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Theodorou CM, Lawrence YS, Brown EG. Chest wall reconstruction in pediatric patients with chest wall tumors: A systematic review. J Pediatr Surg 2022:S0022-3468(22)00736-9. [PMID: 36585305 DOI: 10.1016/j.jpedsurg.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes. METHODS A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction. RESULTS There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing's sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin's tumor (n = 16, 8.5%; a subset of Ewing's sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months. CONCLUSIONS In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States.
| | - Yemi S Lawrence
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
| | - Erin G Brown
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
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Colella S, Brandimarte A, Marra R, Marinari S, D’Incecco A, Di Genesio Pagliuca M, De Vico A, Crisci R, Divisi D. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview. Front Surg 2022; 9:976463. [PMID: 35990091 PMCID: PMC9381953 DOI: 10.3389/fsurg.2022.976463] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Several materials and techniques have been described for the procedure of chest wall reconstruction: the choice of using a technique or a material over another relies mainly on the surgeon's experience as well as thoracic defect localization and dimension, local availability of materials, and costs. From a technical point of view, autologous and alloplastic reconstruction are available, and, in both cases, rigid and non-rigid prostheses are found. Each material has its peculiarities, with advantages and disadvantages; thus, it is mandatory to be confident when planning the intervention to foresee possible complications and minimize them. We have reviewed the literature on chest wall reconstruction in chest wall tumors (both malignant and non malignant) with non-rigid prosthetic materials, focusing on safety outcomes.
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Affiliation(s)
- Sara Colella
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | | | - Roberta Marra
- Unit of Respiratory Diseases, “V. Fazzi” Hospital, Lecce, Italy
| | - Stefano Marinari
- Unit of Respiratory Diseases, “G. Mazzini” Hospital, Teramo, Italy
| | - Armida D’Incecco
- Medical Oncology Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | | | - Andrea De Vico
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Roberto Crisci
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
| | - Duilio Divisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy
- Correspondence: Duilio Divisi ;
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Gangopadhyay A, Nandy K, Puj K, Sharma M, Jayaprakash D, Salunke A, Jain A, Pandya S. Primary chest wall sarcoma; a single institution experience of 3 years. Cancer Treat Res Commun 2021; 27:100326. [PMID: 33524850 DOI: 10.1016/j.ctarc.2021.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Primary chest wall sarcoma is a rare entity. It can be classified based on its origin, as bone sarcomas or soft tissue sarcomas. Various prognostic factors have been studied in different case series like age, sex, tumor histology, grade, resection margin status, adjuvant treatment, and others. The present study aimed to analyze common histological types, their management by resection and reconstruction and prognosis, in cases presenting at a regional cancer center in western India. MATERIAL AND METHOD This was an observational study from a prospectively maintained database. 57 patients with chest wall sarcoma treated with curative intent between January 2016 till January 2019 with a minimum follow-up of 3 months were included in the study. The goals of surgical treatment were to obtain a wide resection margin of 3-4 cm, preserve the function of the chest wall and provide stability and rigidity to protect intrathoracic organs. RESULTS The median follow-up of the present patient's cohort was for 20.2 months. Overall two-year survival was 74.7%. Two-year OS and DFS of bone sarcoma were 62.3% and 35% and soft tissue sarcomas were 91% and 71.3%. Ewing's sarcoma had the worst two-year overall survival of 50.6% and chondrosarcoma and fibromatosis had 100% two-year overall survival. CONCLUSION Chest wall sarcoma forms a heterogeneous group of tumors. In the present study, Ewing's sarcoma was the most common histology with the worst survival, since they presented in advanced stages. Management should be multidisciplinary and surgical resection should be aggressive to achieve an R0 resection. Reconstruction of chest wall should aim to provide structural and functional stability with minimal morbidity. Frozen section assessment should be utilized whenever in doubt.
