Dataset Information

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma.

ABSTRACT:

Background

Thoracotomy is considered the standard surgical approach for the management of pulmonary metastases in osteosarcoma (OST). Several studies have identified the advantages of a thoracoscopic approach, however, the clinical significance of thoracotomy compared to thoracoscopy is yet to be evaluated in a randomized trial.

Aims

The primary aim was to determine the survival outcomes in OST patients based on surgical approach for pulmonary metastasectomy (PM) and secondary aim was to assess the post-operative morbidities of OST PM through various surgical approaches.

Materials and methods

We conducted a single institution retrospective study to compare survival outcomes and surgical morbidity according to the surgical approach of the management of pulmonary metastases in patients with OST.

Results

Sixty-one patients with OST underwent PM. Twenty-one patients were metastatic at diagnosis and underwent PM during primary treatment; nine had thoracotomy, six thoracoscopy, and six combined thoracoscopy with thoracotomy (CTT). Forty-three patients with first pulmonary relapse or progression underwent PM; 18 had thoracotomy, 16 thoracoscopy and nine CTT. There was no difference in survival between surgical approaches. There were significantly more postoperative morbidities associated with thoracotomy for initial PM (pain and postoperative chest tube placement), and for PM at first relapse (pneumothoraces, pain, Foley catheter use and prolonged hospitalizations).

Conclusion

Our study demonstrates that patients with OST pulmonary metastases have comparable poor outcomes despite varying surgical approaches for PM. There were significantly more postoperative morbidities associated with thoracotomy for PM. Surgical bias and other competing risks could not be assessed given the limitations of a retrospective study and may be addressed in a prospective trial evaluating surgical approach for PM in OST.

SUBMITTER: Kuo C

PROVIDER: S-EPMC10652329 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma.

Kuo Christopher C Malvar Jemily J Chi Yueh-Yun YY Kim Eugene S ES Shah Rachana R Navid Fariba F Stein James E JE Mascarenhas Leo L

Cancer medicine 20231006 20

<h4>Background</h4>Thoracotomy is considered the standard surgical approach for the management of pulmonary metastases in osteosarcoma (OST). Several studies have identified the advantages of a thoracoscopic approach, however, the clinical significance of thoracotomy compared to thoracoscopy is yet to be evaluated in a randomized trial.<h4>Aims</h4>The primary aim was to determine the survival outcomes in OST patients based on surgical approach for pulmonary metastasectomy (PM) and secondary aim ...[more]

PMID: 37800658

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Project description:Objective: The surgical resection of pulmonary metastases is associated with a survival benefit in selected patients. The use of laser devices for pulmonary metastasectomy (PM) is believed to facilitate the complete resection of metastases while preserving a maximum of healthy parenchyma. This is a prospective study to evaluate surgical outcome including the changes of lung function after laser-assisted surgery (LAS). Methods: A total of 77 operations in 61 patients in which PM was carried out in a curative intent were analyzed. A 1.320 nm diode-pumped Nd: YAG-Laser was used for resection of the metastases. Surgical and clinical data were collected using a standardized form and postoperative lung function changes 3 and 6 months after surgery were assessed using whole body plethysmography and diffusion capacity for carbon monoxide (DLCO). Size and distance of metastases to the pleural surface were measured radiologically. Results: A median of two metastases were resected per operation (range 1-13). The median duration of postoperative air leak was 1 day (range 0-11). LAS associated postoperative minor and major complications were observed in 4 (5%) cases and 1 (1%) case, respectively; there were no mortalities. The analysis of perioperative lung function showed that mean VC 3 months after surgery was reduced by 11 %, FEV1 by 11% and median DLCO by 11% (all p < 0.0001). There was almost no recovery of lung function between 3 and 6 months in the whole cohort. Patients with two or less metastases showed a recovery of lung function after 3 months regarding DLCO (p = 0.003). Decline of DLCO in the whole cohort correlated with the number of resected metastases at 3 months (r = 0.45, p = 0.006) and at 6 months (r = 0.42, p = 0.02) as well as depth of metastases in the parenchyma at 6 months (r = 0.48, p = 0.001). Conclusions: LAS is a safe and effective method for PM even for higher numbers of metastases, with short duration of postoperative air leak and little morbidity. Number and depth, but not size of metastases affect lung function changes after resection.

Project description:The aim of the present study was to explore the diagnostic value of a deep convolutional neural network (DCNN) model for the diagnosis of pulmonary nodules in adolescent and young adult patients with osteosarcoma. For the present study, 675 chest CT images were retrospectively collected from 109 patients with clinically confirmed osteosarcoma who underwent chest CT examination at Hangzhou Third People's Hospital (Hangzhou, China) from March 2011 to February 2022. CT images were then evaluated using the DCNN and manual models. Subsequently, pulmonary nodules of osteosarcoma were divided into calcified nodules, solid nodules, partially solid nodules and ground glass nodules using the DCNN model. Those patients with osteosarcoma who were diagnosed and treated were followed up to observe dynamic changes in the pulmonary nodules. A total of 3,087 nodules were detected, while 278 nodules were missed compared with those determined using the reference standard given by the consensus of three Experienced radiologists., which was analyzed by two diagnostic radiologists. In the manual model group, 2,442 nodules were detected, while 657 nodules were missed. The DCNN model showed significantly higher sensitivity and specificity compared with the manual model (sensitivity, 0.923 vs. 0.908; specificity, 0.552 vs. 0.351; P<0.05). In addition, the DCNN model yielded an area under the curve (AUC) value of 0.795 [95% confidence interval (CI), 0.743-0.846], outperforming that of the manual model (AUC, 0.687; 95% CI, 0.629-0.732; P<0.05). The film reading time of the DCNN model was also significantly shorter compared with that of the manual model [mean ± standard deviation (SD); 173.25±24.10 vs. 328.32±22.72 sec; P<0.05)]. The AUC of calcified nodules, solid nodules, partially solid nodules and ground glass nodules was calculated to be 0.766, 0.771, 0.761 and 0.796, respectively, using the DCNN model. Using this model, the majority of the pulmonary nodules were detected in patients with osteosarcoma at the initial diagnosis (69/109, 62.3%), and the majority of these were found with multiple pulmonary nodules instead of a single nodule (71/109, 65.1% vs. 38/109, 34.9%). These data suggest that, compared with the manual model, the DCNN model proved to be beneficial for the detection of pulmonary nodules in adolescent and young adult patients with osteosarcoma, which may reduce the time of artificial radiograph reading. In conclusion, the proposed DCNN model, developed using data from 675 chest CT images retrospectively collected from 109 patients with clinically confirmed osteosarcoma, may be used as an effective tool to evaluate pulmonary nodules in patients with osteosarcoma.

Dataset Information

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma.

Background

Aims

Materials and methods

Results

Conclusion

Publications

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma.

Similar Datasets

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