Surgical Margins and Oncologic Outcomes Following Wedge Resection of Pulmonary Metastases in Pediatric and Young Adult Patients with Sarcoma

Children and young adults diagnosed with sarcoma often present with pulmonary metastases requiring wedge resection. It is important to balance the risk of pulmonary recurrence against the desire to limit resection of benign parenchyma. This study aims to determine the impact of resection margins on survival and recurrence among pediatric and young adult sarcoma patients. We conducted a retrospective cohort study of patients ages 25 years and younger with primary or recurrent osteogenic, Ewing's, or soft tissue sarcoma who underwent pulmonary metastasectomy (2006-2022). Margins were categorized as > 1 mm, ≥ 5 mm, or ≥ 10 mm length. Two-year overall survival (OS), disease-free survival (DFS), and regional disease-free survival, consisting of pulmonary recurrence following metastasectomy, were analyzed using the Kaplan-Meier method. Cox analysis utilized patient, tumor, and treatment factors to predict risk of death and/or recurrence. In total, 122 patients were identified for analysis. The median number of wedge resections was 3.5, median nodule size was 12.5 mm, and median margin length was 3 mm. A 5-mm margin was associated with improvements in DFS and regional-DFS (10.6% vs. 29.7%, p = 0.01 and 10.7% versus 31.1%, p = 0.005, respectively). On Cox analysis, margin length was not associated with OS (p > 0.05); however, 5 mm (HR 0.46, p = 0.005) and 10-mm margins (HR 0.39, p = 0.04) were associated with improvements in regional DFS. Margin length was not associated with development of postoperative complications (p = 0.20). Among pediatric and young adult sarcoma patients with pulmonary metastases, increased margin length was associated with decreasing risk of local recurrence but not the development of postoperative complications.