Timothy B Lautz1, Mark D Krailo2, Ruxu Han2, Todd E Heaton3, Roshni Dasgupta4, John Doski5. 1. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL. Electronic address: tlautz@luriechildrens.org. 2. COG Children's Oncology Group, Arcadia, CA, USA. 3. Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Department of Surgery, UT Health Science Center San Antonio, San Antonio, TX.
Abstract
BACKGROUND: Rates of long-term survival for children with pulmonary metastatic osteosarcoma are low, and complete surgical resection of all visible pulmonary metastases is necessary for long term survival. Surgical approaches for metastasectomy include thoracotomy and thoracoscopy, with the approach chosen influenced by training and institutional bias. Thoracotomy with manual palpation of lung surfaces can identify nodules not seen on preoperative imaging, but no clear survival benefit has been demonstrated compared to complete thoracoscopic resection of all visible nodules. METHODS: All member of the American Pediatric Surgical Association were surveyed, and 204 members responded. RESULTS: Thoracoscopy was the preferred approach of 34% of surgeons for patients with 3 unilateral nodules but only 21% for those with 5 unilateral nodules. Hospital volume did not correlate with operative approach. Localization strategies are used by 37% of surgeons who prefer thoracotomy and 64% who prefer thoracoscopy. Importantly, the vast majority of responding surgeons (84%) expressed a willingness to participate in a randomized controlled trial of thoracotomy versus thoracoscopy. CONCLUSION: Findings of this survey of North American pediatric surgeons confirm both the need for, and interest in, a prospective trial to define optimal surgical management of children with osteosarcoma with limited pulmonary metastasis. LEVEL OF EVIDENCE: V.
BACKGROUND: Rates of long-term survival for children with pulmonary metastatic osteosarcoma are low, and complete surgical resection of all visible pulmonary metastases is necessary for long term survival. Surgical approaches for metastasectomy include thoracotomy and thoracoscopy, with the approach chosen influenced by training and institutional bias. Thoracotomy with manual palpation of lung surfaces can identify nodules not seen on preoperative imaging, but no clear survival benefit has been demonstrated compared to complete thoracoscopic resection of all visible nodules. METHODS: All member of the American Pediatric Surgical Association were surveyed, and 204 members responded. RESULTS: Thoracoscopy was the preferred approach of 34% of surgeons for patients with 3 unilateral nodules but only 21% for those with 5 unilateral nodules. Hospital volume did not correlate with operative approach. Localization strategies are used by 37% of surgeons who prefer thoracotomy and 64% who prefer thoracoscopy. Importantly, the vast majority of responding surgeons (84%) expressed a willingness to participate in a randomized controlled trial of thoracotomy versus thoracoscopy. CONCLUSION: Findings of this survey of North American pediatric surgeons confirm both the need for, and interest in, a prospective trial to define optimal surgical management of children with osteosarcoma with limited pulmonary metastasis. LEVEL OF EVIDENCE: V.
Authors: Martha E Teke; Areeba Saif; Amber Leila Sarvestani; Jonathan M Hernandez; Timothy B Lautz; John J Doski Journal: Ann Surg Oncol Date: 2022-09-09 Impact factor: 4.339