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

Background: 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. Methods: We evaluated 177 children with cancer who underwent reconstructive surgery at our institution between 1999 and 2008. Results: 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. Conclusions: 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.