Optimizing the surgical management of lung nodules in children with osteosarcoma: Thoracoscopy for biopsies, thoracotomy for resections

Abstract

Lung nodules in osteosarcoma patients are usually metastases. CT scan is unreliable in detecting all the nodules, especially in the case of predicted bilateral involvement. If excision of all metastases is considered the goal of surgery, a TT approach should be chosen in patients with more than one thoracic nodule.

Minimally invasive thoracoscopic ultrasound for localization of pulmonary nodules in children

“…Therefore, as an oncologic tool, we would currently advocate that MITUS be an option to help localize unifocal lesions that need biopsy to establish diagnosis and, for the time being, not for widespread wedge resections that has the goal of complete eradication of metastatic lesions. Until further studies are conducted that might pave the way for us to advocate this procedure, we would agree with the view that VATS should be used for biopsies and thoracotomy used for resections [67]. This is emphasized by the findings that CT scan alone tends to underestimate the number of metastatic lesions [68,69].…”

Lung nodules in pediatric oncology patients: a prediction rule for when to biopsy

“…Benign lesions have been reported in 14% to 45% of patients with a known tumor undergoing surgery for suspected thoracic nodules [5,20]. In this study, 33% of the biopsies were benign.…”

“…Thoracotomy and video-assisted thoracoscopy are the 2 primary means used to perform a biopsy of these lung nodules [1][2][3]. These techniques have been proven to be both safe and effective for resecting these lesions [4][5][6][7][8]. Because these nodules may represent benign or malignant disease [9,10] (Figs.…”

The Role of Thoracoscopic Surgery in Pediatric Oncology

“…67 Patients with osteosarcoma who presented with pulmonary nodules on CT were resected thoracoscopically in only 43% of cases and required conversion to open thoracotomy due to nonvisualization of the lesion, visualization of more lesions than predicted by CT, anatomic constraints due to apical metastasis with wide implantation, and pleural adhesions. 71 Select patients with metachronous metastatic pulmonary disease who presented with a solitary pulmonary nodule on CT scan greater than 2 months after completion of therapy were found to have no additional malignant lesions at the time of thoracotomy for metastasectomy. 67 Therefore, thoracoscopy may prove beneficial in this selected group of patients in order to spare this group an open thoracotomy and its associated complications when these patients are at risk for requiring repeated thoracic surgeries.…”