Completion pneumonectomy via sternotomy and complete intrathoracic liver migration in metastatic osteosarcoma

Pulmonary metastasectomy is the well-accepted surgical management for recurrent osteosarcoma in the lung. A pneumonectomy is seldom performed, even more so via a sternotomy. We report an unusual case of a pneumonectomy via median sternotomy for a pulmonary metastasis with complete migration of the liver into the intrathoracic space, a complication rarely observed. The patient remains disease-free on follow-up, 21 years following the initial diagnosis. Aggressive approaches for metastasectomy, despite clinician hesitation in the age of minimally invasive surgery, can yield excellent outcomes for a cancer with otherwise poor prognosis.