Comprehensive surgical and reconstructive management with in-depth complication analysis of giant pediatric sarcomas:...

Pediatric musculoskeletal sarcomas, though rare, pose significant therapeutic challenges due to tumor aggressiveness-particularly in tumors exceeding 10 cm-and the complexity of surgery in a growing population. Limb-salvage surgery aims to achieve oncologic control while preserving function and growth potential.

We retrospectively reviewed 45 pediatric patients (0-17 years) who underwent surgery for primary malignant musculoskeletal tumors > 10 cm at two tertiary centers (2016-2022). Demographic data, tumor characteristics, treatments, reconstruction techniques, complications, and oncological outcomes were descriptively analyzed.

The cohort primarily included Ewing sarcoma (56.8%) and osteosarcoma (31.8%). Limb salvage was achieved in 97.8% of patients, all with R0 margins. Reconstruction employed biological (46.7%) or endoprosthetic (40.0%) techniques; cryotherapy was used in 11.1%. Nearly half (48.8%) had an uncomplicated postoperative course. Short-term complications included infections (24%) and wound healing issues (15.6%), while mechanical failures were rare (6.6%). Over a median 60 month follow-up, local recurrence occurred in 4.4%, metastasis in 25%, and mortality in 18.8%. Functional outcomes were favorable, with low chronic pain (6.6%) and late bone deformity (2.2%).

Limb-salvage surgery, guided by meticulous surgical planning and multidisciplinary reconstruction, offers excellent oncologic control and functional preservation in pediatric sarcoma patients with large tumors. Despite notable infection risk, vigilant perioperative care mitigates complications. Prospective studies are warranted to optimize long-term outcomes and evaluate emerging reconstructive technologies.