Surgical Management of Pediatric Head and Neck Sarcoma: A Single-Centre Retrospective Analysis over a 10-Year Period

Objectives: This study evaluates the epidemiological characteristics and survival, functional, and esthetic outcomes of pediatric patients diagnosed with head and neck sarcoma (PHNS) who underwent individualized surgical treatment for local disease control and/or for defect reconstruction. Methods: A cohort of 45 patients aged 0-18 years with histologically confirmed PHNS who underwent surgical resection and/or reconstructive procedures was analyzed. Extracted variables included demographic data, tumor histology and stage, surgical margin status, and systemic therapy modalities. Reconstructive strategies were assessed, considering technique, sequencing, and total duration of treatment. Survival analysis was performed, focusing on both overall survival (OS) and event-free survival (EFS). Results: Rhabdomyosarcoma constituted the predominant diagnosis (19/45), followed by Ewing sarcoma (7/45) and chondrosarcoma (5/45). The maxilla represented the most common primary site (18/45), whereas orbital origin was the least frequent (3/45). Complete surgical excision (R0) was achieved in 80.5% of resected cases. Margin status showed no statistically significant association with final outcome (p = 0.7786). In contrast, nodal metastasis, local recurrence, and distant dissemination were independently and collectively correlated with mortality. Survival analysis demonstrated a 3-year OS of 100% and an EFS of 79.8%, and a 5-year OS of 94.7% with an EFS of 70.7%. Conclusions: Implementation of an individualized surgical and reconstructive protocol was associated with effective local tumor control and favourable reconstructive outcomes. Oncologic prognosis was driven primarily by nodal involvement and recurrent or metastatic disease rather than margin status alone.