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Affiliation(s)
- Abhishek Gangopadhyay
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Kunal Nandy
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Ketul Puj
- Assistant Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Mohit Sharma
- Associate Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Dipin Jayaprakash
- Surgical Oncology Resident Doctor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Abhijeet Salunke
- Assistant Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Abhishek Jain
- Associate Professor, Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Shashank Pandya
- Director, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
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The surgical management of sarcomas of the chest wall: A 13-year single institution experience. J Plast Reconstr Aesthet Surg 2020; 73:1448-1455. [DOI: 10.1016/j.bjps.2020.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/19/2020] [Accepted: 02/16/2020] [Indexed: 11/22/2022]
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Shah AC, Komperda KW, Mavanur AA, Thorpe SW, Weiss KR, Goodman MA. Overall survival and tumor recurrence after surgical resection for primary malignant chest wall tumors: a single-center, single-surgeon experience. J Orthop Surg (Hong Kong) 2020; 27:2309499019838296. [PMID: 30939982 DOI: 10.1177/2309499019838296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Malignant primary chest wall tumors (PCWTs) comprise a rare group of thoracic tumors with unique anatomical considerations, and experience with wide surgical resection is limited to specialty referral centers and specific diagnoses. We investigated the tumor recurrence and overall survival (OS) for patients with a variety of PCWTs diagnoses at our institution. METHODS From 1991 to 2010, patients with malignant PCWT undergoing wide surgical resection for curative intent under a single surgeon were reviewed. Diagnosis and grade (if applicable) of surgical pathology, along with patient demographics, neoadjuvant chemotherapy or radiation therapy, and outcomes (complications, recurrence, and OS) at follow-up were analyzed. RESULTS One hundred fifteen patients were included in the study. The most common tumor diagnoses included pleomorphic sarcoma and liposarcoma. Negative margins were achieved in 70 (74%) of cases. Postoperative complications were reported in 21 (20%) cases. The 5-year survival rate was 54%, while the 10-year survival rate was 29%. The local and distant recurrence rates were 50% and 38%, respectively. OS was significantly less in patients with any recurrence ( p < 0.001) but not significantly different between pathology grades ( p = 0.28). CONCLUSIONS Wide resection for malignant PCWT is feasible when undertaken for a heterogenous group of diagnoses.
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Affiliation(s)
- Aalap C Shah
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kazimierz W Komperda
- 2 Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Arun A Mavanur
- 3 Department of Surgical Oncology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Steven W Thorpe
- 4 Department of Orthopaedic Surgery and Musculoskeletal Oncology, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Kurt R Weiss
- 5 Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark A Goodman
- 6 Department of Orthopedic Surgery and Musculoskeletal Oncology, University of Pittsburgh Medical Center and Hillman Cancer Institute, Pittsburgh, PA, USA
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Soft Tissue Sarcomas of the Thoracic Wall: More Prone to Higher Mortality, and Local Recurrence-A Single Institution Long-Term Follow-up Study. Int J Surg Oncol 2019; 2019:2350157. [PMID: 30956820 PMCID: PMC6425367 DOI: 10.1155/2019/2350157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives This study aims to assess the impact of surgical margin and malignancy grade on overall survival (OS) and local recurrence free rate (LRFR) for soft tissue sarcomas (STS) of the thoracic wall. Methods This retrospective cohort study identified 88 patients, diagnosed and treated surgically for a nonmetastatic STS located in the thoracic wall between 1995 and 2013, using the population based and validated Aarhus Sarcoma Registry and Danish Sarcoma Registry. The Kaplan-Meier method was used to estimate OS and LRFR. Multivariate Cox analyses were used to determine prognostic factors for OS and LRFR. Results The 5-year OS was 55% (95% confidence interval (CI): 0.44-0.65) and 5-year LRFR was 77% (95% CI: 0.67-0.85). High malignancy grade and intralesional/marginal resection were identified as negative predictors for OS. High grade was the only prognostic factor associated with a lower LRFR. Conclusions In this large, single institution, study tumor grade was the key predictor for OS and LRFR. Surgical margin only statistically significantly influenced mortality, not local recurrence.
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Kress RL, Dalwadi SM, Irani AD. R0 resection and reconstruction for a large, rapidly progressive chest wall sarcoma. J Cardiothorac Surg 2018; 13:127. [PMID: 30558620 PMCID: PMC6296059 DOI: 10.1186/s13019-018-0812-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/03/2018] [Indexed: 01/03/2023] Open
Abstract
Background Chest wall sarcomas are a rare group of soft tissue malignancies with variable presentations. Here we describe the definitive management of a large, rapidly progressing chest wall sarcoma arising from the pectoralis major muscle. Case report An obese 42-year-old African American male with multiple medical comorbidities presented with new onset right-sided chest pain and a palpable right chest mass. Initial CT chest demonstrated a 9x9x9cm necrotic mass arising from the pectoralis major. CT-guided core biopsy was positive for high-grade spindle cell neoplasm (positive for smooth muscle actin, desmin, S100, and CD31; negative for CD34, PAX8, and beta-catenin). Staging imaging 2 months later demonstrated growth of the mass to 21.4 × 17.8 × 13.7 cm. The patient underwent neoadjuvant chemoradiation with surveillance CT imaging demonstrating a stable tumor. Then he underwent wide local excision of the mass followed by delayed local myocutaneous flap reconstruction and skin grafting. Final pathology was R0 resection, 38x20x18 cm tumor with 70% gross necrosis. Microscopic examination confirmed high-grade sarcoma with smooth muscle differentiation. Final pathologic staging was Stage III G3 pT2bNxMx. Conclusions This patient presented with a rare, rapidly enlarging high-grade leiomyosarcoma of the chest wall without metastases or violation of the thorax. We describe the definitive management including a multidisciplinary team to manage a complex and rapidly progressive sarcoma of the chest wall.
