METASTASECTOMY FOR SARCOMATOUS PEDIATRIC HISTOLOGIES - RESULTS AND PROGNOSTIC FACTORS

We reviewed our experience of pediatric metastasectomy to define (I) m orbidity/mortality in this population and (2) any preoperative or intr aoperative prognostic predictors of survival. One hundred fifty-two pa tients with median age 19 years (range, 5 to 33 years) had 258 thoraci c explorations (Ewing's sarcoma, 28; rhabdomyosarcoma, 6; nonrhabdomyo sarcoma soft tissue sarcoma, 42; and osteosarcoma, 76). Resections wer e accomplished by 218 wedge resections, 19 anatomic resections, 14 wed ge and anatomic resections, 4 wedge and chest wall resections, and 3 w edge resections/other procedures. An initial complete resection was ac complished in 121/152 patients (80%), With a median potential follow-u p of 10.6 years, median survival from initial thoracotomy is 2.2 years . By the Cox proportional hazards model, three or more positive nodule s (p = 0.021), histology other than osteosarcoma (p = 0.0054) and inco mplete resection (p < 0.0001) were unfavorable prognostic factors for survival. Two or more positive nodules (p = 0.0049), left location (p = 0.0031), age 14 years or greater at diagnosis (p = 0.0052), or rhabd omyosarcoma (p = 0.0066) predicted shorter pulmonary progression-free survivals after resection. Nonrhabdomyosarcoma pediatric metastasectom y can yield selected long-term survival. Morbidity/mortality is low an d a complete resection, if possible, is paramount; Prognostic factors can be defined that can be used to define the limits of this therapy t o the patient and family.