REOPERATIVE PULMONARY METASTASECTOMY FOR SARCOMATOUS PEDIATRIC HISTOLOGIES

Background. The role for reoperative pulmonary metastasectomy in patie nts with ''pediatric sarcomas'' (osteosarcoma, nonrhabdomyosarcoma-sof t tissue sarcoma, and E-wing's sarcoma) is undefined. Methods. We revi ewed our results for patients with these histologic presentations (med ian age, 17.5 years; range, 6 to 32 years) having two (70), three (27) , or four (10) metastasectomies between January 1965 and March 1995 to define postresection survival and potential prognostic factors. Simpl e wedges (88 thoracotomies, 84%) were performed more frequently than a natomic (17 thoracotomies, 16%) resections. Results. With a median pot ential follow-up of 12.7 years, median survival was 2.25, 3.60, and 0. 96 years from the second, third, and fourth explorations, respectively , Primary tumor site, sex, histology, age, maximal metastasis size, an d systemic chemotherapy did not influence survival. Resectability was the most important prognostic factor (5.6 versus 0.7 years, 5.2 versus 2.5 years, 2.2 versus 0.2 years, resectable versus unresectable, medi an survival from second, third,and fourth thoracotomy, respectively). Unresectability, disease-free interval less than 6 months between init ial (ie, first) pulmonary resection and the second thoracotomy, and tw o or more preoperative nodules noted on the right were simultaneously negatively associated with survival from the second thoracotomy. Unres ectability or finding two or more metastases negatively affected survi val from the third thoracotomy. Conclusions. These data imply that rep eat metastasectomy can salvage a subset of patients with sarcomatous p ediatric histologic presentations who retain favorable prognostic dete rminants. (Ann Thorac Surg 1998;66:908-13) (C) 1998 by The Society of Thoracic Surgeons.