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Khamitov K, Dudek W, Arkudas A, Haj Khalaf M, Parjiea C, Higaze M, Horch RE, Sirbu H. Interdisciplinary Treatment of Malignant Chest Wall Tumors. J Pers Med 2023; 13:1405. [PMID: 37763172 PMCID: PMC10532685 DOI: 10.3390/jpm13091405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest wall resections for malignant chest wall tumors (MCWTs), particularly those with full-thickness chest wall involvement requiring reconstruction, present a therapeutic challenge for thoracic and plastic reconstructive surgeons. The purpose of this study was to review our experience with chest wall resection for primary and metastatic MCWTs, with a focus on perioperative outcomes and postoperative overall survival (OS). METHODS All patients who underwent surgical resection for primary and secondary MCWTs at our single institution between 2000 and 2019 were retrospectively analyzed. RESULTS A total of 42 patients (25 male, median age 60 years) operated upon with curative (n = 37, 88.1%) or palliative (n = 5, 11.9%) intent were reviewed. Some 33 (78%) MCWTs were of secondary origin. Chest wall reconstruction was required in 40 (95%) cases. A total of 13 (31%) patients had postoperative complications and one (2.3%) died perioperatively. The 5-year postoperative overall survival rate was 51.9%. The postoperative 5-year survival rate of 42.6% in patients with secondary MCWTs was significantly lower compared to the figure of 87.5% in patients with primary MCWTs. CONCLUSIONS In well-selected patients, chest wall resections for primary and secondary MCWTs are feasible and associated with good perioperative outcomes. For secondary MCWTs, surgery can also be performed with palliative intent.
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Affiliation(s)
- Koblandy Khamitov
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Wojciech Dudek
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Andreas Arkudas
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mohamed Haj Khalaf
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Chirag Parjiea
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Mostafa Higaze
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Raymund E. Horch
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Horia Sirbu
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
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Jo GY, Ki SH. Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection. Arch Plast Surg 2023; 50:10-16. [PMID: 36755660 PMCID: PMC9902099 DOI: 10.1055/s-0042-1760290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/02/2022] [Indexed: 02/09/2023] Open
Abstract
Background The chest wall defects can be caused by various reasons. In the case of malignant tumor resection of the chest wall, it is essential to reconstruct the chest wall to cover the vital tissue and restore the pulmonary function with prevention of paradoxical motion. With our experience, we analyzed and evaluated the results and complications of the chest wall reconstructions followed by malignant tumor resection. Methods From 2013 to 2022, we reviewed a medical record of patients who received chest reconstruction due to chest wall malignant tumor resection. The following data were retrieved: patients' demographic data, tumor type, type of operation, method of chest wall reconstruction of the soft and skeletal tissue and complications. Results There were seven males and six female patients. The causes of reconstruction were 12 primary tumors and one metastatic carcinoma. The pathological types were seven sarcomas, three invasive breast carcinoma, and three squamous cell carcinomas. The skeletal reconstruction was performed in six patients. The series of the flap were eight pedicled latissimus dorsi (LD) myocutaneous flaps, two pectoralis major myocutaneous flap, two vertical rectus abdominis myocutaneous free flap, and one LD free flap. Among all the cases, only one staged reconstruction and successful reconstruction without flail chest. Most of the complications were atelectasis. Conclusion In the case of accompanying multiple ribs and sternal defect, skeletal reconstruction would need skeletal reconstruction to prevent paradoxical chest wall motion. The flap for soft tissue defect be selected according to defect size and location of chest wall. With our experience, we recommend the reconstruction algorithm for chest wall defect due to malignant tumor resection.
