A Phase III, Randomized, Controlled Trial Comparing Open Versus Thoracoscopic Management of Pulmonary Metastases in Patients with Osteosarcoma

Excerpt

Osteosarcoma is the most common primary bone tumor in children and young adults accounting for approximately 400 new cases per year. Up to 20% of children will have metastatic disease on presentation, most commonly to the lung (74%) or bone (9%).¹ The presence of metastases is assosciated with a significantly abbreviated 5-year overall survival of 20–30%.² Pulmonary metastasectomy infers a survival benefit, although long-term survival associated with complete surgical extirpation and systemic therapy is approximately 40%.² An open approach to metastasectomy via sternotomy or thoracotomy is the current standard of care as manual lung palpation allows for improved localization, identification, and detection of lesions. In fact, approximatley one-fourth of patients undergoing pulmonary metatasectomy via an open approach will have additional lesions discovered intraoperatively that were not previously seen on preoperative computed tomography (CT).³ However, clinical benefit from resection of these radiographically occult lesions remains unclear.⁴ As such, metastasectomy technique remains a topic of debate as open techniques are associated with increased postoperative pain, longer inpatient stay, and potential long-term morbidity and chest deformity.²

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