Childhood cancer survivors have a higher risk of requiring major surgical interventions later in life, according to research published in The Lancet Oncology.

An analysis of the Childhood Cancer Survivor Study showed a higher risk of late, major surgical interventions among childhood cancer survivors than among their siblings. 

Survivors of Hodgkin lymphoma, Ewing sarcoma, and osteosarcoma had the highest burden of surgical interventions.

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This analysis included data from 25,656 childhood cancer survivors. The patients had a median age of 6.1 years at cancer diagnosis and a median age of 29.4 years at last follow-up. The cancer survivors were compared to 5045 of their nearest-age siblings. The siblings’ median age at last follow-up was 35.2 years.

The most common cancer diagnoses among survivors were acute lymphocytic leukemia (25.8%), central nervous system tumors (17.5%), and Hodgkin lymphoma (12.1%). The primary anticancer treatment was chemotherapy for 81.4% of survivors, surgery for 72.4%, and radiation for 55.7%.

The median follow-up was 21.8 years for the cancer survivors and 27.0 years for the siblings. The primary outcome was any self-reported late, major surgical intervention that required anesthesia and occurred 5 years or more after the survivors’ initial cancer diagnosis. 

The number of late, major surgical interventions was 28,202 among the cancer survivors and 4110 among the siblings. The mean cumulative count (MCC) of late, major surgical interventions at 35 years was 206.7 per 100 childhood cancer survivors and 128.9 per 100 siblings (adjusted rate ratio [aRR], 1.8; 95% CI, 1.7-1.9).  

The highest burdens of late, major surgical interventions were seen in survivors of Hodgkin lymphoma (35-year MCC, 333.3 per 100 survivors), Ewing sarcoma (322.9 per 100), and osteosarcoma (269.6 per 100). The risk of late, major surgical interventions was higher among female cancer survivors than among male survivors (aRR, 1.4; 95% CI, 1.4-1.5). 

Childhood cancer survivors had a significantly increased risk of late surgical interventions in many organ systems, including the:

  • Breast (aRR, 2.1; 95% CI, 1.7-2.6)
  • Cardiovascular system (aRR, 6.6; 95% CI, 5.2-8.3)
  • Central nervous system (aRR, 16.9; 95% CI, 9.4-30.4)
  • Endocrine system (aRR, 6.7; 95% CI, 5.2-8.7)
  • Gastrointestinal system (aRR, 1.4; 95% CI, 1.3-1.6)
  • Head and neck (aRR, 1.2; 95% CI, 1.1-1.4)
  • Musculoskeletal system (aRR, 1.5; 95% CI, 1.4-1.7)
  • Respiratory system (aRR, 5.3 95% CI, 3.4-8.2) 
  • Renal or urinary system (aRR, 2.0; 95% CI, 1.5-2.6)
  • Spine (aRR, 2.4; 95% CI, 1.8-3.2). 

Cancer survivors did not have an increased risk of late surgical interventions in the female reproductive system (aRR, 1.1; 95% CI, 1.0-1.2) or the male reproductive system (aRR, 1.0; 95% CI, 0.8-1.3). 

“[T]his study demonstrates a newly understood chronic late effect of pediatric cancer therapy comprising a significant burden of late, major surgical interventions,” the researchers concluded. “The need for late surgery should be anticipated and inform the education of parents and caregivers of pediatric patients.”


Dieffenbach BV, Murphy AJ, Liu Q, et al. Cumulative burden of late, major surgical intervention in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS) cohort. Lancet Oncol. Published online May 11, 2023. doi:10.1016/S1470-2045(23)00154-7

This article originally appeared on Cancer Therapy Advisor