Surgery

Control of osteosarcoma after recurrence depends on complete surgical resection of all sites of clinically detectable metastatic disease.

A multi-institutional retrospective analysis compared thoracotomy with thoracoscopy for resection of pulmonary metastases in patients with osteosarcoma.[14] The analysis included patients who had pulmonary metastases at diagnosis, patients with pulmonary relapse after initial management of localized disease, and patients with disease progression while on therapy. The authors recognized a significant selection bias for the patients chosen to undergo thoracoscopy. In a Cox regression analysis, controlling for other factors impacting outcome, there was a significantly increased risk of mortality (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.09–4.09; P = .027) but not pulmonary recurrence (HR, 0.96; 95% CI, 0.52–1.79; P = .90) with a thoracoscopic approach. In a subset analysis limited to patients with oligometastatic disease, thoracoscopy did not increase the risk of mortality (HR, 1.16; 95% CI, 0.64–2.11; P = .62). The ongoing randomized trial (AOST2031 [NCT05235165]) was designed to definitively address this question and the selection bias. This trial will compare the effect of thoracotomy with thoracoscopic surgery.