Global pediatric cancer surgery: Enhancing quality through standardization.
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The global burden of childhood cancer remains substantial, with approximately 400,000 new cases diagnosed annually, nearly 90 % occurring in low- and middleincome countries (LMICs). While high-income countries (HICs) achieve survival rates exceeding 80 %, fewer than 30 % of children survive in LMICs, underscoring profound disparities in access to timely diagnosis, surgical care, and multidisciplinary management. Although advances in chemotherapy and radiotherapy have contributed to improved outcomes, pediatric cancer surgery remains indispensable for cure or durable disease control. However, surgical services in many settings are underdeveloped, inconsistently delivered, and lack standardized guidelines or robust quality improvement frameworks. This manuscript examines barriers to quality pediatric cancer surgery globally, describes novel tools to assess and improve surgical capacity, and discusses early efforts to standardize training, operative reporting and guideline development. Collectively, these initiatives aim to advance equitable, evidence-based care for children with cancer worldwide.