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Affiliation(s)
- Robert L Kress
- Department of Surgery, UT Health at McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA.
| | - Shraddha M Dalwadi
- Department of Surgery, UT Health at McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA
| | - Adel D Irani
- Department of Cardiothoracic And Vascular Surgery, UT Health at McGovern Medical School, Houston, USA
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Ma XL, Wang DB, Ma JX, Wang Y, Sun L, Lu B, Wang Y, Zhao XW, Li F, Fan ZR, Han B, Bai HH, Yang BC, Jiang X, Tian AX, Dong BC, Du YR. Custom-made Prosthesis for Reconstruction after Radical Resection for Chondrosarcoma of Manubrium. Orthop Surg 2018; 10:272-275. [PMID: 30152608 DOI: 10.1111/os.12388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/16/2018] [Indexed: 02/04/2023] Open
Abstract
The clinical incidence of tumors in the manubrium is not high. Regardless of whether the tumor is primary or metastatic, the tumor should be completely removed as long as the patient is able to tolerate the surgery. This procedure can lead to sternal defects. Deciding on the method of defect reconstruction is a critical problem that clinicians face. In this , to reduce the limitations of the patient's upper body movement after surgery due to the inflexibility in the connections of the sternal prosthesis, we created a prosthesis using a computer-assisted design method and a 3-D technique, to completely preserve the agility of the sternum and maximize the patient's post-operational movement. The method used in the present study takes into consideration the individual's chest anatomy, sternum stress, and many other biological characteristics. Care is taken to measure the sternum size accurately, to provide personalized treatment, to accomplish precise results, and to reduce potential future damage. The patient's shoulder function was improved following the procedure.
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Affiliation(s)
- Xin-Long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China.,Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong-Bin Wang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jian-Xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ying Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lei Sun
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Bin Lu
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yan Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xing-Wen Zhao
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Fei Li
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zheng-Rui Fan
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China.,Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Biao Han
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China.,Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao-Hao Bai
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Bao-Cheng Yang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China.,Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuan Jiang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ai-Xian Tian
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ben-Chao Dong
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yu-Ren Du
- Tianjin Hospital, Tianjin University, Tianjin, China
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Ghailane S, Fauquier S, Lepreux S, Le Huec JC. Malignant triton tumor: Grand Round presentation of a rare aggressive case thoracolumbar spine tumor. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 28:1448-1452. [PMID: 28924675 DOI: 10.1007/s00586-017-5277-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/20/2017] [Accepted: 08/17/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We report a rare and aggressive case of malignant triton tumor (MTT) at the thoracolumbar junction with foraminal extension mistreated as schwannoma. MATERIALS AND METHODS A 70-year-old man with a 2-year history of lower back pain and left L4 radiculopathy with no history of neurofibromatosis. RESULTS Pre-operative MRI suggested a typical schwannoma. Upon complete marginal resection, histological findings revealed a MTT. The patient presented with a local and regional recurrence and died 10 months after surgery. MTTs are a subgroup of malignant peripheral nerve sheath tumors, which develop from Schwann cells of peripheral nerves or within existing neurofibromas, and display rhabdomyoblastic differentiation. CONCLUSION Based on the Grand Round case and relevant literature, we present a case of a highly aggressive and fast-growing tumor with a very high local and distant recurrence. There is no consensus treatment plan available and patients usually die shortly after diagnosis.
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Affiliation(s)
- Soufiane Ghailane
- Department of Spinal Surgery Unit 2, Bordeaux University Hospital, Université de Bordeaux, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Sandra Fauquier
- Department of Pathology, Bordeaux University Hospital, Université de Bordeaux, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Sébastien Lepreux
- Department of Pathology, Bordeaux University Hospital, Université de Bordeaux, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Charles Le Huec
- Department of Spinal Surgery Unit 2, Bordeaux University Hospital, Université de Bordeaux, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France.
