Outcomes of reconstructive surgery in pediatric oncology patients: review of 10-year experience.

Abstract

The purpose of our study was to review the role of reconstructive surgery in the management of pediatric oncology patients and to assess patients' outcomes, including functional status. We evaluated 177 children with cancer who underwent reconstructive surgery at our institution between 1999 and 2008. The mean age was 12.1 years, and the mean follow-up duration was 27.3 months. The most common tumor pathology was sarcoma (49.7%), and the most common reconstruction site was the head and neck (41.8%). Nearly half of all patients underwent preoperative (44.1%) and/or postoperative (45.8%) chemotherapy. Immediate reconstruction was performed in 84.7% of patients. Free tissue transfer (33.9%) was the most common form of reconstruction, and the fibula flap (58.4%) was the most common free flap used. Additional surgery (for any reason) was required in 41.8% of patients. In general, functional outcomes were excellent: 78.4% of head and neck reconstruction patients tolerated a regular diet postoperatively, 72.0% of upper extremity reconstruction patients experienced no postoperative functional deficits, and 70.6% of lower extremity reconstruction patients achieved ambulatory status (without assistance). Of the 177 patients, 74.6% had no evidence of disease at last known follow-up. Reconstructive surgery in children with cancer is complex and often requires multiple procedures, although treatment usually results in excellent functional outcomes. A multidisciplinary approach is essential in the treatment of these patients, who are still in their growth phase, to optimize their functional capacity, quality of life, and overall survival.