DISCUSSION
neuropathic pain, Pain, EFS/OS, pain, pneumothoraces, pulmonary disease
PRIMARY TUMOR, SCARRING, PULMONARY DISEASE
Aggressive PMs have been shown to improve survival in patients with metastatic OST since the 1970s.The increased sensitivity of CT scans has allowed detection of pulmonary micronodules (<10 mm) that were not previously appreciated.Studies assessing the impact of different PM approaches in OST are lacking. Importantly, our study reports comparable survival outcomes between thoracotomy versus thoracoscopy versus CTT at initial metastasectomy and at first pulmonary relapse or progression. Contrary to other published reports, there was no significant difference in OS with regards to primary tumor histologic response and in EFS/OS with regards to the laterality of pulmonary disease at diagnosis.Our study suggests that the incidence of pneumothoraces is comparable among all groups at initial metastasectomy but significantly less for the thoracoscopy group at first relapse metastasectomy. Pain was significantly more in the thoracotomy and CTT groups at initial metastasectomy and at first relapse/progression, which could be due to repeated open thoracotomy incisions or extensive dissection caused by previous scarring leading to increased neuropathic pain. This is consistent with other reports with approximately 5%–80% of patients experiencing significant pain 2 months or more after thoracotomy, with approximately 30% of patients with persistent pain for 4–5 years after thoracotomy.Several studies have reported the benefits of thoracoscopy in reducing surgical morbidity and postoperative morbidities such as fewer blood transfusions, earlier chest tube removal, and shorter hospital length of stay.Historically, patients who underwent PM have a 5‐year OS between 11% and 68%.