Should contralateral exploratory thoracotomy be advocated for children with osteosarcoma and early unilateral pulmonary metastases?
OBJECTIVE
Children presenting with osteosarcoma and pulmonary metastases have poor survival rates. The standard approach to treating unilateral metastases is ipsilateral thoracotomy with complete resection of the metastases whenever possible. We analyzed whether contralateral exploratory thoracotomy is beneficial in these patients.


METHODS
We reviewed the records of all osteosarcoma patients presenting with or developing early pulmonary metastases (within 24 months of diagnosis) at the St Jude Children's Research Hospital (Memphis, Tenn) between June 1980 and September 2005. Demographics, imaging results, treatment protocols, surgical procedures, and recurrence, survival, and timeline data were assessed.


RESULTS
Of the 109 patients, initial pulmonary involvement was radiographically identified as unilateral in 81 (74%) and bilateral in 28 (26%) patients. Of the patients presenting with unilateral pulmonary metastases, 2 years later, 13 (16%) had recurrence in the ipsilateral and 19 (23%) in the contralateral lung. In 2 (2.4%) patients, metastases recurred bilaterally. There was no evidence of statistically significant difference between the incidence of recurrence in the ipsilateral and contralateral lung (P = .18).


CONCLUSIONS
Children with osteosarcoma and unilateral pulmonary metastases had similar incidence of recurrence in the ipsilateral and contralateral lung. Their survival rates were also not significantly different. Therefore, contralateral exploratory thoracotomy in patients presenting with unilateral pulmonary metastases will probably not improve survival.
Karplus
Gideon
G
Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
McCarville
M Beth
MB
Smeltzer
Matthew P
MP
Spyridis
George
G
Rao
Bhaskar N
BN
Davidoff
Andrew
A
Li
Chin-Shang
CS
Shochat
Stephen
S
D000293:Adolescent; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures