>> A SUCCESSFUL SURGERY IS IMPORTANT IN TERMS OF TUMOR
BURDEN, BUT ALSO A SUCCESSFUL SURGERY IN WHICH THE PATIENT
RECOVERS QUICKLY CAN FACILITATE THE ADMINISTRATION OF THE NEXT
CYCLE OF CHEMOTHERAPY AND A SMOOTH TRANSITION
ON INTO THE OTHER PHASES OF THAT PATIENT'S TREATMENT.
>> THE MAJORITY OF PATIENTS WITH NEUROBLASTOMA
EVENTUALLY REQUIRE SURGERY.
SURGERY IS AN INTEGRAL PART OF THE CARE OF MOST PATIENTS
WITH NEUROBLASTOMA.
THE OPERATION ITSELF TENDS TO BE QUITE DIFFICULT
BECAUSE THE TUMOR HAS A TENDENCY NOT TO INVADE OTHER
STRUCTURES, BUT TO WRAP ITSELF AROUND VITAL ORGANS
AND STRUCTURES, SUCH AS BLOOD VESSELS AND NERVES.
AND SO IT CAN BE QUITE DIFFICULT SOMETIMES TO
REMOVE THE TUMOR WHILE PRESERVING THOSE STRUCTURES.
>> SURGICAL CARE OF CHILDREN WITH CANCER IS GETTING
BETTER AND BETTER, AND THAT'S BECAUSE
OF INNOVATIONS, AND THAT'S BECAUSE OF THE SURGICAL
SPECIALISTS WE HAVE HERE WHO CAN PROVIDE THAT CARE,
EXCISE THAT TUMOR, AND PRESERVE AS MUCH NORMAL
FUNCTION AS POSSIBLE.
>> WE WANT TO REMOVE AS MUCH OF THE TUMOR AS POSSIBLE,
BUT WE ALSO WANT TO PRESERVE ALL NORMAL ORGANS.
THE PRINCIPAL STRUCTURES THAT WE ENCOUNTER DIFFICULTY
WITH INCLUDE THE AORTA, THE INFERIOR VENA CAVA --
ALL THE BRANCHES OF THE AORTA IN THE ABDOMEN CAN SOMETIMES
BE ENGULFED BY THE TUMOR.
AND SOMETIMES IT'S STRAIGHTFORWARD TO SEPARATE
THE TUMOR FROM THOSE STRUCTURES.
OTHER TIMES IT'S QUITE DIFFICULT.
THE SECOND MOST COMMON TUMOR THAT WE OPERATE ON
IN CHILDREN IS WILMS' TUMOR, WHICH IS A RELATIVELY COMMON
TUMOR OF THE KIDNEYS.
THIS OFTEN REQUIRES A NEPHRECTOMY,
A REMOVAL OF THE KIDNEY.
SOMETIMES A PATIENT MIGHT BE A CANDIDATE FOR A PARTIAL
NEPHRECTOMY, WHERE WE REMOVE THE TUMOR AS WELL AS A VERY
SMALL PART OF THE KIDNEY TO TRY TO PRESERVE AS MUCH
OF THE KIDNEY AS POSSIBLE.
ONE OF THE OTHER MORE COMMON TUMORS THAT WE SEE
IN CHILDREN IS HEPATOBLASTOMA, AND THAT IS AN OPERATION
THAT OFTEN REQUIRES REMOVING A PORTION OF THE LIVER,
OR A HEPATECTOMY.
IN RARE CASES, IF THE TUMOR IS QUITE EXTENSIVE,
THE PATIENT REQUIRES A LIVER TRANSPLANT.
AND IN THAT SITUATION, WE INVOLVE THE LIVER TRANSPLANT
SURGEONS.
>> WE HAVE THE CLINICAL VOLUME THAT HELPS PEOPLE
TO HONE THEIR SKILLS AND BASICALLY GET BETTER.
THE RESULTS HERE ARE FANTASTIC.
THE COLLABORATION WITHIN THE SURGERY DEPARTMENT
IS TREMENDOUS.
THERE IS NO THRESHOLD, BASICALLY,
TO CALL A COLLEAGUE TO HELP OUT IN A CHILD'S CARE.