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Affiliation(s)
- Gang Yeon Jo
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea
| | - Sae Hwi Ki
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea,Department of Plastic and Reconstructive Surgery, School of Medicine, Inha University, Incheon, South Korea,Address for correspondence Sae Hwi Ki, MD, PhD Department of Plastic and Reconstructive SurgeryInha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711South Korea
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Tanaka M, Fujimoto D, Akamatsu H, Sumikawa H, Yamamoto N. Radiographic findings useful for diagnosis of primary chest wall lymphoma without preceding pleural disease: A case report. Respirol Case Rep 2022; 10:e01019. [PMID: 35992553 PMCID: PMC9379257 DOI: 10.1002/rcr2.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
A 70-year-old man with no history of pleural diseases had a dumbbell-shaped chest wall mass extending from the thoracic cavity to the spinal canal at the intervertebral foramen without bone destruction. Computed tomography revealed a positive a 'pleural sandwich sign', where the intercostal artery was enveloped by the mass. A high maximum standard uptake value was noted on fluorodeoxyglucose-positron emission tomography. No lesions were found in areas other than the chest wall. CT-guided biopsy was performed and he was diagnosed with primary chest wall lymphoma. This case report suggests that these radiographic findings may be helpful for diagnosing chest wall lymphomas even in patients without prior pleural disease.
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Affiliation(s)
- Masanori Tanaka
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Daichi Fujimoto
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Hiroaki Akamatsu
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Hiromitsu Sumikawa
- Department of Radiology National Hospital Organization Kinki-Chuo Chest Medical Center Osaka Japan
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Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A Population-Based Analysis. Ann Thorac Surg 2020; 109:203-210. [DOI: 10.1016/j.athoracsur.2019.07.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/29/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
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Abraham VJ, Devgarha S, Mathur RM, Sisodia A, Yadav A. Dedifferentiated chondrosarcoma of the rib masquerading as a giant chest wall tumor in a teenage girl: an unusual presentation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:427-30. [PMID: 25207259 PMCID: PMC4157513 DOI: 10.5090/kjtcs.2014.47.4.427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/16/2022]
Abstract
Chondrosarcoma of the chest wall is a rare primary neoplasm found to occur in elderly men. Patients present with an enlarging, painful, anterior chest wall mass arising from either the vicinity of the costochondral junction or the sternum. Treatment includes wide resection with appropriate chest wall reconstruction. We report an unusual presentation of this uncommon tumor occurring as a huge chest wall mass in a young teenage girl.
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Affiliation(s)
| | - Sanjeev Devgarha
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Hospital
| | | | - Anula Sisodia
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Hospital
| | - Amita Yadav
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Hospital
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Friesenbichler J, Leithner A, Maurer-Ertl W, Szkandera J, Sadoghi P, Frings A, Maier A, Andreou D, Windhager R, Tunn PU. Surgical therapy of primary malignant bone tumours and soft tissue sarcomas of the chest wall: a two-institutional experience. INTERNATIONAL ORTHOPAEDICS 2014; 38:1235-40. [PMID: 24633363 DOI: 10.1007/s00264-014-2304-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/13/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Primary malignant bone tumours and soft tissue sarcomas of the chest wall are exceedingly rare entities. The aim of this study was a retrospective two-institutional analysis of surgical therapy with respect to the kind and amount of the resection performed, the type of reconstruction and the oncological outcome. METHODS Between September 1999 and August 2010 31 patients (seven women and 24 men) were treated due to a primary malignant bone tumour or soft tissue sarcoma of the chest wall in two centres. Eight low-grade sarcomas were noted as well as 23 highly malignant sarcomas. The tumours originated from the sternum in six cases, from the ribs in 12 cases, from the soft tissues of the thoracic wall in 11 cases and from a vertebral body and the clavicle in one case each. RESULTS In 26 cases wide resection margins were achieved, while four were intralesional and one was marginal. In all 31 cases the defect of the chest wall was reconstructed using mesh grafts. At a mean follow-up of 51 months 20 patients were without evidence of disease, three were alive with disease, seven patients had died and one patient was lost to follow-up. One recurrence was detected after wide resection of a malignant triton tumour. CONCLUSIONS Primary malignant bone tumour or soft tissue sarcoma of the chest wall should be treated according to the same surgical oncological principles as established for the extremities. Reconstruction with mesh grafts and musculocutaneous flaps is associated with a low morbidity.
