# Osteosarcoma — GCMD Library living collection

Everything in the library about osteosarcoma — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 67 cited statements

## Episodes
### Evidence & Research
- [Update Course Rewind: 2021 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578) — video · 16:02 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578.md)
- [Bailey Roberts, MD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011) — video · 8:39 · [machine version](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011.md)

### Case-Based Learning
- [Update Course Rewind: Thoracotomy vs VATS for Lung Metastases](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632) — video · 9:40 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632.md)
- [Update Course Rewind: Chest Wall Reconstruction 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839) — video · 5:32 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839.md)

## Chapters
- [0:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=12) Takeaway #10: Medical Management of Uncomplicated Appendicitis (Ep 1)
- [1:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=105) Takeaway #9: Surgical Approach to Osteosarcoma Lung Metastases (Ep 1)
- [3:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=188) Takeaway #8: Flourish Device for Esophageal Atresia (Ep 1)
- [4:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283) Takeaway #7: Indocyanine Green Applications in Pediatric Surgery (Ep 1)
- [6:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=366) Takeaway #6: Timing of Colorectal Procedures (Ep 1)
- [7:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=462) Takeaway #5: Pain Management for Pectus Repair (Ep 1)
- [9:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=569) Takeaway #4: Button Battery Ingestion Management (Ep 1)
- [11:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=672) Takeaway #3: Updated ATLS Guidelines for Pediatric Hemorrhagic Shock (Ep 1)
- [12:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=741) Takeaway #2: Management of Primary Spontaneous Pneumothorax (Ep 1)
- [13:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=829) Takeaway #1: Diversity, Equity, and Inclusion in Pediatric Surgery (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=0) Introduction to thoracotomy versus VATS for lung metastases (Ep 2)
- [0:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=47) Case presentation: 16-year-old with osteosarcoma and lung metastases (Ep 2)
- [2:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=128) Role of metastectomy and detection of small nodules (Ep 2)
- [3:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=210) Thoracotomy approach: advantages and limitations (Ep 2)
- [4:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=281) VATS approach and comparative outcomes data (Ep 2)
- [6:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=381) Chemotherapy timing and bilateral disease management (Ep 2)
- [7:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=449) Expert perspectives and future directions (Ep 2)
- [9:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=550) Closing remarks (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=0) Introduction and presenter identification (Ep 3)
- [0:47](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=47) Osteosarcoma background and study rationale (Ep 3)
- [2:26](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=146) Experimental methods and cell line models (Ep 3)
- [3:42](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=222) Experimental results in K7M2 and K12 tumor models (Ep 3)
- [5:14](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=314) Conclusions and therapeutic implications (Ep 3)
- [5:53](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=353) Question and answer discussion (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=0) Case presentation: 14-year-old with osteosarcoma and cord compression (Ep 4)
- [1:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=90) Surgical technique and reconstruction materials (Ep 4)
- [3:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=217) Outcomes and complications (Ep 4)
- [4:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=292) Summary and future directions (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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 (host_summary) [Ep 1 · 0:43](https://qa.library.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." (host_summary) [Ep 1 · 1:11](https://qa.library.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 (host_summary) [Ep 1 · 1:22](https://qa.library.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." (host_summary) [Ep 1 · 2:15](https://qa.library.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." (host_summary) [Ep 1 · 2:24](https://qa.library.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." (host_summary) [Ep 1 · 2:40](https://qa.library.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." (host_summary) [Ep 1 · 3:16](https://qa.library.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." (host_summary) [Ep 1 · 3:39](https://qa.library.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." (host_summary) [Ep 1 · 3:57](https://qa.library.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 (host_summary) [Ep 1 · 4:43](https://qa.library.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 (host_summary) [Ep 1 · 5:32](https://qa.library.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 (host_summary) [Ep 1 · 5:48](https://qa.library.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." (host_summary) [Ep 1 · 6:37](https://qa.library.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." (host_summary) [Ep 1 · 6:54](https://qa.library.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." (host_summary) [Ep 1 · 7:14](https://qa.library.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." (host_summary) [Ep 1 · 8:11](https://qa.library.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." (host_summary) [Ep 1 · 8:34](https://qa.library.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 (host_summary) [Ep 1 · 9:48](https://qa.library.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 (host_summary) [Ep 1 · 10:13](https://qa.library.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 (host_summary) [Ep 1 · 10:20](https://qa.library.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 (host_summary) [Ep 1 · 10:35](https://qa.library.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 (host_summary) [Ep 1 · 10:51](https://qa.library.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." (host_summary) [Ep 1 · 11:28](https://qa.library.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." (host_summary) [Ep 1 · 11:38](https://qa.library.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." (host_summary) [Ep 1 · 11:46](https://qa.library.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." (host_summary) [Ep 1 · 11:59](https://qa.library.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." (host_summary) [Ep 1 · 12:42](https://qa.library.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." (host_summary) [Ep 1 · 12:53](https://qa.library.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." (host_summary) [Ep 1 · 13:16](https://qa.library.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 (host_summary) [Ep 1 · 14:10](https://qa.library.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 (host_summary) [Ep 1 · 14:19](https://qa.library.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 (host_summary) [Ep 1 · 14:30](https://qa.library.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 (host_summary) [Ep 2 · 1:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=89)
- "About 40% of patients can achieve a durable cure response after 5 years with complete metastatic site clearance." — Roshni Dasgupta (clinical) [Ep 2 · 2:08](https://qa.library.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 2 · 2:23](https://qa.library.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 2 · 2:35](https://qa.library.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 2 · 2:47](https://qa.library.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 2 · 3:13](https://qa.library.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 2 · 3:19](https://qa.library.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 2 · 3:50](https://qa.library.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 2 · 4:15](https://qa.library.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 2 · 4:41](https://qa.library.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 2 · 4:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=298)
- "With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited." — Rod Gerardo (host_summary) [Ep 2 · 5:03](https://qa.library.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 (host_summary) [Ep 2 · 5:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=323)
- "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 2 · 5:34](https://qa.library.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 2 · 5:44](https://qa.library.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 2 · 6:03](https://qa.library.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 2 · 6:34](https://qa.library.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 2 · 7:02](https://qa.library.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 2 · 7:13](https://qa.library.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 2 · 7:29](https://qa.library.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 2 · 7:52](https://qa.library.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 2 · 8:02](https://qa.library.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 2 · 8:05](https://qa.library.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 2 · 8:12](https://qa.library.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 2 · 8:23](https://qa.library.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 2 · 8:43](https://qa.library.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 2 · 8:56](https://qa.library.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 3 · 1:08](https://qa.library.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 3 · 1:11](https://qa.library.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 3 · 1:11](https://qa.library.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 3 · 1:19](https://qa.library.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 3 · 1:25](https://qa.library.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 3 · 1:38](https://qa.library.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 3 · 1:45](https://qa.library.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 3 · 1:52](https://qa.library.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 3 · 1:59](https://qa.library.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 3 · 2:31](https://qa.library.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 3 · 2:35](https://qa.library.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 3 · 2:57](https://qa.library.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 3 · 3:59](https://qa.library.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 3 · 4:18](https://qa.library.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 3 · 4:44](https://qa.library.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 3 · 5:01](https://qa.library.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 3 · 5:09](https://qa.library.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 3 · 5:14](https://qa.library.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 3 · 5:24](https://qa.library.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 3 · 5:30](https://qa.library.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 3 · 6:27](https://qa.library.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 3 · 6:48](https://qa.library.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 3 · 7:10](https://qa.library.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 3 · 7:31](https://qa.library.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 3 · 7:40](https://qa.library.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 3 · 7:57](https://qa.library.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 4 · 0:16](https://qa.library.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 4 · 0:27](https://qa.library.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 4 · 0:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=42)
- "The histopathology report confirmed an aggressive osteosarcoma." — Lizzie Lee (host_summary) [Ep 4 · 0:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=51)
- "PET scan showed a PET avid lesion on the right-hand side just next to the sternum." — Margaret Mutch (clinical) [Ep 4 · 1:04](https://qa.library.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 4 · 1:12](https://qa.library.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 4 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=92)
- "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 (host_summary) [Ep 4 · 1:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=105)
- "A lot of the literature on chest wall reconstruction is coming from adults." — Margaret Mutch (epidemiological) [Ep 4 · 1:55](https://qa.library.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 4 · 2:06](https://qa.library.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 4 · 2:28](https://qa.library.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 4 · 2:44](https://qa.library.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 4 · 2:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=171)
- "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 (host_summary) [Ep 4 · 3:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=185)
- "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 4 · 3:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=194)
- "Permacol is a surgical implant made of a porcine dermal collagen matrix that allows device placement." — Lizzie Lee (host_summary) [Ep 4 · 3:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=209)
- "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 4 · 3:37](https://qa.library.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 4 · 4:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=245)
- "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 (host_summary) [Ep 4 · 4:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=252)
- "The patient is currently having adjuvant chemotherapy." — Margaret Mutch (clinical) [Ep 4 · 4:22](https://qa.library.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 4 · 4:31](https://qa.library.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 4 · 4:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=276)
- "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 (host_summary) [Ep 4 · 4:45](https://qa.library.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 (host_summary) [Ep 4 · 5:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=317)

## Changelog
- Sep 7: 1 item added automatically
- Sep 7: 3 items added automatically

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