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10
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Akhtar A, Shah S, Sheikh AB, Nasrullah A, Haq S, Ghazanfar H, Rizwan M. Sarcoma Arising from the Chest Wall : A Case Report. Cureus 2017; 9:e1604. [PMID: 29075582 PMCID: PMC5654960 DOI: 10.7759/cureus.1604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chest wall contains a wide array of tissues ranging from soft tissues like skin and muscle to bone. A variety of sarcomas can present with a painful or painless mass, which often requires histological testing for diagnosis. Chest wall sarcomas are very rare entities which are often growing slow . A multidisciplinary team is necessary for the management of chest wall sarcomas. We present a case of a 30-year-old male with spindle cell sarcoma of the chest wall and he underwent wide local excision along with surgical reconstruction.
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Affiliation(s)
- Aisha Akhtar
- Surgery, Texas Tech Health Sciences Center Lubbock
| | - Sana Shah
- Student, Aga Khan University Hospital, Karachi
| | | | - Adeel Nasrullah
- Department of Internal Medicine, Shifa International Hospital
| | - Shujaul Haq
- Department of Internal Medicine, Shifa International Hospital
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Kirschner Wire and Bone Cement is a Viable Alternative to Reconstruction of Large Iliac Bone Defects After Strut Bone Graft Harvesting. Clin Spine Surg 2017; 30:308-313. [PMID: 28746126 DOI: 10.1097/bsd.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To assess the safety and efficacy of iliac crest defect reconstruction using Kirschner wire (K-wire)/polymethylmethacrylate (PMMA) versus traditional autologous rib graft reconstruction. SUMMARY OF BACKGROUND DATA The iliac crest has been the preferred donor site for strut bone graft for various spinal fusion surgeries. METHODS Seventy-three patients (44 males and 29 females; average age: 57.2 y) were divided into 2 groups: the rib group (35 patients) and the K-wire/PMMA group (38 patients). All operations involved anterior spinal interbody fusion. Patients were followed-up, on average, for 34.2 months using plain radiographs and both pain and cosmesis visual analog scales (VAS) to assess the clinical results after surgery. RESULTS Almost all patients had pain VAS scores of ≤1 and grade 1 cosmesis VAS scores with no significant difference between the 2 groups in terms of either pain or cosmesis (P=1.00 and 0.505, respectively). In addition, few complications were noted in both groups. Radiographic complications in the rib group and the K-wire group numbered 4 (11%) and 2 (5%), respectively; however, did not significantly differ between the 2 groups (P=0.418). One case required intraoperative revision of the length of the K-wire and 1 case needed reoperation for iliac ring fracture and K-wire migration. An additional case required revision due to a bad fall. CONCLUSIONS K-wire and bone cement reconstruction is an effective and safe alternative method for large iliac bone defect repair when autologous rib graft is not available.
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12
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A multidisciplinary approach to giant soft tissue sarcoma of the chest wall: A case report. Int J Surg Case Rep 2016; 28:211-213. [PMID: 27721200 PMCID: PMC5061302 DOI: 10.1016/j.ijscr.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/30/2016] [Accepted: 10/02/2016] [Indexed: 12/29/2022] Open
Abstract
Chest wall sarcomas most commonly present as painless slow growing masses. Resection is often precarious due to involvement of important structures. The multidisciplinary approach is crucial for the optimal management of this tumor.
Introduction Soft tissue sarcomas of the chest wall are exceptionally rare entities that present as painless slow growing masses. Resection is often precarious due to involvement of vital structures, and patients are left with large chest wall defects postoperatively requiring extensive reconstruction. Presentation of case We present a case report of a 29 year-old man who presented with a giant soft tissue sarcoma of the chest that had been growing slowly for one year prior to presentation. The patient had a biopsy that was positive for sarcoma, and PET CT demonstrated a large lobulated mass in the left chest wall with an SUV of 6.7. He received 50 Gy of radiation therapy; however, the mass continued to grow in size. He subsequently underwent an en-bloc resection of the mass with latissimus and serratus muscle primary reconstruction. Final pathology showed a 27 cm high-grade fibrosarcoma with prominent myxoid component. To our knowledge, this is the largest soft tissue sarcoma of the chest wall reported in the literature. Postoperatively, the patient received 6 cycles of adjuvant chemotherapy. Discussion Surgery is the mainstay of treatment, and chemotherapy and radiation are used in specific circumstances. Risk of recurrence is dependent on many factors, including histologic subtype, grade, and size of tumor. Long term surveillance with physical exam and imaging is recommended. Conclusion We feel that the multidisciplinary approach is crucial for optimal management of large soft tissue sarcomas. We recommend this approach to all patients with chest wall sarcomas.
