Current surgical management of children with osteosarcoma and pulmonary metastatic disease: a survey of the AMERICAN pediatric surgical association
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In brief
In brief
Survey of 204 APSA members reveals divided practice patterns in surgical management of pediatric osteosarcoma pulmonary metastases, with thoracoscopy preferred by 21-34% depending on nodule burden. Despite lack of consensus on optimal approach (thoracotomy with palpation vs. thoracoscopic resection), 84% of surgeons support a randomized trial to establish evidence-based guidelines.
Written by the GCMD Library team from the article.
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.