Pediatr Surg Int. 2025 Jul 13;41(1):209. doi: 10.1007/s00383-025-06127-2.
ABSTRACT
Jain et al. explored associations between surgical complications and survival in pediatric solid tumors, concluding that higher Clavien-Dindo grades are linked to recurrence and mortality. While the study offers timely insights into perioperative risk, critical methodological limitations-including lack of multivariate adjustment, cohort heterogeneity, imprecise blood loss estimation, and omission of ERAS protocols-undermine causal interpretations. We argue that biologic factors, tumor stage, and protocol adherence are stronger predictors of survival in pediatric oncology. This letter urges a re-evaluation of attribution models and calls for prospective, tumor-specific analyses with confounder adjustment and modern surgical quality measures.
PMID:40653581 | DOI:10.1007/s00383-025-06127-2