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Affiliation(s)
- Joerg Friesenbichler
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Nagao E, Hirakawa M, Soeda H, Tsuruta S, Sakai H, Honda H. Transcatheter arterial embolization for chest wall metastasis of hepatocellular carcinoma. World J Radiol 2013; 5:45-48. [PMID: 23494685 PMCID: PMC3596611 DOI: 10.4329/wjr.v5.i2.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/01/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023] Open
Abstract
Hemothorax due to rupture of metastatic hepatocellular carcinoma (HCC) is a very rare complication with high mortality because of uncontrollable hemorrhage. A 71-year-old man treated by transcatheter arterial embolization for HCC with massive bleeding from chest wall metastasis is reported. Enhanced computed tomography and selective intercostal angiogram showed a hypervascular mass in the right chest wall and extravasation of contrast agent. After successful transcatheter arterial embolization with gelatin sponge particles and metallic coils, the patient recovered from shock without major complication. To our knowledge, a successfully treated case of hemothorax due to rupture of metastatic HCC has not previously been described.
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Mlika M, Ayadi-Kaddour A, Racil H, Marghli A, Chabbou A, Kilani T, El Mezni F. [A case of costal haemangioma]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:359-362. [PMID: 22137280 DOI: 10.1016/j.pneumo.2010.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/26/2010] [Accepted: 11/14/2010] [Indexed: 05/31/2023]
Abstract
UNLABELLED Costal primary tumors are rare and dominated by malignant tumors. Haemangioma of the bone represents only 1% of bone tumors. Costal localization accounts only for 1% of the cases and only about fifty cases have been reported in the literature. AIM The authors aim to describe a rare costal tumor, its histological features and the main differential diagnoses. OBSERVATION The authors describe the case of a 46-year-old woman who presented with chest pain. Radiological findings did not permit a malignant tumor to be ruled out and the treatment consisted of a resection of the posterior arch of the rib. Microscopic examination concluded that the patient had a costal haemangioma and the patient didn't present any recurrence after a six-year follow-up. CONCLUSION The costal haemangioma is a very rare tumor with a debated etiology. Some radiological features are specific such as the "soap bubble" or "honeycomb" aspect. However, the basis for diagnosis remains microscopic examination. These tumors have a good prognosis and no cases of recurrence have been reported following complete resection.
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Affiliation(s)
- M Mlika
- Département de pathologie, hôpital Abderrahman Mami, Tunis, Tunisie.
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Chondrosarcoma of the thorax. Sarcoma 2011; 2011:342879. [PMID: 21647360 PMCID: PMC3103988 DOI: 10.1155/2011/342879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/17/2011] [Accepted: 03/09/2011] [Indexed: 11/23/2022] Open
Abstract
Although a rare entity, chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with an enlarging, painful anterior chest wall mass arising from the costochondrosternal junction. CT scan with intravenous contrast is the gold standard radiographic study for diagnosis and operative planning. Contrary to previous dictum, resection may be performed in an appropriate surgical candidate based on imaging characteristics or image-guided percutaneous biopsy results; incisional biopsy is rarely required. The keys to successful treatment are early recognition and radical excision with adequate margins, as chondrosarcoma is relatively resistant to radiotherapy and conventional cytotoxic chemotherapy. Overall survival is excellent in most surgical series from experienced centers. Complete excision with widely negative microscopic margins at the initial operation is of the utmost importance, as local recurrence portends systemic metastasis and eventual tumor-related mortality. This paper summarizes data from relevant surgical series and thereupon draws conclusions regarding preoperative, intraoperative, and postoperative management of thoracic chondrosarcoma.
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Abstract
Primary tumors of the mediastinum and chest wall comprise a diverse group of conditions with a wide range of presentations. A thorough knowledge of thoracic anatomy is essential for appropriate diagnosis and treatment. Given their proximity to critical structures, treatment of these tumors is often challenging. Although surgery is the mainstay of therapy for most mediastinal and chest wall tumors, a multidisciplinary approach is valuable in many cases.
