StayCurrentMD · Journal of Pediatric Surgery Article Highlights: April 2022
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Podcast8 min·Published Jul 2022Older

Journal of Pediatric Surgery Article Highlights: April 2022

With Dr. Christina Theodorou & Dr. Todd Ponsky & Dr. Natalie Lopyan · hosted by Dr. Rod Gerardo & Dr. Brittany Levy
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What the experts said8 expert statements · 10 host summaries
Dr. Christina Theodoro states this study is a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myelomeningocele repair.
ClinicalChristina Theodorou
The technique involves exposing the fetal back, re-exposing the spinal cord, identifying the myelomeningocele defect, placing an extracellular matrix patch with placental stem cells facing the spinal cord in direct contact, closing the skin, and returning the baby to the uterus to continue gestation until term.
ClinicalChristina Theodorou
Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive the stem cells.
ClinicalChristina Theodorou
Dr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation.
ClinicalTodd Ponsky
The survey included self-identified specialists within the field of fetal surgery, yet only 4% of those people reported receiving formal training in fetal surgery.
EpidemiologicalNatalie Lopyan
Dr. Natalie Lopian suggests it will be interesting to see whether fetal surgery exposure becomes a requirement during training or whether fetal centers become the primary training ground for fetal surgeons as the field expands.
OpinionNatalie Lopyan
Dr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery.
OpinionTodd Ponsky
The study was not designed to link subspecialization of fetal surgery to outcomes and was not designed to provide a clear definition of a fetal surgery center.
ClinicalNatalie Lopyan
The first article examines surgical management, staging and outcomes of Wilms tumors with intravascular extension, using results from the SIOP (International Society of Pediatric Oncology) Renal Tumor Study.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
The study looked at children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection of tumor thrombus was successful versus when it was not.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
Dr. Paul Tam states that Wilms tumor has been a great success story for pediatric surgery and pediatric oncology.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
Dr. Paul Tam suggests improving outcomes by identifying subgroups of patients who are still not doing well and trying to improve care in those particular areas.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
If half of Wilms tumor patients have complete tumor removal and half do not, and there is an outcome difference, then surgeons should still try hard to remove all of the tumor.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
The second article examines efficacy of clinical grade human placental mesenchymal stromal cells in fetal ovine myelomeningocele repair.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
The article discussed use of mesenchymal stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs given the intervention.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country.
Host summaryRod Gerardo summarizing the discussion · not cited in answers
Many survey respondents reported receiving fetal training during their pediatric surgery fellowship training, yet when the question was posed differently, many responded that they did not have exposure to fetal surgery during fellowship training.
Host summaryBrittany Levy summarizing the discussion · not cited in answers
Dr. Paul Tam states that fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental.
Host summaryBrittany Levy summarizing the discussion · not cited in answers