target in osteosarcoma EVs — Bailey Roberts (clinical) [Ep 9 · 6:48](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=408) - Surgically removing the primary tumor is the current standard of care for osteosarcoma — Bailey Roberts (guideline) [Ep 9 · 7:10](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=430) - There are certain membrane EV markers, but they're shared by all types of EVs — Bailey Roberts (clinical) [Ep 9 · 7:31](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=451) - The differences in EVs by cell type have more to do with the contents inside of them than the targets on them, which makes them difficult to target as far as treatment — Bailey Roberts (clinical) [Ep 9 · 7:40](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=460) - Studies in dogs have shown ability to take serum of dogs with osteosarcoma and determine their likelihood of metastasis based on the EVs — Bailey Roberts (clinical) [Ep 9 · 7:57](https://team.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=477) - Doctor Margaret Mutch's team has about 10 years of experience with chest wall reconstructions. — Margaret Mutch (clinical) [Ep 11 · 0:16](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=16) - Examination revealed an incomplete cord injury with absent lower limb reflexes and altered motor and sensation below the level of T6. — Margaret Mutch (clinical) [Ep 11 · 0:27](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=27) - The patient underwent an emergency posterior laminectomy and partial tumor debulking initially for cord decompression between the levels of T3 and T7. — Margaret Mutch (clinical) [Ep 11 · 0:42](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=42) - PET scan showed a PET avid lesion on the right-hand side just next to the sternum. — Margaret Mutch (clinical) [Ep 11 · 1:04](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=64) - Radio guided occult lesion localization using technetium 99 was performed, followed by anterior thoracotomy to remove the lesion, which confirmed aggressive osteosarcoma replacing a lymph node. — Margaret Mutch (clinical) [Ep 11 · 1:12](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=72) - Most of the reconstruction needs to be tailored to the needs of each individual, location and size of defects, and the particular type of material used. — Margaret Mutch (opinion) [Ep 11 · 1:32](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=92) - A lot of the literature on chest wall reconstruction is coming from adults. — Margaret Mutch (epidemiological) [Ep 11 · 1:55](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=115) - The spinal surgeons removed all of the vertebral bodies between T4 and T7 and inserted a cage, and the thoracic team resected ribs 4 to 7. — Margaret Mutch (clinical) [Ep 11 · 2:06](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=126) - During surgery, a tumor thrombus was found in the azygos, which extended into the SVC. — Margaret Mutch (clinical) [Ep 11 · 2:28](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=148) - Doctor Mutch's team tends to use resorbable and biosynthetic materials to do the reconstruction. — Margaret Mutch (clinical) [Ep 11 · 2:44](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=164) - In Australia, two systems are used for chest wall reconstruction: one by Stryker and one by KLS, using resorbable plates that are molded in a water bath to reconstruct the rigid part of the chest wall. — Margaret Mutch (clinical) [Ep 11 · 2:51](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=171) - Following plate placement, Permacol is placed on top of the implant, and subsequently a muscular flap, in this case the latissimus dorsi, is used to cover the Permacol. — Margaret Mutch (clinical) [Ep 11 · 3:14](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=194) - The delta plates or the sonic weld system are polylactide and polyglycolide and polylactide plates with a strength of 78% at 2 months and 50% at 6 months. — Margaret Mutch (clinical) [Ep 11 · 3:37](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=217) - The patient had a relapse 18 months following surgery close to his sternum. — Margaret Mutch (clinical) [Ep 11 · 4:05](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=245) - The patient is currently having adjuvant chemotherapy. — Margaret Mutch (clinical) [Ep 11 · 4:22](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=262) - In the team's 10-year experience, there was early postoperative wound infection in one patient, which was treated with IV antibiotics. — Margaret Mutch (clinical) [Ep 11 · 4:31](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=271) - There were sterile seromas in two patients in the early stages, one at 2 months and one at 8 months, both treated with IR drainage. — Margaret Mutch (clinical) [Ep 11 · 4:36](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=276) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Dr. Bailey Roberts from IPSO presented on extracellular vesicles for metastatic osteosarcoma contributing to the creation of pre-metastatic niche — Cecilia summarizing a resource [Ep 10 · 0:08](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=8) - Dr. Dominic Simons from IPSO presented on multimodal 3D visualization of pediatric neuroblastoma aiding surgical planning beyond anatomical information — Cecilia summarizing a resource [Ep 10 · 0:19](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=19) - Dr. Miyake from CAPS presented on using microinjection for drug delivery with nanoparticles in lung explants to study prenatal treatment of CDH — Cecilia summarizing a resource [Ep 10 · 0:31](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=31) - Dr. Urichuk from CAPS presented that individuals with thoracoabdominal congenital surgical anomalies are at increased risk of adverse mental health outcomes — Cecilia summarizing a resource [Ep 10 · 0:47](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=47) - Dr. Matthew Urichuk won Heat 2 of the Best of the Best in Pediatric Surgery 2024 competition — Cecilia summarizing a resource [Ep 10 · 1:27](https://team.