330 Surgery of lung metastases

Abstract

Background A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors. Methods From 1970 to 1992 139 thoracotomies were performed in 91 patients aged between 1 and 19 years with metastases of osteogenic sarcoma (40), nephroblastoma (24), Ewing sarcoma (12) and various other tumours (15). Results There were no perioperative deaths, and only one serious complication: chylothorax necessitating re-operation. Twenty-three patients are currently alive (26%), two with residual disease. Twelve pa (50%) with nephroblastoma aler alive; 7 patients with osteogenic sarcoma (18%) and 4 with other tumours (27%). Negative prognostic factors were: incomplete excision, primary tumour not controlled, or metastases developing during treatment. Not of significant influence on the outcome were: the number of metastases developing during treatment. Not of significant influence on outcome were: the number of metastases, the disease free interval, unilateral versus bilateral metastases, pre-operative and postoperative adjuvant treatment of the number of thoracotomies performed. Conclusion The most important prognostic factor is the type of primary tumour. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation, should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand. A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors. From 1970 to 1992 139 thoracotomies were performed in 91 patients aged between 1 and 19 years with metastases of osteogenic sarcoma (40), nephroblastoma (24), Ewing sarcoma (12) and various other tumours (15). There were no perioperative deaths, and only one serious complication: chylothorax necessitating re-operation. Twenty-three patients are currently alive (26%), two with residual disease. Twelve pa (50%) with nephroblastoma aler alive; 7 patients with osteogenic sarcoma (18%) and 4 with other tumours (27%). Negative prognostic factors were: incomplete excision, primary tumour not controlled, or metastases developing during treatment. Not of significant influence on the outcome were: the number of metastases developing during treatment. Not of significant influence on outcome were: the number of metastases, the disease free interval, unilateral versus bilateral metastases, pre-operative and postoperative adjuvant treatment of the number of thoracotomies performed. The most important prognostic factor is the type of primary tumour. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation, should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand.