Postoperative Care and Management in Pediatric Hematology‐Oncology Patients

Shachi Srivatsa; Sara A Mansfield

doi:10.1111/ejh.70157

. 2026 Mar 25;117(3):673–681. doi: 10.1111/ejh.70157

Postoperative Care and Management in Pediatric Hematology‐Oncology Patients

Shachi Srivatsa ^1,², Sara A Mansfield ^2,^✉

PMCID: PMC13460494 PMID: 41881517

ABSTRACT

Pediatric patients with hematologic and oncologic diseases often undergo surgical procedures as part of diagnosis and therapy. These include central venous catheter placements, tumor resections, lymph node and bone marrow biopsies, among others. Optimal postoperative care in this vulnerable population is critical, as children receiving chemotherapy or stem cell transplantation are immunocompromised and at high risk for infections, bleeding, and other complications. This review provides a comprehensive overview of common pediatric hemato‐oncologic surgeries and detailed postoperative management strategies. A thorough, multidisciplinary postoperative plan is essential for pediatric hematology‐oncology patients to minimize morbidity, avoid delays in adjuvant therapy, and ultimately enhance survival and quality of life.

1. Introduction

Advances in pediatric hematology‐oncology have significantly improved survival rates, making supportive surgical care and postoperative management increasingly important [1]. Pediatric cancer therapy is multimodal, often requiring surgical interventions for diagnosis (biopsies) and treatment (central venous access device [CVAD] placement, tumor resections, debulking) alongside chemotherapy, immunotherapy, or radiation. These patients present unique challenges in the postoperative period due to the effects of their disease and its treatment: immunosuppression from chemotherapy, thrombocytopenia and coagulopathies, organ dysfunction, and poor wound healing [2]. Consequently, they face higher risks of complications such as infections and bleeding than other surgical populations.

Pediatric surgeons play a pivotal role in the multidisciplinary team, contributing to diagnosis, staging, definitive tumor resection, central line placement, and management of complications [3, 4]. Close collaboration between surgeons, pediatric oncologists/hematologists, anesthesiologists, critical care specialists, and nursing is essential for optimal postoperative outcomes. Multidisciplinary tumor boards and co‐management strategies have been shown to improve decision‐making and even survival in pediatric oncology care [5].

In this review, we outline the common surgical procedures encountered in pediatric hematology‐oncology patients and detail evidence‐based postoperative care and complication management. We highlight common and rare postoperative complications and describe emerging innovations aimed at improving recovery. Throughout, the emphasis is on a comprehensive, team‐based approach to ensure safe surgery and timely continuation of oncologic therapy for children with cancer.

2. Common Surgical Interventions in Pediatric Hematology‐Oncology

2.1. Central Venous Access Devices

2.1.1. Indications

Durable central venous access is fundamental for children undergoing chemotherapy, blood product transfusions, total parenteral nutrition (TPN), or hematopoietic stem cell transplant. Thus, placement of tunneled central venous catheters, totally implantable venous ports, or peripherally inserted central catheters (PICCs) is one of the most common surgical procedures in pediatric oncology. To minimize the risk of peri‐operative bleeding, a platelet goal of > 30 000/mcL is likely acceptable, but the strength of literature for this is low [6]. Children with a new diagnosis of leukemia are frequently neutropenic. While there is an increased risk of infection in the setting of neutropenia, there is no evidence that absolute neutrophil count (ANC) affects surgical site infection (SSI) or wound healing following CVAD insertion.

2.1.2. Postoperative Care

After central line placement, standard post‐operative care involves confirming correct catheter tip position by chest X‐ray, maintaining line patency, and sterile dressing care at the insertion site. Vigilant line care is crucial to prevent infection. The child's incision and exit site must be kept clean and dry until healed, with dressing changes performed using aseptic technique.

2.1.3. Complications and Management

CVADs carry a significant risk of both early and late complications. Intraoperative or immediate issues include pneumothorax, hemothorax, arterial puncture, malposition, or cardiac arrhythmia during guidewire insertion [7]. Early postoperative complications can include catheter occlusion by clot or kinking, and bleeding or infection at the surgical site [7]. Over the device's lifespan, infection and thrombosis are the most common concerns. A recent systematic review reported that approximately 31% of CVADs in pediatric cancer patients experience some complication, and about 15% fail before completion of therapy [8]. Central line associated bloodstream infection (CLABSI) occurs in about 21% of devices, with an incidence of ~0.9 per 1000 catheter days [8]. Tunneled external catheters and PICCs have higher rates of infection and mechanical problems compared to fully implanted ports [8]. These complications are not only morbid but can disrupt oncologic treatment schedules.

Strict sterile protocols for catheter access and prophylactic locking are used to reduce CLABSI and occlusions. If a CLABSI occurs, broad‐spectrum IV antibiotics are initiated immediately, tailored to culture results, and the line is removed if infection is severe or persistent [9]. For local site infections without bloodstream infection, targeted antibiotics may sometimes allow the catheter to be retained. Catheter‐associated venous thrombosis is also a concern, especially with long‐term indwelling lines [10]. Signs include arm, neck, or facial swelling or catheter dysfunction. Ultrasound can confirm a central venous thrombosis. Management typically involves anticoagulation, balanced with the patient's risk of coagulopathy [11]. Occluded lines from fibrin sheath or small clots can often be salvaged with thrombolytic enzyme instillation (e.g., tissue plasminogen activator instilled into the catheter) [12]. Mechanical problems like catheter breakage or port separation require surgical revision or replacement. Overall, meticulous postoperative care of central lines, including nurse‐led maintenance protocols and early intervention at any sign of infection or thrombosis, is vital in pediatric oncology patients to prevent treatment delays and life‐threatening complications.

2.2. Tumor Resections

2.2.1. Indications

Surgical resection of solid tumors is often a cornerstone of therapy for pediatric cancers. Tumor types commonly requiring surgery include Wilms tumor, neuroblastoma, hepatoblastoma, sarcomas, and various other extracranial solid malignancies [1, 13]. Surgical management can range from minimally invasive procedures to large open operations involving multiple organ systems.

2.2.2. Postoperative Care

The postoperative management after tumor resection depends on the tumor location, extent of surgery, and patient's preoperative condition (nutritional status, prior therapy).

2.2.2.1. Pain Control

Most patients undergoing invasive procedures will need post‐operative analgesia. Some form of regional analgesia is preferred [14]. This can involve one‐time injection of local anesthetic at the wound, or regional block in the distribution of involved dermatomes [15, 16]. This will typically provide 4–6 h of pain control depending on the type of local anesthetic used. Catheters can also be left in place for continued post‐operative infusions. These can be at the wound itself [17], regional (ESP, TAP, etc.) [18], or epidural catheters [15]. The use of these regional analgesics can be very effective and limit systemic analgesic side‐effects.

Opioids are associated with numerous side‐effects that make their use less desired: sedation, itching, constipation, and so on. The immunosuppressive effect of opioids has also been hypothesized to worsen oncologic outcomes [19, 20, 21, 22, 23]. Therefore, a multi‐modal, opioid‐sparing regimen is preferred. Acetaminophen is routinely used around the clock for its opioid‐sparing effect and safety profile in children. Nonsteroidal anti‐inflammatory drugs (NSAIDs) such as ketorolac are often included as well, provided there are no contraindications. NSAIDs reduce inflammation and have been specifically shown to improve pediatric postoperative pain control and reduce opioid requirements [24]. When using NSAIDs in oncology patients, surgeons balance their benefits with potential risks (e.g., platelet dysfunction or kidney effects) [25]. Gabapentin, an anticonvulsant with analgesic properties, is another adjunct used in multimodal regimens, particularly for neuropathic or refractory pain. Pediatric studies indicate that perioperative gabapentin can modestly reduce postoperative opioid consumption without major adverse effects [26]. Opioid‐sparing, multi‐modal regimens have been associated with improved pain scores during inpatient recovery [27, 28]. Continuing these regimens post‐discharge and minimizing opioid prescription is associated with fewer readmissions and high patient satisfaction [29].