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=87) - The study compared outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus patients who had planned workup and excision. — Todd Ponsky summarizing a resource [Ep 1 · 0:16](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=16) - 40 patients were referred after having an innocuous lesion removed that came back as non-rhabdomyosarcoma. — Todd Ponsky summarizing a resource [Ep 1 · 0:49](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=49) - 5 of the 40 referred patients were deemed impossible to re-excise based on location or other reasons, leaving 35 patients for re-excision. — Todd Ponsky summarizing a resource [Ep 1 · 1:00](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=60) - 44 patients had planned excision at the study institution after workup with MRI or incisional biopsy or core biopsy. — Todd Ponsky summarizing a resource [Ep 1 · 1:10](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=70) - 23 of the 44 planned excision patients received neoadjuvant therapy, leaving 21 for comparison. — Todd Ponsky summarizing a resource [Ep 1 · 1:33](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=93) - 45.7% of patients who underwent re-excision had residual tumor found in the specimen. — Todd Ponsky summarizing a resource [Ep 1 · 1:56](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=116) - There was no difference in disease relapse between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 1 · 2:13](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=133) - There was no difference in 5-year overall survival between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 1 · 2:21](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=141) - There was no difference in disease-free survival between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 1 · 2:26](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146) - There was no difference in local control rates or local recurrence between planned and unplanned excision groups. — Todd Ponsky summarizing a resource [Ep 1 · 2:26](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146) - The study authors concluded that patients should have a higher index of suspicion and should be worked up more thoroughly. — Todd Ponsky summarizing a resource [Ep 1 · 2:56](https://team.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=176) - Blood flow on ultrasound does not exclude torsion because the ovary may be twisted but not completely occluded at that moment in time — Todd Ponsky summarizing the discussion [Ep 2 · 22:35](https://team.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1355) - An Italian study showed that a 5 centimeter tumor in a child less than 3 years old is equivalent to a 3 centimeter tumor in larger patients, suggesting 3 centimeters as the cutoff for excision versus biopsy in toddlers. — Andrea summarizing the discussion [Ep 3 · 6:54](https://team.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414) - Good blood flow on ultrasound does not rule out torsion because the ovary may be intermittently twisted — Todd Ponsky summarizing the discussion [Ep 4 · 21:50](https://team.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1310) - In the Petcova et al. study published in Annals of Surgery 2020, children with uncomplicated appendicitis were randomized to medical management with antibiotics or surgery, with 5-year follow-up. — Ellen Encisco summarizing the discussion [Ep 6 · 0:43](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=43) - In the Petcova et al. appendicitis study, the surgery group had no complications, while 46% of patients in the non-surgical management group required appendectomy during follow-up. — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=71) - Medical management of acute uncomplicated appendicitis may be safe but is associated with a high failure rate, with many children ultimately requiring laparoscopic appendectomy. — Ellen Encisco summarizing the discussion [Ep 6 · 1:22](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=82) - Metastectomy for osteosarcoma lung metastases improves survival and can make patients long-term survivors. — The host summarizing the discussion [Ep 6 · 2:15](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=135) - Approximately 10% of 1 millimeter lung nodules in osteosarcoma patients contain malignant disease. — The host summarizing the discussion [Ep 6 · 2:24](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=144) - The Children's Oncology Group is starting a study to determine whether thoracotomy or thoracoscopy is superior for resection of pulmonary metastases in osteosarcoma, with enrollment expected late 2021 or early 2022. — The host summarizing the discussion [Ep 6 · 2:40](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=160) - The Flourish device is a catheter-based device that places magnets in proximal and distal esophageal pouches to create a compression anastomosis by causing ischemia of tissue between the magnets, which then sloughs off. — The host summarizing the discussion [Ep 6 · 3:16](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=196) - Inclusion criteria for the Flourish device are: atretic gap less than 4 centimeters long, fistula repaired or absent, and G-tube able to accommodate an 18 French catheter. — The host summarizing the discussion [Ep 