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Comparative Study
. 2021 Mar 1;148(5):1164-1171.
doi: 10.1002/ijc.33264. Epub 2020 Aug 31.

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

Timothy B Lautz  1 , Zishaan Farooqui  2 , Todd Jenkins  3 , Todd E Heaton  4 , John J Doski  5 , Jo Cooke-Barber  2 , Andrew J Murphy  6 , Andrew M Davidoff  6 , Sara A Mansfield  6 , Eugene S Kim  7 , Samuel Zuber  7 , Catherine Goodhue  7 , Sanjeev A Vasudevan  8 , Michael P LaQuaglia  4 , Nelson Piche  9 , Annie Le-Nguyen  9 , Jennifer H Aldrink  10 , Marcus M Malek  11 , Vei Shaun Siow  11 , Richard D Glick  12 , Barrie S Rich  12 , Rebecka L Meyers  13 , Scott S Short  13 , Andreana Butter  14 , Reto M Baertschiger  15   16 , Elizabeth A Fialkowski  17 , Roshni Dasgupta  2
Affiliations
Comparative Study

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

Timothy B Lautz et al. Int J Cancer. .

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.

Keywords: child; disease-free survival; metastasectomy; osteosarcoma; thoracotomy.

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References

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