Abstract
Background
The goal of this study was to assess the role of thoracoscopy (TS) and thoracotomy (TT) in the management of lung nodules in children with osteosarcoma.
Methods
Charts of 16 osteosarcoma patients undergoing surgery for lung nodules were retrospectively analyzed for a correlation between nodule localization at CT scan, findings at surgery, and pathology.
Results
Fourteen TSs were performed in 10 children, eight of which were converted: two for technical problems, and six for inconsistency between CT scan and intraoperative findings. In three converted cases, TT allowed detection of more nodules than CT scan and/or TS. Eight TTs were performed as primary intention in seven children, in one as secondary surgery after a previous TS. In three cases, TT detected more nodules than CT scan. Overall, TT detected more nodules than CT scan in seven of 16 cases (sensitivity, 56.2%), six of whom had a predicted bilateral involvement. Neoplastic tissue was present in lung samples of all but three patients (86.4%).
Conclusions
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.
Similar content being viewed by others
References
V Ambrogi M Paci E Pompeo TC Mineo (2000) ArticleTitleTransxiphoid video-assisted pulmonary metastasectomy: relevance of helical computed tomography occult lesions Ann Thorac Surg 70 1847–1852 Occurrence Handle10.1016/S0003-4975(00)01806-3 Occurrence Handle11156082
AG Oliveira-Filho ParticleDe LS Neto S Epelman (1998) ArticleTitleMedian sternotomy for the resection of bilateral pulmonar metastases in children Pediatr Surg Int 13 560–563 Occurrence Handle10.1007/s003830050403 Occurrence Handle9799375
GW Holcomb SuffixIII (1999) ArticleTitleMinimally invasive surgery for solid tumors Semin Surg Oncol 16 184–192 Occurrence Handle10.1002/(SICI)1098-2388(199903)16:2<184::AID-SSU9>3.0.CO;2-9 Occurrence Handle9988872
SC Kaste CB Pratt AM Cain DJ Jones-Wallace BN Rao (1999) ArticleTitleMetastases detected at time of diagnosis of primary pediatric extremity osteosarcoma at diagnosis: imaging features Cancer 86 1602–1608 Occurrence Handle10.1002/(SICI)1097-0142(19991015)86:8<1602::AID-CNCR31>3.0.CO;2-R Occurrence Handle10526292
MB McCarville SC Kaste AM Cain O Goloubeva BN Rao CB Pratt (2001) ArticleTitlePrognostic factors and imaging patterns of recurrent pulmonary nodules after thoracotomy in children with osteosarcoma Cancer 15 1170–1176 Occurrence Handle10.1002/1097-0142(20010315)91:6<1170::AID-CNCR1114>3.0.CO;2-B
PM McCormack MS Bains CB Begg ME Burt RJ Downey DM Panicek VW Rusch M Zakowski RJ Ginsberg (1996) ArticleTitleRole of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial Ann Thorac Surg 62 213–217 Occurrence Handle10.1016/0003-4975(96)00253-6 Occurrence Handle8678645
J Nakajima S Takamoto M Tanaka E Takeuchi T Murakawa T Fukami (2001) ArticleTitleThoracoscopic surgery and conventional open thoracotomy in metastatic lung cancer Sure Endosc 15 849–853 Occurrence Handle10.1007/s004640090005
BN Rao (1997) ArticleTitlePresent day concepts of thoracoscopy as a modality in pediatric cancer management Int Surg 82 123–126 Occurrence Handle9331836
FJ Rescorla KW West CA Gigalewski SA Engum LR Scherer SuffixIII JL Grosfeld (2000) ArticleTitleEfficacy of primary and secondary video-assisted thoracic surgery in children J Pediatr Surg 35 134–138 Occurrence Handle10646791
SS Rothenberg JS Wagner JHT Chang LL Fan (1996) ArticleTitleThe safety and efficacy of thoracoscopic lung biopsy for diagnosis and treatment in infants and children J Pediatr Surg 31 100–103 Occurrence Handle10.1016/S0022-3468(96)90328-0 Occurrence Handle8632258
MD Tabone C Kalifa C Rodary M Raquin D Valteau-Couanet J Lemerl (1994) ArticleTitleOsteosarcoma recurrence in pediatric patients previously treated with intensive chemotherapy J Clin Oncol 12 2614–2620 Occurrence Handle7989936
JHT Waldhausen D Tapper RS Sawin (2000) ArticleTitleMinimally invasive surgery and clinical decision-making for pediatric malignancy Surg Endosc 14 250–253 Occurrence Handle10.1007/s004640000033 Occurrence Handle10741443
AP Yim J Lin AT Chan CK Li JK Ho (1995) ArticleTitleVideo-assisted thoracic wedge resections of pulmonary metastatic osteosarcoma: should it be performed? Aust N Z J Surg 65 737–739 Occurrence Handle7487715
RN Younes JL Gross D Deheinzelin (2002) ArticleTitleSurgical resection of unilateral lung metastases: is bilateral thoracotomy necessary? World J Surg 26 1112–1116 Occurrence Handle10.1007/s00268-002-6209-8 Occurrence Handle12045865
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Castagnetti, M., Delarue, A. & Gentet, J. Optimizing the surgical management of lung nodules in children with osteosarcoma: Thoracoscopy for biopsies, thoracotomy for resections. Surg Endosc 18, 1668–1671 (2004). https://doi.org/10.1007/s00464-003-9315-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-9315-2