6 · 3:39](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=219) - The Flourish device is associated with a high stricture rate and known serious life-threatening complications, and should only be used by centers with capabilities to treat the many issues associated with esophageal atresia. — The host summarizing the discussion [Ep 6 · 3:57](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=237) - Indocyanine green (ICG) has become a topic of interest in the last few years for use in pediatric surgery, especially in minimally invasive procedures to improve visualization of structures. — Ellen Encisco summarizing the discussion [Ep 6 · 4:43](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283) - For laparoscopic cholecystectomy, ICG must be administered intravenously 12 to 18 hours prior to surgery to allow time for accumulation in the extrahepatic ducts, or can be injected directly into the gallbladder during surgery. — Ellen Encisco summarizing the discussion [Ep 6 · 5:32](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=332) - ICG applications in pediatric surgery include laparoscopic cholecystectomies, varicocele repairs, partial nephrectomies, and tumor excisions. — Ellen Encisco summarizing the discussion [Ep 6 · 5:48](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=348) - For anorectal malformations with rectal-perineal or rectal-vestibular fistula, outcomes including complications are similar whether the procedure is done before or after 14 days of life. — The host summarizing the discussion [Ep 6 · 6:37](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=397) - A PCPLC consortium study comparing endorectal pull-through for Hirschsprung disease at less than 31 days versus greater than 31 days found that preoperative enterocolitis, postoperative enterocolitis, constipation, and incontinence were the same between both groups. — The host summarizing the discussion [Ep 6 · 6:54](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=414) - Delayed pull-through with irrigations is a safe alternative to an operation in the neonatal period for Hirschsprung disease. — The host summarizing the discussion [Ep 6 · 7:14](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=434) - Cryoanalgesia is probably effective at improving post-operative pain and decreasing length of stay for pectus patients, with length of stay reduced from 4 days to 1 day. — The host summarizing the discussion [Ep 6 · 8:11](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=491) - There are no long-term studies on the effects of cryoanalgesia for pectus repair. — The host summarizing the discussion [Ep 6 · 8:34](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=514) - The double rim sign or halo sign on X-ray indicates a child has swallowed a button battery rather than a coin. — Ellen Encisco summarizing the discussion [Ep 6 · 9:48](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=588) - The main goal of button battery ingestion treatment is to remove the battery within 2 hours of ingestion. — Ellen Encisco summarizing the discussion [Ep 6 · 10:13](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=613) - Sucralfate or honey can help reduce damage from button batteries on the child's esophagus as temporizing measures. — Ellen Encisco summarizing the discussion [Ep 6 · 10:20](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=620) - Children less than 1 year old should not receive honey due to risk of botulism and should instead receive 10 mL of sucralfate every 10 minutes for up to 3 doses for button battery ingestion. — Ellen Encisco summarizing the discussion [Ep 6 · 10:35](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=635) - Children over age 1 with button battery ingestion should receive honey 10 mL every 10 minutes for up to 6 doses. — Ellen Encisco summarizing the discussion [Ep 6 · 10:51](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=651) - New ATLS recommendations for pediatric trauma patients in hemorrhagic shock call for earlier transfusion: after 1 bolus of 20 cc per kilogram of crystalloid fluid, blood should be given. — The host summarizing the discussion [Ep 6 · 11:28](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=688) - Balanced transfusion protocol for pediatric hemorrhagic shock typically includes 10 to 20 mLs per kilogram of packed red blood cells, plus inclusion of FFP and platelets. — The host summarizing the discussion [Ep 6 · 11:38](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=698) - Earlier transfusion in pediatric trauma was associated with shorter median time to transfusion and a decrease in total fluid volume administered. — The host summarizing the discussion [Ep 6 · 11:46](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=706) - Whole blood in trauma patients requires less volume compared to component therapy. — The host summarizing the discussion [Ep 6 · 11:59](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=719) - Research shows that observation of spontaneous pneumothorax in adults is non-inferior to immediate intervention with tube thoracostomy. — The host summarizing the discussion [Ep 6 · 12:42](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=762) - The Midwest Pediatric Surgery Consortium study on spontaneous pneumothorax management with simple aspiration showed 48% success rate, but 44% of patients in the simple aspiration group recurred. — The host summarizing the discussion [Ep 6 · 12:53](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=773) - 83% of patients who failed simple aspiration for spontaneous pneumothorax ultimately ended up with VATS or blebectomy. — The host summarizing the discussion [Ep 6 · 13:16](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=796) - Greenwood et al. showed that mortality amongst black newborns is 3 times that of white newborns. — Ellen Encisco summarizing the discussion [Ep 6 · 14:10](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=850) - When black newborns are treated by black physicians, their mortality is reduced by 58% compared to black newborns treated by white physicians. — Ellen Encisco summarizing the discussion [Ep 6 · 14:19](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=859) - Bias exists within medicine and can change outcomes; representation matters and can make a difference. — Ellen Encisco summarizing the discussion [Ep 6 · 14:30](https://team.