Experience of surgical treatment of intrathoracic metastasis osteogenenic sarcoma

Objective. The aim of the study is to improve the results of surgical treatment of metastases of osteogenic sarcomas in the lungs, analysis of factors that may affect the effectiveness of surgical treatment. Methods. The study included 120 patients with lung metastases of bone sarcomas who were treated from 1997 to 2013. Among the patients, there were 64 (53.3%) men and 56 (46.7%) women. The median age for diagnosis was 25 years (13 to 68 years). Most osteogenic tumors were osteosarcomas (56.7%). The indication for surgery in most cases (55%) was metastases in the lungs as the only manifestation of the disease. Most often, operations were performed with unilateral lung damage (57%). Results. Surgeries were predominantly performed with thoracotomy access. The most commonly performed surgeries were atypical lung resections. 23 (19%) patients required a lobectomy. In 113 (94%) patients, operations were performed in the volume of R0. Postoperative complications were noted in 10 (8.5%) patients. The most common postoperative complication was pneumonia, in 1 patient it led to postoperative mortality, in another patient - it led to pulmonary failure. The median followup in the study group was 53.2 months (from 3.5 months to 252 months). When analyzing the frequency of therapeutic pathomorphism in patients with bone sarcoma metastases who underwent chemotherapeutic treatment prior to resection, it was shown that the frequency of achieving complete therapeutic pathomorphism was relatively low - only in 5.5% of patients, in 15% moderate and in 79.5% of patients the effect of chemotherapy was not achieved or only a weak therapeutic pathomorphism was achieved. The overall 5-year survival rate in the study group was 56.4%. Conclusion. Surgical treatment can lead to long-term survival in patients with sarcoma metastases in the lungs, while the best treatment results are achieved with a long relapse-free interval, a small number of metastases and their removal in the amount of R0. Performing operations from thoracoscopic access does not worsen the long-term results of treatment.

thoracotomy, osteosarcoma, pulmonary metastasis, surgical treatment, computed tomography

1. Pastorino U. History of the surgical management of pulmonary metastases and development of the International Registry. Semin Thorac Cardiovasc Surg. 2002;14(1):18-28.

2. Garcia Franco CE et al. Long-term results after resection for bone sarcoma pulmonary metastases. Eur J Cardiothorac Surg. 2010;37(5):1205-1208.

3. Billingsley KG et al. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg. 1999;229(5):602-610; discussion 610-2.

4. Pastorino U et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997;113(1):37-49.

5. Lin AY et al. Risk stratification of patients undergoing pulmonary metastasectomy for soft tissue and bone sarcomas. J Thorac Cardiovasc Surg. 2015;149(1):85-92.

6. Beattie EJ et al. Results of multiple pulmonary resections for metastatic osteogenic sarcoma after two decades. J Surg Oncol. 1991;46(3):154-155.

7. Smith R et al. Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy. Eur J Surg Oncol. 2009;35(4):356-361.

8. Nevala R et al. Long-term results of surgical resection of lung metastases from soft tissue sarcoma: A single center experience. J Surg Oncol. 2019;120(2):168-175.

9. Digesu CS et al. Management of Sarcoma Metastases to the Lung. Surg Oncol Clin N Am. 2016;25(4):721-733.

10. Frakulli R et al. Stereotactic Radiotherapy in the Treatment of Lung Metastases from Bone and Soft-tissue Sarcomas. Anticancer Res. 2015;35(10):5581-5586.

11. Gossot D et al. Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach? Ann Thorac Surg. 2009;87(1):238-243.