Diagnosis and surgical treatment of extracorporeal neck tumors in children: 10 years of reference center experience

Aim: to evaluate the efficacy of differential pathomorphological diagnostics and to analyze the profile of postoperative complications in children with extracorporeal neck tumors in a specialized reference center setting. Materials and Methods: a retrospective single-center cohort study was conducted (2012–2022), including patients aged 0–17 years with verified extracorporeal neck tumors who underwent surgical tumor excision. Results: of 430 operated patients, data from 153 (35.6%) were included in the analysis: lymphatic malformation (LM) in 55 (36.0%), benign neoplasms (BN) in 45 (29.4%), and malignant neoplasms (MN) in 53 (34.6%) cases. At disease onset, compressive symptoms (respiratory insufficiency, dysphagia, neurological deficits) were more commonly observed in the MN group (in 18.9% of patients) (p=0.001), with a tendency to escalate by the time of hospitalization. The initial correct pathomorphological diagnosis was established at the National Medical Research Center for Children's Hematology, Oncology and Immunology in 116 (75.8%) patients; at the place of residence in 36 (23.5%); and in another reference center in 1 (0.7%) case. In 20 (13.1%) cases, the preliminary diagnosis established at the place of residence was revised, most commonly in patients with MN — 10 (18.9%) cases (p=0.007). Clinically significant postoperative complications (CDC ≥IIIa) were diagnosed in 20 (13.1%) patients. Among all complications, neurological events occurred in 55 (55.6%) cases, of which 89.1% were transient. The development complications was associated with vascular invasion (17 (29.3%) of the 58 patients in whom they occurred p=0.020), perioperative critical incidents (11 (19.0%), p=0.018), intraoperative adverse events (19 (32.8%), p=0.018), the need for intensive care unit (ICU) monitoring (38 (65.5%), p=0.001), and prolonged hospitalization (>8 days) (36 (62.1%), p<0.001). No statistically significant differences were observed in event-free survival (EFS) between groups with low-grade (CDC <IIIa) and high-grade (CDC ≥IIIa) complications (p=0.230). Conclusion: pediatric extracorporeal neck tumors are characterized by clinical and morphological heterogeneity and a high risk of diagnostic errors. Diagnostics performed in a reference center improves accuracy. Most complications are transient and do not affect oncologic outcomes. KEYWORDS: extracorporeal neck tumors, children, pathomorphological examination, reference center, locoregional recurrence, Clavien– Dindo classification, Comprehensive Complication Index. FOR CITATION: Polev G.A., Grachev N.S., Oganesyan R.S., Yaremenko E.Yu. Diagnosis and surgical treatment of extracorporeal neck tumors in children: 10 years of reference center experience. Russian Medical Inquiry. 2025;9(7):372–381 (in Russ.). DOI: 10.32364/2587- 6821-2025-9-7-1