THERE'S NO EGO INVOLVED.
IT'S JUST WHAT'S BEST FOR THE KID.
SO THE KID IS RIGHT HERE, AND THAT'S REALLY
A BENCHMARK OF THE CHILDREN'S HOSPITAL OF PHILADELPHIA.
>> WE WORK VERY WELL IN A COLLABORATIVE FASHION WITH
ALL OF OUR SUB-SPECIALISTS, AND ESPECIALLY WHEN IT COMES
TO THE ONCOLOGY CENTER, THEY'RE VERY GOOD AT
ORGANIZING AND BRINGING TOGETHER EXPERTS IN ALL
FIELDS WHENEVER NECESSARY.
>> I THINK WHAT'S REALLY UNIQUE ABOUT THE COORDINATED
CARE THAT OUR SURGICAL ONCOLOGISTS AND PEDIATRIC
ONCOLOGISTS ARE ABLE TO DELIVER HERE AT CHOP
IS THAT WE THINK TOGETHER.
WE WORK TOGETHER FREQUENTLY.
WE THINK ABOUT PROBLEMS TOGETHER FREQUENTLY,
AND WE'RE ABLE TO THINK ABOUT THE TECHNICAL ASPECTS
AS WELL AS THE MEDICAL ASPECTS TOGETHER.
WE'VE BEEN ABLE TO PARTNER WITH OUR COLLEAGUES SO THAT
CARE CAN BE DELIVERED CLOSE TO THE PATIENT'S HOME.
BUT RIGHT AROUND THE TIME OF SURGERY,
WE ALL COME BACK INTO THE PICTURE,
HELP THE PATIENT THROUGH WHAT CAN POTENTIALLY BE
A CHALLENGING SITUATION, AND THEN COMMUNICATE BACK WHAT'S
HAPPENED IN THE PERIOPERATIVE PERIOD TO
THE ONCOLOGY AND SURGERY TEAMS THAT ARE GOING TO BE TAKING
CARE OF THE PATIENT DOWN THE ROAD.
>> SOMETIMES IT IS THE SURGICAL ASPECT OF THEIR
CARE THAT REQUIRES A PLACE LIKE CHOP,
AND SO WE'RE HAPPY TO WORK TOGETHER WITH ONCOLOGISTS
IN THE COMMUNITY, FROM ANY PART OF THE COUNTRY OR,
IN SOME CASES, ANY PART OF THE WORLD.
WE'RE NOT TRYING TO TAKE THAT PATIENT AWAY FROM THEM.
WE JUST WANT TO HELP IN ANY WAY THAT WE CAN.
>> I HAD SEVERAL DOCTORS ON THE LIST THAT I WANTED
TO MEET, BUT AFTER WE MET WITH DR. MATTEI,
HE JUST MADE US FEEL COMFORTABLE.
I'VE NEVER HEARD A DOCTOR THAT WOULD SAY,
"I'M HONORED TO HAVE YOU CHOSEN ME TO COME HERE
TO POSSIBLY DO YOUR SON'S SURGERY."
>> I REMEMBER HE CALLED MATTHEW TO HIS
HEAD AND HE SAID -- HE CHECKED HIM,
AND HE SAID, "I'LL TAKE CARE OF HIM JUST LIKE MY SON."
>> AFTER ABOUT NINE HOURS OR 10 HOURS WAITING,
WHEN DR. MATTEI FINALLY COMES AND TELLS YOU,
YOU KNOW, 99 PERCENT OF THE TUMOR IS REMOVED,
IT WAS, YOU KNOW, THE HAPPIEST DAY OF,
YOU KNOW, ME AND MY WIFE.
>> BECAUSE THERE ARE FEW THINGS MORE REWARDING THAN
HELPING A CHILD WITH CANCER.
IT'S A VERY DIFFICULT OPERATION IN MANY CASES.
IT'S VERY CHALLENGING FROM A TECHNICAL STANDPOINT.
IT'S VERY DIFFICULT FROM AN EMOTIONAL STANDPOINT.
BUT, AGAIN, THE REWARDS OF A JOB WELL DONE ARE GREATER
THAN PROBABLY IN ANY OTHER FIELD THAT I CAN IMAGINE.