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Li G, Liu C, Liu Y, Xu F, Su Z, Wang Y, Ren S, Deng T, Huang D, Tian Y, Qiu Y. Analysis of clinical features and prognosis of malignant triton tumor: A report of two cases and literature review. Oncol Lett 2015; 10:3551-3556. [PMID: 26788168 DOI: 10.3892/ol.2015.3762] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 06/22/2015] [Indexed: 11/06/2022] Open
Abstract
Malignant triton tumor (MTT) is a malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. The prognosis of patients is poor, and due to its rarity, large case studies are lacking. The aim of this study is to describe the clinical features and identify potential prognostic factors. Two patients with MTT in the head and neck treated at our department are reported. A literature search revealed another 198 published cases. All of these cases then went through a retrospective analysis. The ratio of male-to-female incidence was 1.5:1, and the median age at diagnosis was 29 years. In 41.7% of cases it occurred in patients with neurofibromatosis type 1. The five-year survival of MTT was found to be just 35%. Cox proportional hazards analysis revealed that complete resection (hazard ratio, 0.396; P=0.032) and metastases (hazard ratio, 3.188; P=0.004) were associated with mortality, indicating that complete resection may lead to a longer life span, and that the existence of metastasis suggested a worse prognosis for patients with MTT.
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Affiliation(s)
- Guo Li
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Chao Liu
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yong Liu
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Fang Xu
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zhongwu Su
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yunyun Wang
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Shuling Ren
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Tengbo Deng
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Donghai Huang
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yongquan Tian
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yuanzheng Qiu
- Department of Otolaryngology and Head-Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Otolaryngology Major Disease Research Key Laboratory of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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14
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High-grade soft tissue sarcomas of the extremities: surgical margins influence only local recurrence not overall survival. INTERNATIONAL ORTHOPAEDICS 2015; 39:935-41. [PMID: 25743028 DOI: 10.1007/s00264-015-2694-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE After surgical treatment of high-grade soft tissue sarcomas, local recurrences, metastases and survival remain a great concern. Further knowledge on factors with a possible impact on these endpoints, specifically resection margins, is relevant for decision-making regarding the aggressiveness of local treatment. The aim of this study is to investigate the impact of prognostic factors on local recurrence and overall survival for patients with high-grade soft tissue sarcomas of the extremities. METHODS In a retrospective cohort study of 127 patients (mean age 48 years, range five to 91; median follow-up 71 months) the prognostic effect of margin status and other clinicopathologic characteristics on local recurrence and overall survival were analysed by employing a multivariate Cox regression. RESULTS Five-year cumulative incidence of local recurrence and distant metastases was 26% and 40%, respectively. The estimated five-year overall survival was 59%. Tumour size proved a consistent adverse prognostic factor for local recurrence (hazard ratio (HR) 3.9), distant metastasis (HR 4.9) and overall survival (HR 2.4). The significant association of resection margins with local recurrence (HR 10.2) was confirmed. Margins were however not significantly associated with the occurrence of distant metastasis or overall survival. The occurrence of local recurrence had a significant impact on overall survival (HR 2.0). CONCLUSIONS The results of this study confirm the critical role of tumour size on survival and margins on local recurrence, and stress the need for further investigation concerning the association between margins, local recurrence and survival.
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15
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Temiz G, Şirinoğlu H, Yeşiloğlu N, Sarıcı M, Çardak ME, Demirhan R, Bozkurt M. A salvage maneuver for the caudal part of the pectoralis major muscle in the reconstruction of superior thoracic wall defects: The pectoralis kite flap. J Plast Reconstr Aesthet Surg 2015; 68:698-704. [PMID: 25704731 DOI: 10.1016/j.bjps.2015.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/11/2015] [Indexed: 11/18/2022]
Abstract
The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.
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Affiliation(s)
- Gökhan Temiz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Hakan Şirinoğlu
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey.
| | - Nebil Yeşiloğlu
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - Murat Sarıcı
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | | | - Recep Demirhan
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Thoracic Surgery, Istanbul, Turkey
| | - Mehmet Bozkurt
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey
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