Background/Aim: Epigallocatechin gallate (EGCG), a major polyphenol of green tea, has been shown to inhibit cancer cell proliferation. In this study the effect of EGCG on cell metabolism and the human hedgehog signalling pathway (HH) in human rhabdomyosarcoma (RMS) cells was investigated. Materials and Methods: Two human RMS cell lines (RD and RH30) were incubated with EGCG. To evaluate the effects of EGCG on RMS cells, cell viability, colony formation, cell migration, and alteration of genes related to the HH signalling pathway were investigated. Results: EGCG showed cytostatic effects on RMS cells in a dose-dependent manner. Incubation with 25 μM EGCG resulted in a significant reduction of cell migration by 70% and downregulation of the HH pathway transcription factor GLI1. Conclusion: EGCG inhibits RMS cells in vitro by reducing cell proliferation and downregulating the HH signalling pathway. It may therefore be a promising agent in chemoresistant or advanced RMS in children.

Solid tumors of the cervicothoracic junction, the posterior mediastinum, or bilateral dorsal thoracic tumors represent a challenge in pediatric surgical oncology. The aim of this study was to evaluate trap-door thoracotomy and clamshell thoracotomy as surgical approaches. A single-center retrospective study of children with solid tumors in these specific localizations was performed. From 2015 to 2023, 26 children (17 girls; 9 boys) were treated at a median age of 54 months (range 8–229). Tumor resection was performed for neuroblastoma (n = 11); metastatic disease (n = 7); malignant rhabdoid tumor (n = 4); Ewing sarcoma (n = 1); inflammatory myofibroblastic tumor (n = 1); rhabdomyosarcoma (n = 1); and neurofibroma (n = 1). The surgical goal of macroscopic complete excision was achieved in all of the 14 children who underwent trap-door thoracotomy and in 11 of the 12 children who underwent clamshell thoracotomy. There were no major complications. At a median follow-up of 8 months (range 0–60), the disease was under local control or in complete remission in 66.7% of the children. In conclusion, surgical resection of solid tumors of the cervicothoracic junction in children can be performed safely and successfully with trap-door thoracotomy and with clamshell thoracotomy for posterior mediastinal or bilateral dorsal thoracic tumors.

The management of congenital lung malformations (CLM) remains controversial. The aim of this study was to analyze the timing, approach, and outcomes of surgical treatment in children with CLM. A cohort study was conducted comparing children with CLM who underwent thoracoscopic resection with open resection via thoracotomy. All children were treated according to an institutionalized multidisciplinary coordinated treatment algorithm. Between 2002 and 2019, 68 children with CLM were treated. Thoracoscopic resection of CLM (n=44) resulted in a statistically significant longer operative time (mean 169 vs. 97 minutes, p=0.04) but shorter hospital stay (mean 7.2 vs. 16.7/12 days, p=0.01) compared to thoracotomy (n=15) or after conversion to thoracotomy (n=9). There were no major complications in either group. At a mean follow-up of 32.2 months (range 0.5–163), patients after thoracoscopic resection had statistically significantly fewer rip fusions than patients after open resection (n=0 vs. 2/2, p≤0.004) and less chest wall asymmetry than after conversion (n=0 vs. 2, p=0.004). Thoracotomy proved to be a fast and safe surgical approach in respiratory unstable CLM patients. In respiratory stable CLM patients, thoracoscopic resection was feasible in early infancy with good surgical and musculoskeletal outcomes. Thoracoscopic resection of CLM offers advantages over resection by thoracotomy in terms of surgical recovery and musculoskeletal function. Therefore, it should be offered to respiratory-stable patients in specialized centers.

