Tony Sandler

Tony's statements about Abdominal Wall Defects 48 statements

Open the Abdominal Wall Defects collection →

Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...

Statement Current standard for bilateral Wilms tumor is to start chemotherapy, give 2 cycles, and stop when tumor shrinkage plateaus (defined as less than 50% volume reduction). Open

Statement When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation. Open

Statement Bilateral nephron-sparing surgery for Wilms tumor can be performed by placing kidneys on ice, clamping vessels, and performing sharp tumor dissection—surprisingly feasible even for large tumors. Open

Quotation I never like to stick around for post-op complications. Open

Statement It is debated whether anaplasia in Wilms tumor is present initially or develops secondary to chemotherapy-induced differentiation; most pathologists believe it is present primarily, making these heterogeneous tumors. Open

Statement 97% of bilateral kidney tumors in children are Wilms tumor, so biopsy is not needed upfront—chemotherapy should be started empirically. Open

Statement For gastroschisis closure using Tegaderm technique, if the fascia is not cut to widen the defect, most umbilical hernias will close spontaneously and do not require repair. Open

Statement Tegaderm can be applied directly over reduced gastroschisis without Betadine or other topical agents, left in place for approximately 3 days, then converted to dry dressing once tissues are adherent. Open

Statement Even when a gastroschisis silo fails and the defect dilates significantly, Tegaderm-only closure can achieve successful cicatrization over 8 weeks. Open

Statement When gastroschisis is reduced without closing the fascia, ambient intra-abdominal pressure is lower than with fascial closure, which may benefit bowel function. Open

Quotation I wasn't smart enough to bring it out through the umbilicus. Open

Statement Re-exploration at 2 weeks after initial gastroschisis reduction (rather than the traditional 4-6 weeks) can reveal that inflamed 'gastroschisis bowel' has transformed into viable intestine suitable for anastomosis. Open

Statement For apple-peel ileal atresia with ischemic distal bowel, if the bowel does not pink up on the operating table and is not twisted, resection with primary anastomosis is appropriate. Open

Statement Plication of massively dilated proximal bowel in intestinal atresia is helpful and the plication typically unravels over time, preserving bowel length for later lengthening procedures if needed. Open

Statement In newborns with questionable short-gut syndrome, tapering should be avoided to preserve bowel for potential lengthening procedures later; plication is preferred. Open

Statement If a child has extensive bowel length and only a segment is dilated, tapering is reasonable. Open

Compiled Sandler Rapid Fire Sessions: Update Course 2015

Quotation I congratulate you for putting on an incredible symposium Open

Statement Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction) Open

Statement When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation Open

Statement Bilateral nephron-sparing surgery is feasible even in large bilateral Wilms tumors by placing kidneys on ice, clamping vessels, and performing sharp dissection Open

Quotation I never like to stick around for post-op complications. I, I'm that's a joke, sorry. Open

Quotation They gotta look a lot. You have to look a lot. Open

Statement Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy Open

Statement 97% of bilateral kidney tumors in children are Wilms tumor, with only a small percentage being other diagnoses Open

Statement Umbilical hernias after gastroschisis closure will close spontaneously if no fascia was cut; if fascia is cut, a permanent defect results Open

Statement Tegaderm closure of gastroschisis without fascial closure allows cicatrization over 3 days to 8 weeks, with feeding started when bowel function returns rather than waiting for complete closure Open

Statement When gastroschisis defect dilates during silo reduction attempts, Tegaderm closure alone can still achieve successful cicatrization without fascial closure Open

Statement In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the extent of remaining intra-abdominal bowel from external examination Open

Quotation You cannot tell what's going on with this bowel, whatever you, whatever you do. Now, something strange we did and absolutely not take it out, never take it out. Open

Statement Re-exploration at 2 weeks after gastroschisis closure (rather than the traditional 4-6 weeks) can reveal that inflamed gastroschisis bowel has transformed into functional intestine suitable for anastomosis Open

Statement Plication of dilated bowel in ileal atresia usually unravels with time, allowing the bowel to be used later for lengthening procedures Open

Statement In neonatal ileal atresia with dilated proximal bowel, plication is preferred over tapering to preserve bowel length for potential future lengthening procedures Open

Tony's statements about Adrenal Tumors 16 statements

Open the Adrenal Tumors collection →

Neuroblastoma

Statement Familial neuroblastoma occurs in approximately 1% of patients Open

Quotation I think one of the other things when you speak to the family, it's really important to reassure them that even if the mass increases in size and you take it out, it is likely to be a very, very low risk tumor. Open

Statement In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival Open

Statement Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma Open

Statement Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status Open

Statement NMEC amplification automatically means high-risk neuroblastoma regardless of other factors Open

Quotation I sort of think of it like imperforate anus. And you think of it as there's different ways of classifying imperforate anus. But for me, practically, there's high and there's low. Open

Quotation If NMEC is amplified, it is automatically high-risk disease, irrespective of any other categorization. Open

Statement Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months) Open

Statement Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy Open

Statement Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes Open

Quotation I think the bottom line is patients don't die of local disease. They die of systemic disease, in neuroblastoma. Open

Statement High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence Open

Statement Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction Open

Statement Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60% Open

Statement Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor Open

Tony's statements about Colorectal / ARM & Hirschsprung 16 statements

Open the Colorectal / ARM & Hirschsprung collection →