Effective pain management not only improves comfort but also enables earlier mobilization, which is associated with better outcomes [30, 31]. Patients are encouraged to begin gentle movement and respiratory exercises as soon as feasible to reduce risks of atelectasis, pneumonia, and deconditioning.

2.2.2.2. Fluid Management

Effective perioperative fluid management in pediatric oncology patients is crucial for maintaining hemodynamic stability and promoting optimal recovery. Goal‐directed fluid therapy has been shown to reduce intraoperative fluid volumes and expedite postoperative bowel function recovery compared to traditional liberal fluid strategies [32]. Balanced crystalloids, such as Lactated Ringer's or Plasma‐Lyte, are preferred over normal saline to minimize the risk of hyperchloremia and associated complications [33, 34]. Postoperatively, fluid regimens should be tailored based on individual patient assessments, including monitoring of intake/output, daily weight, and signs of organ perfusion. Early transition to enteral hydration is encouraged when feasible. Special consideration is necessary for children with a solitary kidney or those who have received nephrotoxic chemotherapy agents, as they are at increased risk for kidney injury.

2.2.2.3. Nutrition

As most children with cancer have some impact on their underlying nutrition, minimizing NPO (nil per os) times while minimizing the risk of post‐operative complications is of utmost importance. Operations that involve a high‐risk or very proximal bowel anastomosis may require longer bowel rest to ensure healing. Nasogastric tube decompression is sometimes necessary for these cases. Outside of these scenarios, most children may safely resume their diet as tolerated post‐operatively [25, 35]. However, this comes with some caveats. Patients should be back to their baseline mental status to minimize the risk of aspiration. Early diet advancement is best accomplished in the setting of a comprehensive enhanced recovery pathway, discussed later [31]. Patients that are euvolemic, mobilized early, and aren't requiring constipating opioids can tolerate diet advancements immediately after surgery.

2.2.2.4. Organ‐Specific Management

Specific organ‐focused care must be provided based on the surgery performed. After nephrectomy, the remaining kidney function is monitored (urine output, serum creatinine) and nephrotoxic medications are adjusted [36, 37]. If partial nephrectomy was done, attention is paid to fluid balance and avoiding hypertension. After hepatic tumor resection, liver function tests and coagulation parameters are followed closely, and the team should monitor for signs of post‐resection liver failure, especially if the resection was extensive [38]. Adrenal or endocrine tumor resections require monitoring of adrenal insufficiency or blood pressure lability postoperatively [39]. Limb‐salvage surgeries for bone tumors require immobilization or splinting, and early involvement of rehabilitation services for mobilization and, if applicable, prosthesis fitting after amputation [40]. Thoracic tumor resections necessitate pulmonary care: chest tube management, respiratory therapy, and pain control to ensure adequate ventilation [41].

2.2.2.5. Activity

Importantly, all these children are at risk for impaired wound healing due to prior or ongoing chemotherapy and nutritional deficits [2, 42]. Meticulous wound care is required: incisions are inspected daily for erythema, drainage, or dehiscence. Any sign of infection prompts obtaining cultures and starting empiric antibiotics, given the high stakes of infection in immunocompromised patients. Early postoperative mobilization is strongly emphasized in pediatric patients, as it accelerates recovery and reduces complications [43]. Early mobilization with getting the child sitting up, out of bed, and walking (with assistance if needed) as soon as feasible has been shown to improve pulmonary function, muscle strength, and overall outcomes in children, mirroring findings in adults [44]. Key considerations include adequate pain control (as pain is a major barrier to movement) and careful protection of surgical sites (for instance, abdominal incisions may benefit from an abdominal binder during ambulation for support). For children who underwent limb‐sparing orthopedic surgeries, weight‐bearing on the affected limb may be restricted for a period to protect the surgical site [45]. In these cases, early mobilization focuses on engaging the child in bed‐to‐chair transfers, use of crutches, or wheelchair mobility, while the surgical limb is immobilized or braced as directed [46, 47].

2.2.3. Resumption of Therapy

A critical aspect of postoperative care in pediatric oncology is planning for the timely resumption of chemotherapy or radiotherapy after surgery. Excessive delays in adjuvant therapy can compromise survival outcomes, so the aim is to optimize recovery to allow treatment to continue as soon as safely possible [48]. Typically, chemotherapy is held until the patient has adequately healed from surgery, often about 7–14 days for major surgeries, assuming no complications, and with requirements such as adequate wound healing, no uncontrolled infections, and sufficient organ function to tolerate therapy [13]. Close coordination between surgeons and oncologists is required to individualize this timing.

2.2.4. Common Complications

Postoperative complications after tumor resections can be general (fever, ileus, pain, etc.) or specific to the operation. SSI is a concern, especially as many children might be neutropenic or have indwelling lines. A multidisciplinary guideline‐driven approach (using preoperative antibiotics, maintaining normothermia, and sterile technique) helps reduce SSIs [49]. Wound dehiscence or delayed healing can occur if the child has been recently on steroids or other chemotherapy; in such cases, sometimes longer hospitalization for wound observation can be considered. The risk of post‐operative hemorrhage is dependent on the extent of surgery. Post‐operative hemoglobin monitoring should be based on this risk and clinical concern [50]. If an anastomosis or organ reconstruction was performed, there is a risk of anastomotic leak [51, 52]. Signs like prolonged ileus, peritonitis, or unexpected drainage prompt immediate evaluation [51]. Managing a leak might involve re‐operation, antibiotics, or percutaneous drainage [53, 54].

2.2.5. Specific Complications

2.2.5.1. Intussusception After Retroperitoneal Tumor Resections

Postoperative intussusception (POI) is an uncommon yet significant cause of bowel obstruction in children following abdominal surgery. It predominantly involves the small intestine and typically manifests within the first 2 weeks postoperatively [55, 56]. Children undergoing extensive retroperitoneal procedures, such as nephrectomies for Wilms tumor or neuroblastoma resections, are at elevated risk, likely due to substantial bowel manipulation and disruption of normal motility [57, 58, 59]. Diagnosing POI can be challenging, as its symptoms (persistent abdominal distension, delayed return of bowel function, and feeding intolerance) often mimic those of postoperative ileus. Analgesic use may further obscure clinical signs. High clinical suspicion is essential, especially if a child's recovery deviates from the expected course. Abdominal ultrasound is the preferred initial diagnostic modality, capable of identifying the characteristic “target” or “bull's‐eye” sign of intussusception [58]. Management typically necessitates prompt surgical intervention, as POIs are often small bowel in nature and less amenable to nonoperative reduction methods like enemas. Timely diagnosis and treatment are crucial to prevent complications such as bowel ischemia or perforation.

2.2.5.2. Chyle Leak

In pediatric oncology, chyle leaks most commonly occur after neck or mediastinal dissections, leading to chylothorax, or following extensive retroperitoneal lymph node resections, resulting in chylous ascites [53, 60]. These leaks can lead to significant losses of protein, electrolytes, and lymphocytes, increasing the risk of malnutrition and infection. The incidence of chyle leaks varies, with reported rates ranging from 7% to 20% after pediatric solid tumor surgeries, and higher rates observed in procedures involving the thoracic duct, such as neuroblastoma resections with mediastinal or paraspinal lymph node dissection, where rates can reach up to 40% [60]. Clinically, chyle leaks typically present 5–10 days postoperatively, manifesting as milky drainage from surgical drains or chest tubes [61]. In cases where the pleural space is not drained, chylothorax may present with respiratory distress and pleural effusion visible on imaging [61]. Chylous ascites presents with abdominal distension and increasing turbid drain output. Laboratory analysis of the fluid often reveals elevated triglyceride levels (> 110 mg/dL) and the presence of chylomicrons [62]. Management usually begins with conservative measures, including dietary modifications such as a low‐fat diet enriched with medium‐chain triglycerides [60]. In more severe cases, complete bowel rest with TPN may be employed to minimize lymph production [60]. Pharmacologic therapy with octreotide, a somatostatin analog, has been used to reduce thoracic duct flow and has shown efficacy in resolving postoperative chylothorax [63]. If conservative management fails after 5–7 days, interventional radiology techniques such as lymphangiography with thoracic duct embolization may be considered [53]. This minimally invasive procedure involves cannulation of the lymphatic system, identification of the leak site, and sealing of the leaking lymphatic channel using adhesive agents or coils. In cases where interventional radiology is unavailable or unsuccessful, surgical intervention may be necessary. Surgical options include direct ligation of the thoracic duct or leaking lymphatics and pleurodesis for refractory chylothorax [60]. Throughout the management process, aggressive nutritional support is crucial to counteract losses and monitor for immunosuppression due to lymphocyte loss.

