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

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.