Lung metastases are found in up to 30% of patients with osteosarcoma. Survival rates up to 45% are possible in interdisciplinary concepts, i.e. studies with aggressive surgical approach and (neo-) adjuvant chemotherapy. To elucidate these concepts concerning pulmonary metastasectomy, existing studies are reviewed and our own results are presented.
Methods: Studies with the main topic in pulmonary metastases in osteosarcoma were reviewed. They overlook a period of 70 years and a total of more than 10,000 osteosarcoma patients and about 1,800 patients with pulmonary metastases. Studies have been reviewed concerning surgical concepts, prognostic factors and survival outcome. Our own results in 85 patients operated on for pulmonary metastases in 164 operations are presented and surgical procedures, prognostic factors and outcome are discussed.
Results: About 1,800 patients with pulmonary metastases are presented in the reviewed studies from 1939 to 2007. There is a surprising consistency concerning surgical techniques, historically changing with the introduction of stapling machines and laser surgery. Survival rates between 30% and 40% also show a certain consistency in interdisciplinary studies, with a range from 11% to 63% in all studies. The main prognostic factor affecting survival is complete surgical remission (CSR). It shows high significance particularly in studies with large numbers of patients. Time of metastatic presentation, and number and localization of metastases show significance more infrequently. Our own series focusses on overall survival rate (48%) and the importance of CSR as a prognostic factor (p < .001).
Conclusion: Pulmonary metastasectomy is mandatory for long-term survival in patients with pulmonary metastases in osteosarcoma. This does not depend on the metastatic stage or the number of operations needed to achieve CSR, which is the main prognostic factor for survival. Bilateral surgery is necessary in most patients; minimally invasive techniques should not be used routinely.