Error Traps and Culture of Safety in Pediatric Surgical Oncology

The three most frequent extracranial solid tumors in pediatric surgical oncology are neuroblastoma, hepatoblastoma, and Wilms tumor.

For neuroblastoma, hepatoblastoma, and Wilms tumor, the surgeon should know when to perform upfront resection versus delaying until neoadjuvant chemotherapy has reduced tumor size and risks.

Avoiding vascular lesions is key in all three tumor types (neuroblastoma, hepatoblastoma, and Wilms tumor).

Implementation of IRDFs (image-defined risk factors) in neuroblastoma can help achieve better resection.

Exposure should be adequate and dissection thorough in pediatric solid tumor surgery.

Some pediatric solid tumor cases can be done with minimally invasive surgery, while others require complex approaches.

The PRETEXT staging system in hepatoblastoma has proven to have prognostic implications.

The PRETEXT staging system can guide hepatoblastoma surgery while maintaining goals of complete resection without postoperative liver failure.

In Wilms tumor surgery, the surgeon should avoid intraoperative rupture and vascular lesions.

Lymph nodes should always be obtained during Wilms tumor surgery.

In bilateral Wilms tumors, preservation of as much renal parenchyma as possible is the aim.

Surgical planning for pediatric solid tumors relies on imaging studies.

The use of 3D printed models, if available, can add to surgical planning for pediatric solid tumors.