Prognostic factors in surgery for pulmonary metastases in children

A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors.

From 1970 to 1992, 139 thoracotomies were performed in 91 patients between 1 and 19 years of age with metastases of osteogenic sarcoma (40 patients), nephroblastoma (24 patients), Ewing sarcoma (12 patients), and various other tumors (15 patients).

There were no perioperative deaths and only one serious complication, chylothorax necessitating reoperation. Twenty-three patients (25%) are currently alive, two with residual disease. Twelve patients (50%) with nephroblastoma 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 developing during treatment. The number of metastases, the disease-free interval, unilateral versus bilateral metastases, preoperative and postoperative adjuvant treatment, and the number of thoracotomies performed were not of significant influence on outcome.

The most important prognostic factor is the type of primary tumor. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand.