PROGNOSTIC FACTORS IN SURGERY FOR PULMONARY METASTASES IN CHILDREN

Background. A retrospective analysis was performed of the results of s urgical excision of lung metastases zn children to identify prognostic factors. Methods. From 1970 to 1992, 139 thoracotomies were performed in 91 patients between I and 19 years of age with metastases of osteo genic sarcoma (40 patients), nephroblastoma (24 patients), Ewing sarco ma (12 patients), and various other tumors (15 patients). Results. THe re were no perioperative deaths and only one serious complication, chy lothorax necessitating reoperation. Twenty-three patients (25%) are cu rrently alive, two with residual disease. Twelve patients (50%) with n ephroblastoma are alive; 7 patients (18%) with osteogenic sarcoma and 4 (27%) with other tumors are alive. Negative prognostic factors were incomplete excision, primary tumor not controlled, or metastases devel oping during treatment. The number of metastases, the disease-free int erval, unilateral versus bilateral metastases, preoperative and postop erative adjuvant treatment, and the number of the thoracotomies perfor med were not of significant influence on outcome. Conclusions. The mos t important prognostic factor is the type of primary tumor. Excision o f lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major opera tion should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand.