Challenge of supportive surgical care in pediatric oncology

The advent of aggressive treatment protocols and the development of new techniques and procedures now require that the pediatric surgeon be an integral part of all aspects of pediatric oncology care. Supportive care issues, rather than primary tumor management decisions, now dominate the pediatric surgeon's experience and range from managing the different types of vascular access devices and their complications to assessing the surgical implications of the toxic complications of current chemotherapy protocols. New treatments such as bone marrow transplantation have presented new challenges to the pediatric surgeon, while new techniques such as minimally invasive surgery have dramatically improved our ability to render compassionate and more effective care to our patients as they undergo these potentially toxic treatment regimens. (C) 1999 Wiley-Liss, Inc.