Background: Gastric transposition (GT) is a possible option for esophageal replacement in long-gap esophageal atresia (LGEA). The present study aims to report and compare indications and outcome of laparoscopic-assisted GT (LAGT) versus open (OGT) GT for LGEA repair. Methods: Retrospective single-center analysis of all LGEA patients undergoing GT between 2002 and 2021. Results: Thirty-one children with LGEA underwent GT. Of these, 19 underwent LAGT (mean weight at surgery 5.6 kg; mean age 167 days) and 12 underwent OGT (6.1 kg; 233 days). Indications for OGT were previous surgery (n = 7), associated severe cardiac malformations (n = 4), and a simultaneous resection of a choledochal cyst (n = 1). The conversion rate was 1. The two procedures (LAGT/OGT) differed in anesthetic time (308/350 min), duration of ventilation (5.1/5.3 days), hospital stay (34/32 days), and complications (22/15). None of the differences reached statistical significance. Outcome was also comparable: completely oral nutrition uptake in 66%/73%, slow weight gain in the low centiles in both groups, no patient developed dumping syndrome, symptomatic reflux was seen in 1 patient after OGT. Conclusion: In our cohort, LAGT for repair of LGEA provided similar outcomes as open surgery. The minimally invasive approach preserves thoracal structures, prevents additional thoracotomy or laparotomy, and is faster. To realize LAGT, a postpartal treatment concept including gastrostomy placement via a microincision to minimize adhesions is essential. The open surgical approach should be considered in cases of previous extensive surgical attempts of EA correction causing severe adhesions as well as associated anomalies or genetic syndromes causing hemodynamic instability.

(1) Background: The aim of this study was to investigate potential translational factors for optical 3D reconstruction in an in vivo setting using a newly developed computerized bowel length measurement system (BMS) as a real-time application. (2) Methods: The BMS was evaluated in an in vivo porcine experiment for the influence of light source power (Watt), laparoscope-to-bowel distance (cm), bowel rotation, image background, and surgical objects in the image. Endpoints were robustness, calculated as success rate (SR) in percent, and accuracy, defined as relative error (RE) in percent of BMS measurement result to ground truth. (3) Results: A total of 1992 bowel measurements were performed on n = 7 pigs using the BMS. Bowel measurements were robust and accurate regardless of light source power, at a laparoscope-to-bowel distance of 5 cm (SR 100%, RE 18 ± 38.5%), when the small bowel was aligned horizontally (SR 100%, RE 7.3 ± 36.2%) or in the image background (SR 100%, RE 15.2 ± 23.4%), and when no additional instruments were in the image. (4) Conclusions: Applications based on optical 3D reconstruction are feasible for intraoperative use and could enable quantitative laparoscopy.

Background/Objectives: In bilateral nephroblastoma and high-risk neuroblastoma in children with extensive tumor involvement of the renal vessels or pedicle, complete tumor resection with preservation of healthy renal tissue is not feasible with in situ nephron-sparing surgery or vascular replacement. The aim of this study was to present our experience with ante situ tumor resection and renal autotransplantation (RATX) in these children. Methods: A retrospective study of children with bilateral nephroblastoma and high-risk neuroblastoma who underwent tumor resection and RATX at an international referral center for pediatric surgical oncology between 2006 and 2024 was performed. RATX was performed by transection of renal vessels, ante situ mobilization, and perfusion of the kidney with Bretschneider’s solution. Tumor resection was performed on a bloodless kidney under hypothermia. Results: Ante situ tumor resection and RATX were performed at a median age of 36 months (range 13–62) in 4 children with bilateral nephroblastoma and 4 children with high-risk neuroblastoma. Complete tumor resection was achieved in all patients. One patient with neuroblastoma died of sepsis after 14 days. The 7 surviving patients showed no evidence of disease and normal to slightly decreased glomerulofiltration rates at a median follow-up of 20 months (range 3–155). Limitations include the retrospective design, small sample size, and heterogeneity of the study population due to very rare indication. Conclusions: Ante situ tumor resection and RATX is a feasible surgical approach for children with multifocal bilateral nephroblastoma or high-risk neuroblastoma who are ineligible for in situ nephron-sparing surgery or vascular reconstruction.