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Affiliation(s)
- Jae Y Kim
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson, 1515 Holcombe Boulevard, PO Box 0445, Houston, TX 77030, USA
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12
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Wouters MW, van Geel AN, Nieuwenhuis L, van Tinteren H, Verhoef C, van Coevorden F, Klomp HM. Outcome after surgical resections of recurrent chest wall sarcomas. J Clin Oncol 2008; 26:5113-8. [PMID: 18794540 DOI: 10.1200/jco.2008.17.4631] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Sarcomas of the chest wall are rare, and wide surgical resection is generally the cornerstone of treatment. The objective of our study was to evaluate outcome of full-thickness resections of recurrent and primary chest wall sarcomas. PATIENTS AND METHODS To evaluate morbidity, mortality, and overall and disease-free survival after surgical resection of primary and recurrent chest wall sarcomas, we performed a retrospective review of all patients with sarcomas of the chest wall surgically treated at two tertiary oncologic referral centers between January 1980 and December 2006. Patient, tumor, and treatment characteristics, as well as the follow-up of these patients, were retrieved from the patients' original records. RESULTS One hundred twenty-seven patients were included in this study, 83 patients with a primary sarcoma and 44 patients with a recurrence. Age, sex, tumor size, histologic type, grade and localization on the chest wall were similar for both groups. Fewer neoadjuvant and adjuvant therapies were used in the treatment of recurrences. Chest wall resection was more extensive in the recurrent group, which did not result in more complications (23%) or more reinterventions (5%). Microscopically radical resection was achieved in 80% of the primary sarcomas and 64% of the recurrences. With a median follow-up of 73 months, disease-free survival after surgery for recurrences was 18 months versus 36 months for primary sarcomas, with 5-year survival rates of 50% and 63%, respectively. CONCLUSION Although chances for local control are lower after surgical treatment of recurrent chest wall sarcoma, chest wall resection is a safe and effective procedure, with an acceptable survival.
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Affiliation(s)
- Michael W Wouters
- Department of Surgical Oncology and Medical Statistics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Gera PK, La Hei E, Cummins G, Harvey J. Thoracoscopy in Chest Wall Ewing's Sarcoma. J Laparoendosc Adv Surg Tech A 2006; 16:509-12. [PMID: 17004879 DOI: 10.1089/lap.2006.16.509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Minimally invasive surgery has a role in planning the resection of malignant chest wall tumors in the pediatric population. We studied the role of thoracoscopy in both the diagnosis and definitive surgery of chest wall Ewing's sarcoma tumors.
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Hsu PK, Hsu HS, Lee HC, Hsieh CC, Wu YC, Wang LS, Huang BS, Hsu WH, Huang MH. Management of primary chest wall tumors: 14 years' clinical experience. J Chin Med Assoc 2006; 69:377-82. [PMID: 16970274 DOI: 10.1016/s1726-4901(09)70276-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary chest wall tumor is rare but it encompasses tumors of various origins. We analyzed our experience with primary chest wall tumors with emphasis on its demographic presentation and management. METHODS From 1991 to 2004, 62 patients with the diagnosis of primary chest wall tumors were enrolled. Lipoma, chest wall metastasis, direct invasion from nearby malignancy, infection, and inflammation of chest wall were excluded. The clinical features, management, and the outcome of these patients were retrospectively reviewed. RESULTS There were 37 males and 25 females. Malignant and benign tumors were equally distributed. Chondrosarcoma and lymphoma were the 2 most common types of malignant chest wall tumors. The most common clinical symptoms were palpable mass (54.8%) and pain (40.3%). Nine of 31 patients (29.0%) with benign chest wall tumors were free of symptoms whereas patients with malignant chest wall tumors were all symptomatic (p = 0.002). A definite diagnosis was obtained in 21 of 26 patients (80.7%) who received nonexcision biopsy. All patients with primary chest wall tumors, except 6 who had medical treatment only, underwent surgical resection. Patients with malignant chest wall tumors were older than those with benign tumors (p < 0.001). The mean largest diameter of tumors was also larger in malignant tumors than in benign tumors (p = 0.04). CONCLUSION Patients with primary malignant chest wall neoplasm were older than those with benign tumors. The mean size of malignant tumors was larger than that of benign tumors. Adequate surgical resection remains the treatment of choice for patients with primary chest wall tumors. Nonexcision biopsy should be reserved for patients with a past history of malignancy, suspicion of hematologic disease, and with high operative risk. For patients with isolated chest wall lymphoma, surgical resection followed by chemotherapy can be considered to obtain a better outcome.
