Welcome to the APSA Quality and Safety Committee Oncology Toolkit. This page is intended to help anyone who is interested in quality improvement pertaining to pediatric surgical oncology.

Available toolkit projects are listed below. Many of the approaches described are evidence based - some are not. These approaches have not been approved by APSA.

Enhanced Recovery after Nephrectomy

see Enhanced Recovery after Oncologic Procedures

Ovarian Preservation

Nationwide Children’s Hospital

These surgeons were interested in improving ovarian salvage rates for benign ovarian masses as they had previously shown that their rate was very low - especially among pediatric surgery faculty. They utilized quality improvement methodology and interventions such as creation of an ovarian mass algorithm, multi-disciplinary education, implementation of ovarian salvage techniques and standardized pelvic ultrasound reporting [1][2].



Stakeholders: pediatric surgeons, pediatric/adolescent gynecologists, oncologists, radiologists, pathologists

Challenges and solutions: “buy-in” from those pediatric surgeons who are newer to ovarian sparing surgery; education and collegial and collaborative environment between surgeons and gynecologists; adoption of “co-surgeons” until all surgeons comfortable with the technique.

Submitted by Jennifer Aldrink

Anterior Mediastinal Mass

Texas Children’s Hospital

As part of its Quality and Patient Safety Program, TCH created an evidence based outcomes center (EBOC) that takes a subject of importance and carefully and critically evaluates literature, involves in house content experts and generates a “clinical standard” for the institution. The subject of how to deal with children with anterior mediastinal masses is an important and complicated one. This was taken on by the team at TCH. An evidence based report and resulting algorithm was generated. [3][4]


Evidence summary and algorithm of management of anterior mediastinal masses

Stakeholders: anesthesiologists, pediatric surgeons, oncologists (practitioners who are involved in the work-up and management of anterior mediastinal masses)

Challenges and solutions: multidisciplinary education and adoption of the information.

Submitted by Rahul Baijal


  1. Gonzalez DO, Cooper JN, Aldrink JH, et al. Variability in surgical management of benign ovarian neoplasms in children. J Pediatr Surg. 2017;52(6):944-950.  [PMID:28343661]
  2. Papic JC, Finnell SM, Slaven JE, et al. Predictors of ovarian malignancy in children: overcoming clinical barriers of ovarian preservation. J Pediatr Surg. 2014;49(1):144-7; discussion 147-8.  [PMID:24439599]
  3. Perger L, Lee EY, Shamberger RC. Management of children and adolescents with a critical airway due to compression by an anterior mediastinal mass. J Pediatr Surg. 2008;43(11):1990-7.  [PMID:18970930]
  4. Stricker PA, Gurnaney HG, Litman RS. Anesthetic management of children with an anterior mediastinal mass. J Clin Anesth. 2010;22(3):159-63.  [PMID:20399999]
  5. Aldrink JH, Gonzalez DO, Sales SP, et al. Using quality improvement methodology to improve ovarian salvage for benign ovarian masses. J Pediatr Surg. 2017.  [PMID:29106919]
  6. Dasgupta R, Renaud E, Goldin AB, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg. 2018;53(7):1387-1391.  [PMID:29153467]
  7. Renaud EJ, Sømme S, Islam S, et al. Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg. 2019;54(3):369-377.  [PMID:30220452]
  8. Walker SK, Lal DR, Boyd KP, et al. Management of pediatric ovarian torsion: evidence of follicular development after ovarian preservation. Surgery. 2018;163(3):547-552.  [PMID:29329768]
Last updated: May 7, 2019