Results of Chest Wall Resection and Reconstruction With and Without Rigid Prosthesis

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
The Annals of thoracic surgery (Impact Factor: 3.85). 02/2006; 81(1):279-85. DOI: 10.1016/j.athoracsur.2005.07.001
Source: PubMed


Chest wall resections are associated with significant morbidity, with respiratory failure in as many as 27% of patients. We hypothesized that our selective use of a rigid prosthesis for reconstruction reduces respiratory complications.
The records of all patients undergoing chest wall resection and reconstruction were reviewed. Patient demographics, use of preoperative therapy, the location and size of the chest wall defect, performance of lung resection if any, the type of prosthesis, and postoperative complications were recorded. Predictor of complications were identified by chi2 and logistic regression analyses.
From January 1, 1995, to July 1, 2003, 262 patients (median age, 60 years) underwent chest wall resection for tumor in 251 (96%), radiation necrosis in 7 (2.7%); and infection in 4 patients (1.3%). The median defect size was 80 cm2 (range, 2.7 to 1,200 cm2) and the median number of ribs resected was 3 (range, 1 to 8). Major lung resection was performed in 85 patients (34%). Prosthetic reconstruction was rigid (polypropylene mesh/methylmethacrylate composite) in 112 (42.7%), nonrigid (polytetrafluoroethylene or polypropylene mesh) in 97 (37%), and none in 53 patients. Postoperatively, 10 patients died (3.8%), 4 of whom had pneumonectomy plus chest wall resection. Respiratory failure occurred in 8 patients (3.1%). By multivariate analysis, the size of the chest wall defect was the most significant predictor of complications.
Our incidence of respiratory failure is lower than previously reported and may relate to our use of rigid repair for defects likely to cause a flail segment. Pneumonectomy plus chest wall resection should be performed only in highly selected patients.

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    • "The decision of whether to perform reconstruction is based on lesion location and defect size. Chest wall reconstruction is recommended when at least 3 ribs are resected or the size of the chest wall defect is >3 cm [5]. A case of an asymptomatic 29-years old female with a tumor size of 10 cm × 12 cm on the left anterior chest wall involving the 8th rib is presented through this paper which was later diagnosed histologically as chondrosarcoma with atypical chondroblastoma like areas. "
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    ABSTRACT: Chondrosarcoma of a rib is a very rare malignant tumor of the bone. Most patients were present with an enlarging painful anterior chest wall tumor. We present a case of an asymptomatic 29-years old female with a tumor size of 10cm×12cm on the left anterior chest wall involving the 8th rib. CT scan with intravenous contrast is the gold standard for radiological imaging and planning for surgery. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment. Copyright © 2015 Z. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Mar 2015 · International Journal of Surgery Case Reports
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    • "For a chest wall reconstruction, it is necessary to do a skeletal and soft tissue reconstruction. Management of the pleural cavity is important to decrease the rate of postoperative complications and mortality [1]. The availability of prosthetic materials influences the surgeon's choice, and complications are sometimes caused by those materials [2] [3] [4]. "
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    ABSTRACT: A large full-thickness chest wall defect over 10 cm in diameter requires skeletal reconstruction and soft tissue coverage. Use of various flaps for soft tissue coverage was previously reported, but en bloc resection in each case affects these flap pedicles and sizes. We present a case of a 74-year-old man with a soft tissue tumor involving the left lateral chest wall. We performed an en block resection and skeletal reconstruction using a mesh, free tensor fascia lata (TFL) flap for soft tissue coverage. This procedure could be performed in one position. A fixed fascia lata of the flap was also useful for tight reconstruction with the mesh. We suggest that free TFL and/or anterior lateral thigh flap is a useful technique to reconstruct anterior to posterior lateral chest wall defects.
    Full-text · Article · Sep 2013 · Case Reports in Medicine
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    • "The additional impairment of respiratory function related to the combined procedure is as high as 27% as highlighted in a recent paper from Memorial Sloan Kettering Cancer Center, NY, USA [1]. Most of the papers addressing the issue of pneumonectomy with chest wall resection conclude that this procedure should be performed only in highly selected patients [1] [2] [3] [4] [5] [6] and should not be routinely recommended. Such negative attitude denies some patients the chance of a potentially radical and curative procedure. "
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    ABSTRACT: OBJECTIVE Pneumonectomy with en bloc chest wall resection is often denied because of the procedure-related high risk. We evaluated the short- and long-term outcome of this procedure.METHODS From January 1995 to October 2011, 34 patients (30 males and 4 females; mean age: 61.8 years) underwent pneumonectomy with en bloc chest wall resection for 33 non-small-cell lung cancer and 1 metastatic osteosarcoma in two institutions. Data were retrospectively reviewed.RESULTSOperative (30-day) mortality was 2.9% (1 of 34), and morbidity was 38.2% (13 of 34). There were 14 (41.1%) right-side procedures and 20 (58.8%) left-side procedures. Three (8.8%) patients developed bronchopleural fistulas. The mean number of resected ribs per patient was 2.7 ± 1.1. In 13 (38.2%) patients, a prosthetic reconstruction of the chest wall was needed. In 3 (8.8%) cases, the bronchial step was buttressed. Preoperative pain was statistically significantly related to the depth of chest wall invasion (P = 0.026). The N status was N0 in 18 (52.9%) cases, N1 in 9 (26.4%), N2 in 6 (17.6%) and Nx in 1 (metastatic osteosarcoma). Patients were followed-up for a total of 979 months. The median survival was 40 months. The overall 5-year survival was 46.8% (±95% confidence interval [CI]: 0.2-0.6): 45.2 (±95% CI: 0.03-0.8) for right-side and 48.4% (±95% CI: 0.2-0.7) for left-side procedures, respectively. According to the N status, the 5-year survival was 59.7 (±95% CI: 0.3-0.8) in N0, 55.5 (±95% CI: 0.06-1) in N1 and 16.6% (±95% CI: 0-0.4) in N2. The subgroup N0 plus N1 (27 patients) showed a 58.08% (±95% CI: 0.3-0.8) 5-year survival compared with 16.6% (±95% CI: 0-0.4) in N2 (χ(2): 3.7; P = 0.053).CONCLUSION Pneumonectomy with en bloc chest wall reconstruction can be safely offered to selected patients. The addition of en bloc chest wall resection to pneumonectomy does not affect operative mortality and morbidity compared with standard pneumonectomy. The pivotal additional effect of the chest wall resection should not be considered a contraindication for such procedures. Survival showed a clinically relevant difference by comparing N0 plus N1 with N2 (58.1 vs 16.6%), not confirmed by the statistical analysis (P = 0.053).
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