{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:45:33Z","timestamp":1777974333385,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,30]],"date-time":"2023-04-30T00:00:00Z","timestamp":1682812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pediatric liver surgery is a complex and challenging procedure and can be associated with major complications, including mortality. Best practices are not established. The aims of this study were to evaluate surgeons\u2019 individual and institutional practices in pediatric liver surgery and make recommendations applicable to the management of children who require liver surgery. Methods: A web-based survey was developed, focusing on the surgical management of children with liver conditions. It was distributed to 34 pediatric surgery faculty members of the Biliary Atresia and Related Disorders (BARD) consortium and 28 centers of the European Reference Network\u2014Rare Liver. Using the Delphi method, a series of questions was then created to develop ideas about potential future developments in pediatric liver surgery. Results: The overall survey response rate was 70.6% (24\/34), while the response rate for the Delphi questionnaire was 26.5% (9\/34). In centers performing pediatric liver surgery, most pediatric subspecialties were present, although pediatric oncology was the least present (79.2%). Nearly all participants surveyed agreed that basic and advanced imaging modalities (including ERCP) should be available in those centers. Most pediatric liver surgeries were performed by pediatric surgeons (69.6%). A majority of participants agreed that centers treating pediatric liver tumors should include a pediatric transplant program (86%) able to perform technical variant grafts and living donor liver transplantation. Fifty-six percent of responders believe pediatric liver transplantation should be performed by specialized pediatric surgeons. Conclusion: Pediatric liver surgery should be performed by specialized pediatric surgeons and should be centralized in regional centers of excellence where all pediatric subspecialists are present. Pediatric hepatobiliary and transplant training needs to be better promoted amongst pediatric surgery fellows to increase this subspecialized workforce.<\/jats:p>","DOI":"10.3390\/jcm12093229","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T12:10:03Z","timestamp":1682943003000},"page":"3229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pediatric Liver and Transplant Surgery: Results of an International Survey and Expert Consensus Recommendations"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0934-7495","authenticated-orcid":false,"given":"Caroline P.","family":"Lemoine","sequence":"first","affiliation":[{"name":"Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7239-8973","authenticated-orcid":false,"given":"Omid","family":"Madadi-Sanjani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1789-7163","authenticated-orcid":false,"given":"Claus","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-5650","authenticated-orcid":false,"given":"Christophe","family":"Chardot","sequence":"additional","affiliation":[{"name":"Service de Chirurgie P\u00e9diatrique Visc\u00e9rale, H\u00f4pital Necker\u2014Enfants Malades, Universit\u00e9 de Paris, 75015 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7681-6178","authenticated-orcid":false,"given":"Jean","family":"de Ville de Goyet","sequence":"additional","affiliation":[{"name":"Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, ISMETT, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Superina","sequence":"additional","affiliation":[{"name":"Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1002\/pbc.24215","article-title":"The epidemiology of hepatoblastoma","volume":"59","author":"Spector","year":"2012","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.jpedsurg.2021.07.012","article-title":"Integration of a dedicated management protocol in the care of pediatric liver cancer: From specialized providers to complication reduction","volume":"57","author":"Whitlock","year":"2022","journal-title":"J. Pediatr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1001\/jamasurg.2016.0261","article-title":"Understanding the Operative Experience of the Practicing Pediatric Surgeon: Implications for Training and Maintaining Competency","volume":"151","author":"Abdullah","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1007\/s11605-011-1777-2","article-title":"Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital","volume":"16","author":"Pecorelli","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.juro.2015.01.096","article-title":"Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States","volume":"194","author":"Wang","year":"2015","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.jpedsurg.2011.04.013","article-title":"Biliary atresia in England and Wales: Results of centralization and new benchmark","volume":"46","author":"Davenport","year":"2011","journal-title":"J. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jpedsurg.2009.01.023","article-title":"Effect of hospital case volume on outcome in congenital diaphragmatic hernia: The experience of the Canadian Pediatric Surgery Network","volume":"44","author":"Grushka","year":"2009","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/pbc.22631","article-title":"Does Children\u2019s Oncology Group hospital membership improve survival for patients with neuroblastoma or Wilms tumor?","volume":"55","author":"Gutierrez","year":"2010","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1503\/cmaj.080372","article-title":"A guide for the design and conduct of self-administered surveys of clinicians","volume":"179","author":"Burns","year":"2008","journal-title":"CMAJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jpedsurg.2003.10.013","article-title":"Outcome and complications after resection of hepatoblastoma","volume":"39","author":"Towu","year":"2004","journal-title":"J. Pediatr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s00383-014-3492-z","article-title":"Morbidity and mortality associated with liver resections for primary malignancies in children","volume":"30","author":"Zwintscher","year":"2014","journal-title":"Pediatr. Surg. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1002\/pbc.25240","article-title":"Impact of postoperative complications on overall survival of patients with hepatoblastoma","volume":"62","author":"Becker","year":"2015","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1053\/j.sempedsurg.2016.10.004","article-title":"Complications in pediatric hepatobiliary surgery","volume":"25","author":"Grisotti","year":"2016","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1002\/cncr.10282","article-title":"Surgical view of the treatment of patients with hepatoblastoma: Results from the first prospective trial of the International Society of Pediatric Oncology Liver Tumor Study Group","volume":"94","author":"Schnater","year":"2002","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1053\/jpsu.2001.28811","article-title":"World Federation of Associations of Pediatric Surgeons. Declaration of pediatric surgery","volume":"36","author":"Grosfeld","year":"2001","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jpedsurg.2015.10.038","article-title":"Subspecialization within pediatric surgical groups in North America","volume":"51","author":"Langer","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.jpedsurg.2020.02.006","article-title":"Subspecialization in pediatric surgery: Results of a survey to the American Pediatric Surgical Association","volume":"55","author":"Rich","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1016\/j.jpedsurg.2020.08.001","article-title":"The Right Child\/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association","volume":"55","author":"Alaish","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.jpedsurg.2018.02.004","article-title":"The Shrinking Landscape of Pediatric Surgery: Is Less More?","volume":"53","author":"Superina","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1007\/s11605-014-2514-4","article-title":"The subspecialization of surgery: A paradigm shift","volume":"18","author":"Bruns","year":"2014","journal-title":"J. Gastrointest. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.gassur.2004.03.008","article-title":"Training, practice, and referral patterns in hepatobiliary and pancreatic surgery: Survey of general surgeons","volume":"9","author":"Dixon","year":"2005","journal-title":"J. Gastrointest. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1002\/cncr.25722","article-title":"Successful nontransplant resection of POST-TEXT III and IV hepatoblastoma","volume":"117","author":"Lautz","year":"2011","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1542\/peds.2013-3820","article-title":"Referral to pediatric surgical specialists","volume":"133","author":"Klein","year":"2014","journal-title":"Pediatrics"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3229\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:27:08Z","timestamp":1760124428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,30]]},"references-count":23,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["jcm12093229"],"URL":"https:\/\/doi.org\/10.3390\/jcm12093229","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,30]]}}}