Osteosarcoma (OS) is the most common primary bone tumor in children and adults. In 15–20% of patients, distant metastases are detected at the time of diagnosis of OS. In more than 80% of cases, metastases are located in the lungs and are the most common disease-related cause of death in OS patients. OS can only be cured if complete surgical remission in the lungs is achieved through surgery involving palpation, identification and resection of all detected metastases. Among thoracic surgeons, it is common practice to perform a wedge resection of the affected lung parenchyma as it spares healthier lung tissue. Lobectomy or pneumonectomy can be carried out if either is indicated in the patient. There is, however, no consensus on the best surgical approach for metastasectomy. Our study includes 32 patients who underwent simultaneous bilateral thoracotomy at the Department of Oncology and Pediatric Surgery of the D. Rogachev NMRCPHOI in the period from 2018 to 2023. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. Every case was thoroughly analyzed whether it was primary or secondary surgery, the number of lesions, as evident from computed tomography images and intraoperative findings, the post-treatment necrosis and postoperative follow-up were estimated in details.