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Affiliation(s)
- Po-Kuci Hsu
- Divisions of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Wei YF, Wang HC, Chang YC. Hemothorax due to metastatic hepatocellular carcinoma presenting with massive hemoptysis. J Formos Med Assoc 2006; 105:346-8. [PMID: 16618616 DOI: 10.1016/s0929-6646(09)60127-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hemoperitoneum caused by ruptured hepatocellular carcinoma (HCC) is not uncommon in patients with HCC. Hemothorax due to rupture of metastatic HCC, however, is a very rare complication with high mortality because of uncontrollable hemorrhage. We describe a 42-year-old male HCC patient with chest wall metastasis complicated by hemothorax with an unusual presentation of massive hemoptysis. He received tube thoracotomy immediately and emergency surgery because of persistent bleeding. Hemostasis was achieved transiently. Despite intensive care, he died of multiple organ failure on the 6th postoperative day. We conclude that hemothorax due to a ruptured HCC, as in this case, indicates a very poor prognosis despite intensive treatment.
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Affiliation(s)
- Yu-Feng Wei
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Hsu PK, Hsu HS, Li AFY, Wang LS, Huang BS, Huang MH, Hsu WH. Non-Hodgkin’s Lymphoma Presenting as a Large Chest Wall Mass. Ann Thorac Surg 2006; 81:1214-8. [PMID: 16564245 DOI: 10.1016/j.athoracsur.2005.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 11/10/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. METHODS From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. RESULTS There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. CONCLUSIONS Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
A 73-year-old woman evidencing an abnormal shadow on chest X-ray film since 1993 was admitted after a tumor of the left 8th rib was diagnosed in 2001. Computed tomography showed a low-density mass with coarse calcification arising from the left 8th rib and protruding into the abdominal cavity. The tumor was diagnosed as low-grade chondrosarcoma by incision biopsy and was resected together with the left 7th, 8th, and 9th ribs. The chest wall was reconstructed using Marlex mesh. Histological findings were compatible with Grade I chondrosarcoma. The patient had a long clinical course without distant metastasis thanks to the tumor's low malignancy.
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Affiliation(s)
- Takehiko Shimoyama
- Department of Thoracic Surgery, Cancer Center of Niigata Hospital, Niigata, Japan
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Abstract
A 59-year-old man with an enlarged left chest wall mass that had been followed up for 3 years underwent surgical resection. The mass was pathologically diagnosed as cavernous hemangioma of the rib. This is the fourth case of this rare disease to be reported. However, it suggests that hemangioma of the rib should be considered in the differential diagnosis of rib tumors, especially in asymptomatic patients.
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Affiliation(s)
- Katsuhiko Shimizu
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
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Warzelhan J, Stoelben E, Imdahl A, Hasse J. Results in surgery for primary and metastatic chest wall tumors. Eur J Cardiothorac Surg 2001; 19:584-8. [PMID: 11343936 DOI: 10.1016/s1010-7940(01)00638-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Resection of chest wall tumors is often indicated for palliation from pain or chronic ulceration. However, under various conditions, it may lead to lasting tumor control and substantial freedom of disease might be achieved. Therefore, the long-term survival after chest wall resection for primary and metastatic tumors and its relation to the underlying histology was analyzed. METHODS The medical files of 82 consecutive patients with tumors of the chest wall operated between 1 January 1989 and 31 October 1998 were reviewed. Follow-up data were collected from the outpatient's clinic and house physicians, respectively. Complete excision was accomplished in 71 patients. In 19 patients, partial or complete resection of the sternum was performed. Twenty-eight patients underwent chest wall resection extending to intrathoracic structures (lung, diaphragm, pericardium). The following subgroups were defined according to the histology: (A), sarcoma (n=32); (B), breast cancer (n=22); (C), renal cell cancer (n=9); (D), other metastases (n=7); (E), miscellaneous (n=12). The survival probability was calculated by the Kaplan-Meier method (SAS software system). RESULTS One of 41 female patients died from postoperative complications on day 30 after resection of ulcerating breast cancer recurrence (hospital mortality, 1.2%). The median survival times in groups A-E were 27, 32, 19, 16 and 22 months, respectively. CONCLUSIONS Chest wall resection offers immediate relief in the case of severe pain and unpleasant sequelae of ulceration. Moreover, it contributes to substantial long-term survival. This, in particular, applies to local recurrence after breast cancer.
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Affiliation(s)
- J Warzelhan
- Department of Thoracic Surgery, University Hospital of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
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Rupprecht H, Spriewald BM, Hoffmann AR. Successful removal of a giant recurrent chondrosarcoma of the thoracic wall in a patient with hereditary multiple exostoses. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:216-7. [PMID: 11289764 DOI: 10.1053/ejso.2000.1025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chondrosarcoma represents the most common malignant tumour of the chest wall, with a tendency for local recurrence after resection. Here we report the successful complete resection of a giant, local recurrent chondrosarcoma of the chest wall (max. diameter 25 cm), in a patient with hereditary multiple exostoses, who had had a wide resection 8 years before. Clinical features and surgical management are described.
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Affiliation(s)
- H Rupprecht
- Department of Surgery, University Erlangen-Nürnberg, Germany
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21
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Walsh GL, Davis BM, Swisher SG, Vaporciyan AA, Smythe WR, Willis-Merriman K, Roth JA, Putnam JB. A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections. J Thorac Cardiovasc Surg 2001; 121:48-60. [PMID: 11135159 DOI: 10.1067/mtc.2001.111381] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary sarcomas involving the chest wall requiring full-thickness excision are rare. We reviewed our experience with these lesions in a tertiary referral cancer center by using multidisciplinary approaches. METHODS A 10-year retrospective study identified 51 patients referred with primary sarcomas of the chest wall: 40 for initial treatment and 11 after previous unsuccessful surgical excisions elsewhere (secondary referral). Presenting symptoms were pain alone in 23 (45%) of 51 patients, pain with an associated mass in 8 (16%) patients, and an asymptomatic mass alone in 13 (25%) patients. Median symptom duration was 241 days in the primary group and 225 days in the recurrent group. Tumor locations were the sternum (n = 11), the rib alone (n = 36), and the posterior rib with extension into vertebral bodies (n = 4). Histologic types included the following: chondrosarcomas (n = 15), malignant fibrous histiocytomas (n = 9), osteosarcomas (n = 4), Ewing sarcomas (n = 3), desmoid tumors (n = 7), and other types (n = 13). The median tumor volume of those referred initially was 311 cm(3) compared with 84 cm(3) in patients with recurrent lesions. RESULTS Twenty-six (51%) of 51 patients received treatment before resection, including chemotherapy alone (n = 22), radiation alone (n = 3), and combined chemotherapy and radiation therapy (n = 1). The complete sternum was removed in 6 of 11 patients, and the average number of ribs requiring resection was 3.8. Four patients had vertebral body resections. Prosthetic meshes alone were required in 16 of 51 patients, and meshes with methylmethacrylate were required in 18 of 51 patients. Muscle flap reconstructions by plastic surgery were required in 24 patients. Negative margins were obtained in 47 of 51 patients. There were no perioperative deaths with morbidities occurring in 12 (24%) of 51 patients (wound [n = 3], prolonged air leak [n = 1], prolonged ventilator requirement [n = 1], arrhythmias [n = 3], doxorubicin (Adriamycin)-induced cardiomyopathy [n = 1], and other [n = 3]). Postoperative treatment was administered to 13 patients (chemotherapy alone, n = 9; chemotherapy with radiation therapy, n = 4). The cumulative 5-year survival of all patients was 64% (initial referral, 61.3%; secondary referral, 72.7%). The average follow-up is 44.7 months. CONCLUSIONS A combined aggressive multidisciplinary approach to primary sarcomas of the chest wall resulted in no treatment-related deaths and a cumulative 5-year survival of 64% in patients referred to our tertiary care cancer center.
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Affiliation(s)
- G L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Chowdhury SK, Subbarao KSVK, Nachiappan M, Agrawal K. Primary Neoplasm of the Chest Wall: Surgical Management. Asian Cardiovasc Thorac Ann 2000. [DOI: 10.1177/021849230000800313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From January 1986 to December 1997, 17 patients (12 males and 5 females) aged 13 to 70 years were treated for primary neoplasms of the chest wall. There were 4 cases of fibrous dysplasia, 3 each of chondrosarcoma and Askin's tumor, 2 of plasmacytoma, and 1 each of fibrosarcoma, Ewing's sarcoma, synovial sarcoma, osteosarcoma, and enchondroma. All patients, except the case of Ewing's sarcoma, underwent wide excision or debulking for unresectable tumor, and reconstruction of the chest wall. Preoperative neoadjuvant chemotherapy was given to 1 patient with osteosarcoma, radiotherapy and chemotherapy were given to 2 others. In 8 patients, the skeletal defect was reconstructed with prosthetic material. Soft tissue reconstructive procedures with various myocutaneous flaps were performed in 6 patients. None of the patients required mechanical ventilation postoperatively. There were 2 early deaths. During follow-up of 3 months to 10 years, all patients with benign tumors were free of recurrence, 2 with Askin's tumors and 1 with osteosarcoma died. Prefabricated acrylic ribs are recommended for skeletal support during chest wall reconstruction.
