West Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter. Asian Pacific Journal of Cancer Prevention 1513-7368 26 10 2025 10 01 Comparison of Outcomes between Prolonged Neoadjuvant Chemotherapy followed by Delayed Surgery and Immediate Surgery with Adjuvant Chemotherapy in Osteosarcoma Patients: A Systematic Review and Meta-Analysis 3589 3597 91911 10.31557/APJCP.2025.26.10.3589 EN Kevin Kusuman Resident of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia. I Gede Eka Wiratnaya Consultant of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia. Putu Astawa Consultant of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia. Erfan Sanjaya Resident of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia. Mohamad Dimas Ismail Resident of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia. 0009-0003-6013-0835 Journal Article 2025 04 20 Introduction: In Indonesia, it is common to have prolonged neoadjuvant chemotherapy followed by postponement of surgery due to the fact that diagnostic imaging, the surgical waiting list, and even sociodemographic cultures would delay the operation. This research aims to compare the results of osteosarcoma patients who had immediate surgery followed by adjuvant chemotherapy to those who received prolonged neoadjuvant chemotherapy for a longer period of time and delayed surgery. Methods: The databases MEDLINE/PubMed, EMBASE, Google Scholar, and Cochrane Library were searched through April 2023. Studies focused on prolonged neoadjuvant chemotherapy and delayed surgery versus immediate surgery and adjuvant chemotherapy strategies for osteosarcoma patients that met the inclusion criteria were retrieved and assessed for methodological quality. Data on participant characteristics, interventions, follow-up periods, and outcomes from the included studies were extracted and analyzed using Review Manager 5.4. Results: Seven studies involving 805 patients were selected. There were no significant differences between prolonged neoadjuvant chemotherapy with delayed surgery and immediate surgery strategies group in local recurrence (OR, 0.98; 95% CI, [0.59–1.63]; P = 0.95), wound problems (OR, 1.01; 95% CI, [0.74–1.37]; P = 0.97), and 5-year event-free survival (MD, 7.16; 95% CI, [-18.14–3.81]; P = 0.97). However, the 5-year overall survival rate was significantly higher in the prolonged neoadjuvant chemotherapy group compared with that in the immediate surgery group (MD, 10.23; 95% CI, [1.41–19.05]; P = 0.02). Conclusion: This study demonstrated that prolonged neoadjuvant chemotherapy and delayed surgery result in a significantly increased 5-year survival rate. https://journal.waocp.org/article_91911_9adb5fbd17866f6995da728a479642e6.pdf