Necessity of thoracotomy in pulmonary metastasis of osteosarcoma

Gao, Erji; Yang, Li; Zhao, Weigang; Zhao, Tong; Guo, Xiang; He, Weiwei; Wu, Weiming; Zhao, Yongliang; Yang, Yi

doi:10.21037/jtd.2019.07.65

Cited by 23 publications

(24 citation statements)

References 13 publications

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“…Advocates for the thoracoscopic approach maintain that overall rather than recurrence-free survival is the most important metric since Multiple studies have demonstrated that thoracotomy with manual palpation of all lung surfaces identifies more nodules, including malignant nodules, than seen on preoperative CT imaging. 12,22,24,35,36 Our study supports this finding. The number of malignant nodules resected exceeded the number detected on preoperative CT imaging in 27% of patients who underwent thoracotomy but only 2% who underwent thoracoscopy.…”

Section: Discussionsupporting

confidence: 89%

“…Multiple studies have demonstrated that thoracotomy with manual palpation of all lung surfaces identifies more nodules, including malignant nodules, than seen on preoperative CT imaging 12,22,24,35,36 . Our study supports this finding.…”

Section: Discussionsupporting

confidence: 87%

“…20,21 Thoracotomy allows for manual palpation of all surfaces of the lung, and multiple studies have demonstrated that open thoracotomy detects malignant lesions not identified on preoperative CT in 20%-25% of patients. 12,[22][23][24] However, a survival benefit from resection of these radiographically occult lesions has never been demonstrated. Furthermore, reports of comparable ipsilateral and contralateral relapse after unilateral thoracotomy argue against the importance of identifying and resecting these occult nodules.…”

Section: Discussionmentioning

confidence: 99%

“…However, even with aggressive chemotherapy and complete surgical resection, long term survival has been less than 40% 20,21 . Thoracotomy allows for manual palpation of all surfaces of the lung, and multiple studies have demonstrated that open thoracotomy detects malignant lesions not identified on preoperative CT in 20%‐25% of patients 12,22‐24 . However, a survival benefit from resection of these radiographically occult lesions has never been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study

Lautz

Farooqui

Jenkins

et al. 2020

Intl Journal of Cancer

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Complete surgical resection of pulmonary metastatic disease in patients with osteosarcoma is crucial to long‐term survival. Open thoracotomy allows palpation of nodules not identified on imaging but the impact on survival is unknown. The objective of this study was to compare overall survival (OS) and pulmonary disease‐free survival (DFS) in children who underwent thoracotomy vs thoracoscopic surgery for pulmonary metastasectomy. A multi‐institutional collaborative group retrospectively reviewed 202 pediatric patients with osteosarcoma who underwent pulmonary metastasectomy by thoracotomy (n = 154) or thoracoscopy (n = 48). Results were analyzed by Kaplan‐Meier survival estimates and multivariate Cox proportional hazard regression models. With median follow‐up of 45 months, 135 (67.5%) patients had a pulmonary relapse and 95 (47%) patients were deceased. Kaplan‐Meier analysis showed no significant difference in 5‐year pulmonary DFS (25% vs 38%; P = .18) or OS (49% vs 42%, P = .37) between the surgical approaches of thoracotomy and thoracoscopy. In Cox regression analysis controlling for other factors impacting outcome, there was a significantly increased risk of mortality (HR 2.11; P = .027; 95% CI 1.09‐4.09) but not pulmonary recurrence (HR 0.96; P = .90; 95% CI 0.52‐1.79) with a thoracoscopic approach. However, in the subset analysis limited to patients with oligometastatic disease, thoracoscopy had no increased risk of mortality (HR 1.16; P = .62; 0.64‐2.11). In conclusion, patients with metastatic osteosarcoma and limited pulmonary disease burden demonstrate comparable outcomes after thoracotomy and thoracoscopy for metastasectomy. While significant selection bias in these surgical cohorts limits the generalizability of the conclusions, clinical equipoise for a randomized clinical trial in patients with oligometastatic disease is supported.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study

Lautz

Farooqui

Jenkins

et al. 2020

Intl Journal of Cancer

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“…Thus, the sensitivity of high-resolution CT for detecting pulmonary metastases is lower than that of other tumor types (31)(32)(33). Some authors recommend sufficient palpation during surgery in order to avoid missing small metastatic nodules in patients with pulmonary metastases from osteosarcoma, as preoperative CT may underestimate the number of metastatic lesions (32,34). However, the sensitivity of high-resolution CT for detecting pulmonary metastases in patients with nonosteosarcoma is sufficiently high (31), so the necessity of palpating the lung during surgery remains controversial (35,36).…”

Section: Radiological Examinationsmentioning

confidence: 99%

Preoperative evaluation and indications for pulmonary metastasectomy

Kanzaki¹,

Fukui²,

Kanou³

et al. 2021

J Thorac Dis

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Pulmonary metastasectomy (PM) is an established treatment that can provide improved longterm survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.

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Solitary pulmonary metastases at first recurrence of osteosarcoma: Presentation, treatment, and survival of 219 patients of the Cooperative Osteosarcoma Study Group

Mettmann,

Baumhoer,

Bielack

et al. 2023

Cancer Medicine

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BackgroundTo evaluate patient and tumour characteristics, treatment and their impact on survival in patients with a solitary pulmonary metastasis at first relapse of high‐grade osteosarcoma.ProcedureTwo‐hundred and nineteen consecutive patients who had achieved a complete surgical remission and then developed a solitary pulmonary metastasis at first recurrence of high‐grade osteosarcoma were retrospectively reviewed.ResultsTwo hundred and three (94.9%) of 214 patients achieved a second complete remission. After a median time from initial diagnosis of osteosarcoma to first relapse of 2.3 years (range, 0.3–18.8 years), actuarial post‐relapse overall survival after 2 and 5 years was 72.0% and 51.2%. Post‐relapse event‐free survival was 39.1% and 31.1%. Median follow‐up time was 3.2 years (range, 0.1–29.4 years). A longer time until first relapse and diagnosis due to imaging were positive prognostic factors in uni‐ and multivariate analyses, as were a second complete surgical remission and, in regard to death, the absence of a subsequent relapse. The use of salvage chemotherapy and radiotherapy were not associated with patient outcomes, nor was the surgical approach (thoracoscopy vs. thoracotomy) nor the exploration (uni‐ vs. bilateral).ConclusionApproximately half of the patients who experience a solitary pulmonary relapse at first recurrence of osteosarcoma remain alive 5 years after this first relapse. Only one third will remain disease‐free. A complete surgical resection of the lesion is essential for long‐term survival while relapse chemotherapy does not seem to improve survival. Innovative therapies are required to improve outcomes.

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Necessity of thoracotomy in pulmonary metastasis of osteosarcoma

Cited by 23 publications

References 13 publications

Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study

Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study

Preoperative evaluation and indications for pulmonary metastasectomy

Solitary pulmonary metastases at first recurrence of osteosarcoma: Presentation, treatment, and survival of 219 patients of the Cooperative Osteosarcoma Study Group

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