Should contralateral exploratory thoracotomy be advocated for children with osteosarcoma and early unilateral pulmonary metastases?

Gideon Karplus, M. Beth McCarville, Matthew P. Smeltzer, George Spyridis, Bhaskar N. Rao, Andrew Davidoff, Chin-Shang Li, Stephen Shochat

Research output: Contribution to journalArticle

10 Scopus citations


Purpose: Children presenting with osteosarcoma and pulmonary metastases have poor survival rates. The standard approach to treating unilateral metastases is ipsilateral thoracotomy with complete resection of the metastases whenever possible. We analyzed whether contralateral exploratory thoracotomy is beneficial in these patients. Methods: We reviewed the records of all osteosarcoma patients presenting with or developing early pulmonary metastases (within 24 months of diagnosis) at the St Jude Children's Research Hospital (Memphis, Tenn) between June 1980 and September 2005. Demographics, imaging results, treatment protocols, surgical procedures, and recurrence, survival, and timeline data were assessed. Results: Of the 109 patients, initial pulmonary involvement was radiographically identified as unilateral in 81 (74%) and bilateral in 28 (26%) patients. Of the patients presenting with unilateral pulmonary metastases, 2 years later, 13 (16%) had recurrence in the ipsilateral and 19 (23%) in the contralateral lung. In 2 (2.4%) patients, metastases recurred bilaterally. There was no evidence of statistically significant difference between the incidence of recurrence in the ipsilateral and contralateral lung (P = .18). Conclusions: Children with osteosarcoma and unilateral pulmonary metastases had similar incidence of recurrence in the ipsilateral and contralateral lung. Their survival rates were also not significantly different. Therefore, contralateral exploratory thoracotomy in patients presenting with unilateral pulmonary metastases will probably not improve survival.

Original languageEnglish (US)
Pages (from-to)665-671
Number of pages7
JournalJournal of Pediatric Surgery
Issue number4
StatePublished - Apr 2009
Externally publishedYes



  • Childhood
  • Contralateral thoracotomy
  • Osteosarcoma
  • Pulmonary metastases

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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