>> THERE'S NO OTHER HOSPITAL IN THE U.S.,
AT LEAST, THAT DOES MORE NEUROBLASTOMA THAN CHOP.
THEY SEE THE MOST VOLUME THAN ANY,
SO WE DECIDED TO ALSO GO INTERVIEW THE DOCTORS
OVER THERE.
AND AS SOON AS WE COMPLETED THE INTERVIEW,
WE KNEW WE WANTED TO TAKE HIM TO PHILADELPHIA.
>> FOR A CHILD AND FOR A FAMILY FACING CANCER,
WE HAVE EVERY SURGICAL RESOURCE IMAGINABLE
AT THE CHILDREN'S HOSPITAL OF PHILADELPHIA.
WHEN YOU THINK ABOUT IT, WE HAVE AN ARRAY OF PEDIATRIC
SURGICAL SPECIALISTS.
SEVENTY-FIVE IN NUMBER, MORE THAN ANY CENTER
IN THE WORLD THAT CAN PROVIDE ANY EXPERTISE
THAT A CHILD WITH CANCER NEEDS.
>> THE NICE THING ABOUT A PLACE LIKE CHOP IS THAT WE
HAVE EXPERTS IN REALLY JUST ABOUT EVERY AREA
OF PEDIATRIC SUBSPECIALTY.
AND SO IF PATIENTS COME WITH A PROBLEM THAT IS UNUSUAL
OR UNCOMMON, WE KNOW THAT WE CAN FIND THE EXPERTISE.
>> I CAN THINK OF EIGHT TO 10 DIFFERENT TECHNIQUES
THAT WE'VE DEVELOPED HERE IN RESPONSE TO CHALLENGING
SITUATIONS OR PROBLEMS.
THE WHOLE FIELD OF LIMB-SPARING SURGERY HAS
BEEN AROUND FOR A LONG TIME, BUT WITHIN THE UMBRELLA
OF THAT FIELD THERE ARE MANY DIFFERENT NUANCES
AND VARIATIONS THAT HAVE BEEN DEVELOPED HERE AT CHOP OVER
THE YEARS.
>> THE RIGHT APPROACH TO SURGERY ON THE BRAIN
IS A LITTLE BIT DIFFERENT THAN OTHER SURGERIES BECAUSE
THE FUNCTION IS NOT QUITE AS WELL DEFINED,
THE WHOLE MIND-BRAIN BARRIER.
SO A GREAT CONCERN IS ALWAYS TO BE AGGRESSIVE WITHOUT
BEING RECKLESS.
YOU WANT TO REMOVE AS MUCH TUMOR AS YOU CAN AND LEAVING
THEM NEUROLOGICALLY INTACT.
>> THE MAJORITY OF PATIENTS WITH NEUROBLASTOMA
EVENTUALLY REQUIRE SURGERY.
SURGERY IS AN INTEGRAL PART OF THE CARE OF MOST PATIENTS
WITH NEUROBLASTOMA.
MOST OF THE TIME IS SPENT PAINSTAKINGLY REMOVING
THE TUMOR, LITERALLY MILLIMETER BY MILLIMETER.
AND SOMETIMES IT MEANS SEPARATING IT VERY CAREFULLY
FROM THESE VERY DELICATE STRUCTURES.
WE ALWAYS HAVE TO TAKE OUR TIME AND BE VERY CAREFUL.
>> A SURGEON HAS TO HAVE A GREAT DEAL OF TECHNICAL
EXPERTISE IN ORDER TO BE ABLE TO CARRY OUT,
FOR EXAMPLE, A LIMB SALVAGE PROCEDURE.
I THINK WHAT SETS THE TEAM AT CHOP APART IS AN ABILITY
TO UNDERSTAND THE CHEMOTHERAPY,
THE RADIATION CONSIDERATIONS,
AND ALL THE OTHER ASPECTS THAT GO INTO THE ENTIRETY
OF A PATIENT'S CARE.
PATIENTS COME FROM A VERY LONG WAY TO TAKE ADVANTAGE
OF THE EXPERTISE AND THE VOLUME THAT WE HAVE HERE
AT CHOP.
>> VOLUME IS CRITICAL IN A SURGICAL PROGRAM FOR THE
SIMPLE REASON THAT THE MORE EXPERIENCE SOMEBODY HAS
IN ALL THE VARIETIES OF THAT CLINICAL PRESENTATION,
THE BETTER OFF THE PATIENT IS GOING TO BE IN TERMS
OF THAT SURGEON BEING ABLE TO ANTICIPATE,
AS WELL AS TO DEAL WITH THE UNEXPECTED.
IF YOU'RE DOING 100 OPERATIONS FOR BRAIN TUMORS
A YEAR, THE VARIETY AND THE DIFFERENCES OF CLINICAL
EXPERIENCE THAT YOU'RE GOING TO HAVE AND BE ABLE TO BRING
TO THIS INDIVIDUAL PATIENT IS GOING TO BE MUCH RICHER
AND MUCH MORE POWERFUL.
>> THE FACT THAT WE SEE SO MANY CHILDREN WITH RARE,
UNCOMMON, DIFFICULT TUMORS, I THINK,
LEADS TO THIS OR HELPS FOSTER SUPPORT THIS
ENVIRONMENT OF INNOVATION.
TRYING TO FIND NEW AND BETTER WAYS.
>> FOR MOST PATIENTS AND PARENTS WHOSE CHILD IS ABOUT
TO UNDERGO A MAJOR OPERATION UNDER GENERAL ANESTHESIA,
IT'S OFTEN THE ANESTHESIA THAT IS THE SCARIEST PART
FOR THOSE PATIENTS.
AND SO WE TRY TO ADDRESS THAT IN A PROACTIVE WAY
AHEAD OF TIME.
WE REASSURE THEM THAT GENERAL ANESTHESIA IS VERY
SAFE FOR PATIENTS, ESPECIALLY YOUNG PATIENTS.
BUT WE ALSO REASSURE THEM THAT IT IS A VERY SERIOUS BUSINESS.
>> WE'RE FORTUNATE TO HAVE AN ANESTHESIA PAIN PROGRAM
HERE AT CHOP, WHICH I BELIEVE IS VERY UNIQUE
AND HUGELY VALUABLE AFTER THIS TYPE OF SURGERY.
OUR ANESTHESIA TEAM IS LOOKING FOR CATHETERS
OR REGIONAL BLOCKS OR POSTOPERATIVE PAIN
MANAGEMENT TECHNIQUES THAT WILL HELP MAKE IT A LESS 00:04:50.458,00:00:00.000 PAINFUL EXPERIENCE FOR THE CHILD AFTER SURGERY.