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J Am Coll Surg. 2014 Aug;219(2):265-71. doi: 10.1016/j.jamcollsurg.2013.12.064. Epub 2014 Mar 4.

Long-term pulmonary function after metastasectomy for childhood osteosarcoma: a report from the St Jude lifetime cohort study.

Author information

  • 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN. Electronic address: jdenbo@uthsc.edu.
  • 2Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
  • 3Department of Pediatrics, University of Tennessee Health Science Center, and Program in Pediatric Pulmonary Medicine Le Bonheur Children's Hospital-St. Jude Children's Research Hospital, Memphis, TN.
  • 4Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
  • 5Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
  • 6Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.



Complete resection of lung metastases improves survival in patients with osteosarcoma. We evaluated the long-term effect of metastasectomy on pulmonary function of patients treated for osteosarcoma during childhood.


We reviewed the medical records of patients who had pulmonary function tests (PFTs) after metastasectomy for osteosarcoma. Patient, tumor, and treatment variables were abstracted along with PFTs. The PFTs were recorded as a percentage of predicted value and were classified as abnormal for forced vital capacity (FVC) < 80%, forced expiratory volume in 1 second (FEV1) < 80%, total lung capacity (TLC) < 75%, and single breath diffusion capacity for carbon monoxide corrected for hemoglobin (DLCOcorr) < 75%.


Twenty-one patients had PFTs performed during follow-up. Mean age at diagnosis of osteosarcoma was 13.2 ± 4.7 years (SD). Fifteen patients had a single thoracotomy, and 6 patients had ≥2 thoracotomies (range 2 to 6). Eighty lesions were resected. Nine patients had ≤2 lesions resected and 12 patients had >2 lesions (range 3 to 12) resected. Mean time from the last surgical procedure to measurement of PFTs was 20.3 ± 9.0 years (SD). Total lung capacity was abnormal for 28.6%, DLCOcorr for 47.4%, FVC for 40%, and FEV1 for 47.6% of the cohort members. Individual PFTs were abnormal in 13.3% (TLC) to 46.7% (DLCOcorr) of patients who had 1 thoracotomy and in 50.0% (DLCOcorr) to 66.7% (FEV1, TLC) of patients with ≥2 thoracotomies. The number of thoracotomies was associated with abnormal TLC (p = 0.03).


Patients who underwent pulmonary metastasectomy for osteosarcoma as children often had abnormal PFTs on long-term follow-up, but the reduction in lung volumes and DLCOcorr was relatively mild. Multiple thoracotomies predicted greater impairment of pulmonary function.

Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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