Iftikhar Muhammad Khubaib, Khan Saad Sajjad
Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan.
Pediatr Surg Int. 2025 Jul 13;41(1):209. doi: 10.1007/s00383-025-06127-2.
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.
贾恩等人探讨了小儿实体瘤手术并发症与生存率之间的关联，得出结论：较高的Clavien-Dindo分级与复发和死亡率相关。虽然该研究及时提供了围手术期风险的见解，但关键的方法学局限性——包括缺乏多变量调整、队列异质性、失血估计不精确以及遗漏加速康复外科方案——破坏了因果解释。我们认为生物学因素、肿瘤分期和方案依从性是小儿肿瘤学中更强的生存预测因素。这封信敦促重新评估归因模型，并呼吁进行前瞻性的、针对肿瘤的分析，同时进行混杂因素调整和采用现代手术质量指标。
