ONCOLOGY AND ORTHOPEDIC SURGERY IN PEDIATRIC AND ADULT PATIENTS: A COMPARATIVE ANALYSIS

Abstract

Background: The intersection of oncology and orthopedic surgery presents unique challenges that vary significantly between pediatric and adult populations. While age-specific treatment protocols have evolved independently, a comprehensive understanding of the differences in surgical approaches, outcomes, and complications between these age groups remains critically important for optimizing patient care. This multicenter study investigates these age-specific variations to develop more targeted and effective treatment strategies for both populations.

Methods: We conducted a retrospective analysis of 1,248 patients who underwent orthopedic oncologic surgery between January 2018 and December 2023 across 12 major medical centers in North America and Europe. The study population comprised 486 pediatric patients (≤18 years) and 762 adult patients (>18 years). We analyzed patient demographics, tumor characteristics, surgical approaches, reconstruction methods, complications, and functional outcomes. Functional assessment utilized the Musculoskeletal Tumor Society (MSTS) scoring system, with a minimum follow-up period of two years. Computer-assisted navigation was employed following standardized protocols, and all pathological specimens were evaluated according to the WHO Classification of Bone and Soft Tissue Tumors (2020 edition).

Results: Significant age-related differences emerged in tumor distribution patterns, with osteosarcoma predominating in pediatric patients (42.8%) and chondrosarcoma in adults (35.6%). Pediatric patients demonstrated superior wound healing capabilities (mean 14.3 ± 3.2 days vs. 18.7 ± 4.5 days, p<0.001) and higher five-year survival rates (78.6% vs. 71.3%, p=0.002). While pediatric cases showed higher rates of growth-related complications (15.2% vs. 0.4%, p<0.001), adults experienced more mechanical failures (11.4% vs. 7.8%, p=0.038) and infections (12.9% vs. 9.3%, p=0.048). Biological reconstruction methods yielded better outcomes in pediatric patients (45.2% success rate), whereas endoprosthetic reconstruction proved more successful in adults (58.2% success rate). Mean MSTS scores at two-year follow-up were significantly higher in pediatric patients (24.8 ± 3.2 vs. 22.1 ± 4.1, p<0.001).

Conclusions: This comprehensive analysis reveals that age-specific biological and functional differences significantly influence surgical outcomes in orthopedic oncology, necessitating tailored approaches for pediatric and adult populations. The superior healing capacity and functional adaptation observed in pediatric patients support more biological reconstruction options, while adult patients benefit from endoprosthetic solutions. These findings emphasize the importance of age-specific surgical protocols and perioperative management strategies to optimize patient outcomes. The study provides evidence-based guidance for surgical decision-making and highlights the need for continued development of age-adapted surgical techniques and rehabilitation protocols.