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Repeat resection of pulmonary metastasis is beneficial for patients with osteosarcoma of the extremities

^a Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
^b Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^c Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^d Department of Tissue Regeneration, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan

*Corresponding author. Tel.: +81-75-751-3835; fax: +81-75-751-4647.

E-mail address: hdate{at}kuhp.kyoto-u.ac.jp (H. Date).

Pulmonary metastasectomy in osteosarcoma can lead to long-term survival, but the role for repeat pulmonary metastasectomy is undefined. To confirm the value of repeat pulmonary resection of recurrent pulmonary metastases, we herein reviewed our institutional experience. Between 1989 and 2007, 25 patients with pulmonary metastases from osteosarcomas of the extremities underwent pulmonary resection, and 14 patients underwent repeat pulmonary metastasectomy. Ten of 14 patients underwent complete resection. Various perioperative variables were investigated retrospectively in these patients to confirm a role for repeat metastasectomy and analyze prognostic factors for overall survival (OS) after repeat pulmonary metastasectomy. OS rate after repeat pulmonary metastasectomy was 43% at two years and 19% at five years. On multivariate analysis, patients with complete resection presented significantly favorable OS (P=0.02). Interestingly enough, survival curve of patients with complete resection after the first pulmonary metastasectomy was almost the same as that of patients with complete resection after the second pulmonary metastasectomy. In conclusion, patients with complete resection for recurrent pulmonary metastasis show a significantly better prognosis after repeat pulmonary metastasectomy. Our data imply that repeat pulmonary metastasectomy might be beneficial because it can salvage a subset of patients with osteosarcoma who retain favorable prognostic determinants.

Key Words: Lung; Metastasectomy; Osteosarcoma; Recurrence; Repeat resection