Bilateral Pulmonary Metastases in Pediatric Oncology: Single-Stage or Two-Stages Operation?

Background and Aims: Nowadays, the optimal surgical approach for resection of pulmonary metastases in paediatric oncology is still debated. This study aims to compare the advantages of single-stage (SSO) vs two-stages operations (TSO) in case of bilateral pulmonary metastases at the time of surgery. Methods: Patient’s primary tumour, surgical approach, length of surgery, beginning of postoperative chemotherapy and long-term outcomes were evaluated, comparing those who underwent SSO with those who underwent TSO. Results: Between 1/2007 and 12/2018, 10 patients (median age 16 years), underwent 20 surgical procedures for bilateral pulmonary metastases: 6 SSO, 14 TSO. Primary tumours were: osteosarcoma (5), hepatoblastoma (3), germ cell tumours (2). SSO: 4 bilateral thoracotomies (TT), 1 right thoracoscopy (TS) and left TT, 1 bilateral TS (1 side converted). TSO: 9 TT, 3 TS (1 converted) performed at 19±5days from the first procedure. Considering the number of single SSO and the sum of the TSO, the surgical time was lower for SO (300 vs 350 min) but the length of stay was similar (22 vs 20 days; p=ns). The time between surgery and the post-surgical medical therapy was 15 days for SSO and 39 for TSO (p<0,02). Long-term disease-free interval was similar between the two groups, while survival was lower inTSO(54% vs 68%). Conclusions: Bilateral metastasectomy is a standard procedure, both in SSO and TSO. Despite being more aggressive, especially in small children, SSO allows similar recovery and an earlier beginning of postoperative chemotherapy and may be related to a better long-term survival.