2.2.5.3. Acute Kidney Injury (AKI)/Renal Failure

Children undergoing cancer‐related surgeries, particularly those involving the kidneys, are at risk for postoperative AKI. While a healthy contralateral kidney often compensates after unilateral nephrectomy, the overall renal reserve is diminished, necessitating careful postoperative monitoring [64]. Risk factors for AKI include intraoperative hypotension, significant blood loss, use of nephrotoxic medications, and pre‐existing renal conditions. Monitoring involves regular assessment of serum creatinine, blood urea nitrogen, electrolytes, and strict intake‐output measurements. Management strategies focus on maintaining adequate renal perfusion through appropriate fluid management and avoiding nephrotoxic exposures. Long‐term follow‐up is essential, as studies have shown that approximately 19% of Wilms tumor survivors exhibit signs of kidney disease in adulthood, with a 2% subset progressing to end‐stage renal disease [64]. Long‐term nephrology follow‐up is crucial for children who have undergone nephrectomy. Regular monitoring for signs of kidney injury, such as proteinuria, hypertension, and decreased glomerular filtration rate, is recommended. Structured follow‐up protocols help in early detection and management of chronic kidney disease [65]. Maintaining adequate hydration is essential to support the function of the remaining kidney and to minimize the risk of further renal impairment. Education on lifestyle modifications, including hydration strategies and avoidance of nephrotoxic substances, is an integral part of long‐term care.

2.2.5.4. Neurologic

Surgical resection of pediatric tumors, especially those located in the neck, chest, or pelvis, can lead to nerve injuries depending on tumor location and extent. Horner syndrome, characterized by ptosis, miosis, and anhidrosis, may occur following surgeries involving the cervical sympathetic chain, such as cervicothoracic neuroblastoma resections [66]. Injuries to the phrenic nerve can result in diaphragmatic paralysis [67], leading to respiratory difficulties, while damage to the recurrent laryngeal nerve may cause vocal cord palsy, presenting as hoarseness or stridor [68]. Brachial plexus injuries from axillary or neck tumors can lead to limb weakness or sensory deficits. Management includes supportive care, physical and occupational therapy, and, in some cases, surgical interventions.

2.2.5.5. Gastrointestinal Complications

Postoperative gastrointestinal (GI) complications in pediatric oncology patients range from transient ileus to more severe conditions like adhesive small bowel obstruction (SBO). Children who have received abdominal radiation or multiple prior surgeries are at higher risk for postoperative adhesions and bowel obstruction [69]. Although early enteral nutrition is encouraged when the gut is functional, if ileus persists beyond expected, further workup is done to rule out obstruction. TPN may be needed temporarily for nutritional support in those with prolonged ileus or healing issues. Initial management of SBO typically involves conservative measures such as bowel rest, nasogastric decompression, and intravenous fluids, though some cases may require surgical intervention. Infectious diarrhea, including Clostridioides difficile infection, is more prevalent in pediatric oncology patients due to immunosuppression and antibiotic use [70]. Rarely, tumors secreting vasoactive intestinal peptide can cause profound secretory diarrhea, necessitating aggressive fluid and electrolyte management [71, 72]. Long‐term GI complications may include malabsorption and chronic diarrhea, especially in patients who have received abdominal radiation.

2.3. Diagnostic Biopsies and Bone Marrow Procedures

2.3.1. Indications

Minor surgical procedures are frequently performed in pediatric hemato‐oncology for diagnostic purposes. These include excisional or incisional biopsies of lymph nodes or tumors, bone marrow aspirates and biopsies, lumbar punctures with intrathecal chemotherapy, and placement of intraventricular reservoirs (Ommaya reservoir) for chemotherapy.

2.3.2. Postoperative Care

After a lymph node or tumor biopsy under anesthesia, patients generally recover quickly. The focus is on pain control and monitoring for bleeding. Many children with suspected lymphoma or other cancers might have some degree of thrombocytopenia or coagulation issues at baseline; thus, surgeons ensure adequate hemostasis intraoperatively and sometimes administer platelet transfusions pre‐ or post‐procedure if counts are very low to prevent hemorrhage [9, 73]. Wound care for biopsy sites is straightforward: keeping the area clean, dry, and covered for 24–48 h, and watching for any signs of infection. Because the incisions are small, they typically heal well. For bone marrow aspiration/biopsy, which is often done from the iliac crest, complications are infrequent. Post‐procedure care involves applying pressure to the site and monitoring for pain [74]. In cases where a bone marrow harvest is performed, which involves multiple marrow aspirates from the iliac crests, children may have more pain and require overnight observation, pain medication, and occasionally a blood transfusion if a large volume of marrow was taken [75].

2.3.3. Complications

The complications from diagnostic procedures are uncommon but can occur, especially in the context of hematologic abnormalities. Bleeding at the biopsy site or marrow site is the most pertinent risk: for instance, an iliac crest marrow biopsy could cause a retroperitoneal hematoma or gluteal hemorrhage due to injury of the internal iliac artery or superior gluteal artery [74]. This risk is mitigated by checking coagulation status and platelets beforehand. If significant bleeding does occur, it is managed with local pressure, transfusions, and rarely surgical exploration. Infection is another concern: though uncommon for small procedures, an immunosuppressed child can develop cellulitis at a biopsy site or an abscess. Prophylactic postoperative antibiotics are not routinely given for clean minor procedures, but a low threshold is kept for starting antibiotics if any redness or fever develops post‐biopsy. Bone marrow biopsy site infection or osteomyelitis is exceedingly rare but has been reported [76]; sterile technique and skin antisepsis minimize this risk. Cerebrospinal fluid (CSF) leak is a theoretical risk after lumbar puncture or Ommaya placement, but careful technique usually prevents it: patients are often kept flat for a couple of hours after lumbar puncture to reduce headache risk [77]. For Ommaya reservoir placement, postoperative neurosurgical care includes head elevation, neurologic checks, and monitoring for signs of infection; any fever or neurological change prompts a scan and possible CSF analysis [78].

2.3.4. Special Considerations

Children with leukemia and some with solid tumors require repeated lumbar punctures and marrow aspirates throughout therapy. While these are not “postoperative” in the traditional sense each time, it is worth noting that attention to pain control and vigilance for infection should be paid at each encounter. If a child has refractory coagulopathies, even necessary diagnostic procedures may be deferred or modified until safer, highlighting again the need for individualized, multidisciplinary planning in such cases. Generally, however, biopsies and marrow procedures are well tolerated, and their postoperative management is straightforward, focusing on analgesia and avoiding bleeding.

2.4. General Postoperative Complications and Management Considerations

Children with cancer are uniquely vulnerable to postoperative complications due to immunosuppression, cytopenias, and impaired tissue healing. General complications are often categorized as infectious, hematologic (bleeding or thrombotic), or organ‐specific, with management guided by high clinical suspicion and multidisciplinary coordination. Vigilant monitoring and timely interventions are essential to prevent delays in oncologic therapy and minimize morbidity.

