The surgical management of metastases in pediatric cancer

A significant proportion of children presenting with pediatric solid tumors will have disease distant from the primary site at diagnosis while still more will develop metastases. In this article an appropriate role for the surgical oncologist was determined by extracting surgical and survival data from the literature. It is concluded that aggressive pulmonary metastasectomy is indicated in metastatic osteogenic sarcoma but not in most embryonal soft tissue sarcomas. Wilms' tumor pulmonary metastases are probably best treated by chemotherapy and whole-lung irradiation except for very young children with solitary or localized metastases. However, resection of hepatic metastases from Wilms' tumor may result in long-term disease-free survival. Finally, available data support resection of hepatoblastoma metastases to lung. Surgery maintains an important role in the treatment of metastatic disease but surgeons must remain objective in the reporting and interpretation of results.