Simultaneous bilateral thoracotomy in patients with osteosarcoma and bilateral pulmonary metastases: the experience of the D. Rogachev NMRCPHOI

Osteosarcoma (OS) is the most common primary bone tumor in children and adults. In 15–20% of patients, distant metastases are detected at the time of diagnosis of OS. In more than 80% of cases, metastases are located in the lungs and are the most common disease-related cause of death in OS patients. OS can only be cured if complete surgical remission (CSR) in the lungs is achieved through surgery involving palpation, identification and resection of all detected metastases. Among thoracic surgeons, it is common practice to perform wedge resection of the affected lung parenchyma as it spares more healthy lung tissue. Lobectomy or pneumonectomy can be carried out if either is indicated in the patient. There is, however, no consensus on the best surgical approach for metastasectomy. Our study includes 24 patients who underwent simultaneous bilateral thoracotomy at the Department of Oncology and Pediatric Surgery of the D. Rogachev NMRCPHOI in the period from February 2018 to May 2021. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. Eighteen patients underwent primary surgery as part of combination protocol treatment, and six patients were surgically treated for relapse. In 66.7% of the patients treated with upfront surgery, the number of lesions was underestimated, as evident from computed tomography images and intraoperative findings. Post-treatment necrosis grade IV was detected only in 3 patients, in 21.1% of the resected metastases. The median time from bilateral thoracotomy to systemic anti-cancer therapy reinitiation was 12 days. Two patients experienced progression of metastatic disease in the lungs during and immediately the protocol treatment. At the last follow-up, 3 patients were alive with evidence of disease, and 2 patients had died of OS progression. A total of 33.3% of the patients who had had primary surgery developed metastatic (n = 6) and local (n = 1) relapses.