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=870) - About 20% of osteosarcoma patients already have lung metastases by the time of diagnosis, usually picked up on staging chest CT. — Rod Gerardo summarizing the discussion [Ep 8 · 1:29](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=89) - With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited. — Rod Gerardo summarizing the discussion [Ep 8 · 5:03](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=303) - A multi-institution study of 200 patients with metastatic osteosarcoma—the largest study ever done—compared outcomes between open resection and thoracoscopy. — Rod Gerardo summarizing the discussion [Ep 8 · 5:23](https://team.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=323) - The histopathology report confirmed an aggressive osteosarcoma. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 0:51](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=51) - There is a lack of clear evidence-based guidelines for reconstructive materials, but the priority is long-term durability, aesthetics, function, and accommodating future growth. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 1:45](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=105) - Instead of using screws that came packaged with the plates, they used a K-wire drill to drill through the remaining ribs and then used Prolene sutures to secure the implant. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 3:05](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=185) - Permacol is a surgical implant made of a porcine dermal collagen matrix that allows device placement. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 3:29](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=209) - Doctor Mutch performed a further chest wall reconstruction where they excised the entire sternum, costochondral cartilages, and anterior ribs and replaced it with a cement mesh. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 4:12](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=252) - There was one case of minor scoliosis on follow-up, which is being followed by the spinal team and so far has not needed intervention. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 4:45](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=285) - Bioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions. — Lizzie Lee summarizes what Dr. Margaret Mutch said [Ep 11 · 5:17](https://team.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=317) ## Common questions ### Who requires surgical intervention for circumcision? Patients requiring surgical intervention for circumcision include infants over 3 months of age or weighing more than 13 pounds, who cannot safely undergo office circumcision. Additionally, patients with isolated chordee without hypospadias benefit from operative circumcision to release adhesions and straighten the penis. Conversely, elective circumcision in infants under 3 months should not require general anesthesia due to anesthetic safety concerns. ### How is Sarcoma (Ewing/Rhabdo) diagnosed? Diagnosis of soft tissue sarcomas (rhabdo and non-rhabdo) involves imaging and tissue sampling. The workup includes MRI and either incisional or core biopsy. Histological grade is critical in non-rhabdomyosarcoma soft tissue sarcomas for treatment decisions. For regional disease assessment, sentinel node biopsy is performed because clinically negative nodes may harbor occult disease; 40–50% of biopsied nodes are positive, and positive nodes carry worse prognosis and require radiation therapy. ### What did Todd Ponsky say about Sarcoma (Ewing/Rhabdo)? Todd Ponsky discussed surgical decision-making for non-rhabdomyosarcoma soft tissue sarcomas. He presented a study comparing outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus those with planned workup and excision. The study involved 40 patients referred after innocuous lesion removal that returned as non-rhabdomyosarcoma. Ponsky concluded that since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma. ## Changelog - Oct 1: Removed 6 off-topic recordings (lymphatic anomalies, thyroid, APSA50 AI, urology, adult inguinal hernia, pyloric stenosis) — Ramy 2026-10-01 - Sep 24: 11 off-topic items removed (matched a keyword, not the subject) - Sep 24: 2 promotional items removed (trailer / commercial) - Sep 9: Summaries and takeaways published for 4 audiences - Sep 7: 2 promo items hidden (trailer / commercial); unhide from the owner view - Sep 7: 8 items hidden — never mention Sarcoma (Ewing/Rhabdo); unhide from the owner view - Aug 31: 38 doctors auto-found from episode dossiers - Aug 30: 37 doctors auto-found from episode dossiers - Aug 30: 29 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 32 doctors auto-found from episode dossiers - Aug 29: 33 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 42 items, 28 dossiers, summaries for 4 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 31 items, 28 dossiers, summaries for 3 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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