Surgery · 2025
International patterns and disparities in functional sequelae (FUSE) follow-up after pediatric solid tumor resection: A report from the International Society of Pediatric Surgical Oncology.
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Pio Luca, Lobos Pablo, Abib Simone, Karpelowsky Jonathan, Cox Sharon, Fernandez Pineda Israel, Davidoff Andrew M, Wijnen Marc, Mothi Suraj Sarvode, Losty Paul D, Abdelhafeez Hafeez H, IPSO FUSE collaborators
Аннотация
INTRODUCTION: Pediatric cancer survivors face significant treatment-related morbidity from multimodal therapies. Although late effects of chemotherapy and radiation are well-documented, surgical sequelae regarding long-term functional outcomes remain inadequately studied. This international survey analyzed current follow-up practices and quantified variability in functional sequelae assessment after pediatric solid tumor surgical resections.
METHODS: A 20-item survey was distributed through the International Society of Pediatric Surgical Oncology to pediatric surgical oncologists worldwide, assessing institutional practices regarding surgical follow-up periods, specialists involved, and organ-specific protocols. Centers were categorized by surgical volume as low (<20 resections/year), medium (20-50), or high (>50) for comparative analyses.
RESULTS: A total of 121 pediatric surgical centers from 46 countries responded. Functional follow-up was conducted primarily by surgeons and oncologists in most centers (56.2%), with limited specialist involvement (20.7%). Significant deficiencies were identified in standardized protocols, particularly for fertility assessment after bladder/prostate resections (62.8% without structured follow-up) and pulmonary function testing after thoracic interventions (67.8% not routinely performed). High-volume centers demonstrated significantly better standardized follow-up practices for biliary (82.5% vs 54.3%, P = .003) and pulmonary sequelae compared with lower-volume centers. All respondents acknowledged the crucial importance of functional follow-up, with 97.5% stating improvements were needed.
DISCUSSION: This exploratory survey reveals significant gaps and variability in functional follow-up practices, suggesting many survivors may not receive optimal surveillance. The identified deficiencies, particularly in standardized protocols for fertility and pulmonary assessment, highlight urgent needs for evidence-based guideline development in pediatric surgical oncology.
METHODS: A 20-item survey was distributed through the International Society of Pediatric Surgical Oncology to pediatric surgical oncologists worldwide, assessing institutional practices regarding surgical follow-up periods, specialists involved, and organ-specific protocols. Centers were categorized by surgical volume as low (<20 resections/year), medium (20-50), or high (>50) for comparative analyses.
RESULTS: A total of 121 pediatric surgical centers from 46 countries responded. Functional follow-up was conducted primarily by surgeons and oncologists in most centers (56.2%), with limited specialist involvement (20.7%). Significant deficiencies were identified in standardized protocols, particularly for fertility assessment after bladder/prostate resections (62.8% without structured follow-up) and pulmonary function testing after thoracic interventions (67.8% not routinely performed). High-volume centers demonstrated significantly better standardized follow-up practices for biliary (82.5% vs 54.3%, P = .003) and pulmonary sequelae compared with lower-volume centers. All respondents acknowledged the crucial importance of functional follow-up, with 97.5% stating improvements were needed.
DISCUSSION: This exploratory survey reveals significant gaps and variability in functional follow-up practices, suggesting many survivors may not receive optimal surveillance. The identified deficiencies, particularly in standardized protocols for fertility and pulmonary assessment, highlight urgent needs for evidence-based guideline development in pediatric surgical oncology.