Tumor-Specific Critical Intraoperative Findings Influence Multidisciplinary Therapy

Background: Local control strategies in pediatric oncology are guided by disease-specific considerations. Effective communication of the goals of surgical procedure and associated intraoperative events plays a crucial role in shaping subsequent treatment decisions. However, accurately and comprehensively documenting these findings remains challenging, with considerable variability across different tumor types. This investigation aims to achieve a consensus on critical intraoperative oncologic observations pertaining to pediatric solid tumors, thereby facilitating the enhancement of surgical reporting and the optimization of subsequent treatment strategies. Methods: An expert panel comprising childhood cancer specialists from diverse disciplines and geographical regions participated in a Delphi consensus process. After reviewing relevant literature and engaging in multiple voting rounds, the panel identified essential tumor-specific intraoperative documentation elements. Results: A Delphi panel of 16 experts from diverse geographical locations completed two rounds of voting with a 94% participant retention rate and achieved consensus on 15 key statements. Essential documentation components included completeness of resection, evaluation of locoregional spread, and vascular involvement, with tumor-specific variations. For instance, neuroblastoma required documentation of resection percentage, while sarcoma emphasized biopsy tract resection and plane of resection. Ovarian germ cell tumors necessitated ascitic fluid sampling and contralateral ovary evaluation. Additionally, the presence of tumor thrombus was highlighted as particularly relevant in renal, liver, and adrenocortical carcinomas. Despite recognizing the significance of these findings, the panel noted deficiencies in operative reports, including omissions of documentation of tumor spillage, lymph node sampling, and residual disease, underscoring the need for improved documentation to support multidisciplinary decision-making. Conclusions: This study highlights the critical role of precise intraoperative documentation in guiding multidisciplinary care for pediatric solid tumors. The variability across tumor types underscores the need for tailored documentation guidelines. While a standardized synoptic operative report could improve consistency and communication, a hybrid model combining universal elements with tumor-specific details may offer an effective solution for comprehensive and adaptable reporting.