Infectious complications are the most frequent and consequential postoperative issues. While central line infections and SSIs are covered previously, it is important to emphasize that immunocompromised children may not display typical signs of infection. Even subtle wound changes or unexplained fever can signal serious underlying pathology, especially in neutropenic patients. Broad‐spectrum empiric antibiotics should be promptly initiated when infection is suspected, and fungal infections must be considered in non‐healing or necrotic wounds [9]. Source control through drainage or hardware removal is often required, and infectious disease consultation is crucial for guiding antimicrobial duration and spectrum.

Hemorrhagic and thrombotic risks are heightened in this population due to treatment‐related cytopenias and the prothrombotic state associated with malignancy. Bleeding may present overtly or insidiously and often necessitates both transfusion support and correction of coagulopathy [50]. Conversely, venous thromboembolism, frequently associated with central lines or steroid/asparaginase therapy, may require anticoagulation, which must be carefully balanced against bleeding risk [10, 11]. Multidisciplinary input from hematology is often needed to navigate these complex cases.

Finally, delayed wound healing, poor mobilization, postoperative pneumonia, and nutritional challenges may complicate recovery. Respiratory support, physiotherapy, and early enteral nutrition support overall recovery and reduce complications like atelectasis and ileus [31]. A low threshold for imaging and specialist involvement ensures that rare but serious organ‐specific issues are not missed. Ultimately, the goal is to manage complications swiftly and effectively to allow safe and timely resumption of anticancer therapy.

2.5. Comprehensive Supportive and Multidisciplinary Postoperative Care

Postoperative recovery in pediatric oncology patients requires a comprehensive, team‐based approach that addresses not only surgical healing but also systemic vulnerabilities unique to this population. Malnutrition, pain, immobility, and psychosocial stress are common barriers to recovery [79, 80]. Early initiation of enteral nutrition, preferably via oral or nasogastric routes, helps preserve gut integrity and immune function, while dietitians monitor for deficits and guide supplementation [81]. Multimodal pain control, tailored to minimize both under‐treatment and over‐sedation, facilitates mobilization and respiratory function [82]. Physical and occupational therapy should begin early to prevent deconditioning. Simultaneously, child life specialists and mental health professionals play critical roles in mitigating anxiety and fostering coping strategies that improve overall participation in care [79].

Recovery is further optimized through close, daily interdisciplinary collaboration. Surgeons, oncologists, intensivists, infectious disease specialists, hematologists, and supportive care teams work in concert to manage ongoing risks, from fluid shifts and electrolyte imbalances to infection and coagulopathy. Enhanced Recovery After Surgery (ERAS) protocols customized for pediatric cancer patients emphasize early feeding, ambulation, and streamlined analgesia, reducing complications and shortening hospital stays [1, 14, 18, 25, 30, 31, 83, 84, 85]. These pathways may also decrease complications [28]. When feasible, minimally invasive or robotic‐assisted surgery can further minimize physiological disruption and promote quicker return to baseline function.

Vigilance for medical and surgical complications remains essential throughout the postoperative course. Organ dysfunction, rare technical complications, and delayed healing may not manifest immediately. Structured daily assessments that include evaluation of nutritional intake, respiratory status, wound integrity, and functional progress allow the team to intervene promptly. Anticipating complications and responding early prevents setbacks and helps maintain the critical timeline for resuming chemotherapy or radiation.

Effective transitions of care, from ICU to floor, and hospital to home, require clear communication and education. Families must be equipped with knowledge of warning signs, wound care protocols, and follow‐up plans to ensure safety after discharge. Ultimately, postoperative management in pediatric oncology hinges on integrated, proactive care that aligns surgical recovery with the overarching goal: timely continuation of cancer therapy with the least possible disruption to the child's health and development.

3. Conclusion

Postoperative care in pediatric hematology‐oncology patients is a critical component of cancer treatment, requiring proactive, multidisciplinary coordination to prevent complications and support timely recovery. By adhering to evidence‐based practices and fostering close collaboration across specialties, care teams can minimize postoperative morbidity and ensure a smooth transition back to cancer therapy.