Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study. Issue 5 (31st August 2020)

• Record Type: Journal Article
• Authors: Lautz, Timothy B.; Farooqui, Zishaan; Jenkins, Todd; Heaton, Todd E.; Doski, John J.; Cooke‐Barber, Jo; Murphy, Andrew J.; Davidoff, Andrew M.; Mansfield, Sara A.; Kim, Eugene S.; Zuber, Samuel; Goodhue, Catherine; Vasudevan, Sanjeev A.; LaQuaglia, Michael P.; Piche, Nelson; Le‐Nguyen, Annie; Aldrink, Jennifer H.; Malek, Marcus M.; Siow, Vei Shaun; Glick, Richard D.; Rich, Barrie S.; Meyers, Rebecka L.; Short, Scott S.; Butter, Andreana; Baertschiger, Reto M.; Fialkowski, Elizabeth A.; Dasgupta, Roshni
• Is Part Of: International journal of cancer. Volume 148:Issue 5(2021)
• Page Start: 1164
• Page End: 1171
• Publication Date: 2020-08-31
• Subjects: child -- disease‐free survival -- metastasectomy -- osteosarcoma -- thoracotomy; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33264
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: 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. Abstract : What's new? In patients with osteosarcoma that has metastasized to the lungs, complete surgical resection is crucial for long‐term survival. But is full thoracotomy necessary? In this study, the authors found that, in patients with limited metastases, both mortality and risk of pulmonary recurrence were similar for patients who had thoracoscopic surgery vs. those who underwent thoracotomy. Thoracotomy did improve survival for patients with more extensive disease, however. These results indicate that the less invasive, lower‐risk thoracoscopic approach may be preferable for a subset of patients.