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Affiliation(s)
| | | | | | - Karoon Agrawal
- Department of Plastic Surgery Jawaharlal Institute of Postgraduate Medical Education & Research Pondicherry, India
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Abstract
PURPOSE Primary chest wall malignancies, which occur infrequently in children, can pose complex technical challenges to the surgeon. This study was undertaken to evaluate the pathology, treatment approaches, role of surgical resection and reconstruction, and outcomes of patients with these tumors. METHODS This is a retrospective review of all patients with malignant primary chest wall tumors treated at our institution between February 1983 and July 1998. RESULTS Nineteen cases were identified: malignant small round cell type (MSRCT, also called Ewing's sarcoma, primitive neuroectodermal tumor [PNET], and Askin's tumor; n = 8), rhabdomyosarcoma (RMS; n = 6), and other tumors (n = 5). Three patients underwent "upfront" complete resections. Sixteen patients underwent initial biopsy, followed by chemo- or radiotherapy. Nine of these 16 survived to undergo delayed chest wall resections. Six of the 12 "resected" patients required en bloc resection of adjacent muscles or organs; 7 required complex chest wall reconstruction. Eight of 19 patients (42%) have survived (median follow-up of survivors, 4 years), all with no evidence of disease; the remaining 11 patients died of progressive disease. Local invasion did not alter chance of survival. Two of the 10 patients with metastases at diagnosis (20%) survived. Six of the 9 patients (67%) with localized disease survived. All five patients with tumor types other than MSRCT or RMS, metastatic or not at diagnosis, are alive with no evidence of disease. There were no local recurrences. CONCLUSION Surgical resection, with en bloc removal of involved structures and chest wall reconstruction, provides excellent local control of malignant chest wall tumors.
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Affiliation(s)
- N C Dang
- Department of Surgery, Children's Hospital, Los Angeles, CA, USA
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24
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Seyfer AE. Breast cancer invasion into the chest wall with resection and reconstruction. Semin Thorac Cardiovasc Surg 1999; 11:285-92. [PMID: 10451261 DOI: 10.1016/s1043-0679(99)70070-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the advent of limited resections and radiation therapy in the treatment of breast cancer, a substantial number of women experience recurrence or persistent disease that invades the skin, soft tissues, and musculoskeletal layers of the chest wall. This problem, which can compromise local control of the tumor, can also involve pleura, lung tissue, and mediastinal structures. This article will cover some of the pertinent clinical decisions related to these lesions, their prognosis, and management by chest wall resection and reconstruction.
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Affiliation(s)
- A E Seyfer
- Division of Plastic and Reconstructive Surgery, Oregon Health Sciences University, Portland 97201-3098, USA
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25
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Abstract
A chondrosarcoma is the most common primary malignant tumor of the chest wall. It usually presents on the anterior chest wall arising from the costochondral arches or sternum. It may occur as the result of malignant degeneration of a benign chondroma. Both chondrosarcomas and benign chondromas present as painful, slow-growing, hard, fixed, and nontender anterior chest wall masses. Microscopic differentiation between the two tumors is difficult and the treatment for both tumors is wide excision with a margin of at least 4 cm. Chemotherapy is ineffective and radiation therapy is used only for patients with tumors that are either not amenable to surgical resection or have positive resection margins.
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Affiliation(s)
- J Somers
- Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
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26
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Abstract
Chest wall reconstruction has been refined and expanded in recent years so that almost any defect may be repaired with an excellent cosmetic and physiological result. The first step in a good reconstruction is an appropriate and thorough resection that leaves healthy, viable margins to which the materials and tissues used in a reconstruction may be anchored securely. In most instances, chest wall stabilization will not be necessary. In some cases in which large areas of chest wall will be removed or a lateral aspect of a chest wall needs to be resected, stabilization may be necessary. Stabilization may also be required in patients who suffer from debilitating lung disease and need a chest wall resection and reconstruction. Soft tissue coverage completes the reconstruction by moving healthy, viable tissue to fill the defect. In most instances, pedicled muscular, musculocutaneous, and omental flaps will provide adequate soft tissue coverage. Very infrequently, a free flap will be necessary to achieve total closure of a chest wall defect. The soft tissue coverage is completed by using meshed, split thickness skin grafts to provide epithelialization of any exposed muscle or omentum.
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Affiliation(s)
- G M Graeber
- Department of Surgery, West Virginia University School of Medicine, Morgantown 26506, USA
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Andrianopoulos EG, Lautidis G, Kormas P, Karameris A, Lahanis S, Papachristos I, Kaselouris C, Argyropoulos A. Tumors of the ribs: experience with 47 cases. Eur J Cardiothorac Surg 1999; 15:615-20. [PMID: 10386406 DOI: 10.1016/s1010-7940(99)00086-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib. METHODS Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant. Twenty-one benign tumours originated from cartilage and bone, seven were inflammatory, six originated from the bone marrow, and minor percentages (2.5-5%) had vascular, neurogenous, degenerative or miscellaneous origin. Three of the malignant tumours were primary chondrosarcomas and two were metastatic from kidney. The rest were metastatic from stomach (adeno-Ca), and skin (melanoma). The mean age in the benign group was 25.2 years and in the primary malignant group was 20.7 years. Related symptoms were pain (47%) and swelling (42.5%). One-third (32%) of the patients were asymptomatic and the lesion was accidentally found during routine chest radiography. All patients were treated surgically with wide excision of the tumour and the diagnosis was established histologically. RESULTS Resection was complete and curative in all cases without recurrence. CONCLUSIONS Since the likelihood of malignancy cannot be excluded, all rib tumours should be considered malignant until proven otherwise. Therefore, prompt intervention is necessary and wide and radical initial excision of the involved rib is advocated.
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Affiliation(s)
- E G Andrianopoulos
- Department of Thoracic Surgery, 401 Army General Hospital, Athens, Greece.
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29
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Abstract
We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.
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Affiliation(s)
- B Ali Özuslu
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Onur Genç
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Sedat Gürkök
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Kunter Balkanli
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
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Incarbone M, Nava M, Lequaglie C, Ravasi G, Pastorino U. Sternal resection for primary or secondary tumors. J Thorac Cardiovasc Surg 1997; 114:93-9. [PMID: 9240298 DOI: 10.1016/s0022-5223(97)70121-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHODS From January 1980 to December 1993, 52 patients underwent surgical-resection for tumors involving the sternum. The series included 20 primary malignant tumors, 4 desmoid tumors, 2 malignant tumors infiltrating the sternum from adjacent organs, 19 local recurrences or metastases of breast tumors, and 7 metastases of other tumors. Total sternectomy was performed in 5 patients, subtotal sternal resection in 19, and partial resection (less than 50% of the sternum) in 28. Concurrent en bloc resection included anterior ribs in 37 patients, clavicle in 11, lung in 12 patients, pericardium in 7, and diaphragm in 2. The chest was reconstructed with prosthetic material and a myocutaneous flap in 26 patients (50%), prosthetic material only in 12 patients (23%), a myocutaneous flap in 5 patients (10%), and other techniques in the remaining patients. In 47 patients (90%) the resection was radical, and in the remaining 5 patients it was palliative. RESULTS No perioperative deaths occurred. After a median follow-up of 39 months, the overall 3-year survival was 58% and the 5-year survival 46%, with a median survival of 50 months. In 24 patients with primary tumor the 5-year survival after radical resection was 63%, and in 23 patients with secondary invasion (direct extension or metastasis) the 5-year survival was 38% (median 35 months). In recurrent breast cancer the 5-year survival was 48% in patients with direct extension to the chest wall and 60% in patients with distant bone metastasis. CONCLUSIONS Our experience demonstrates that sternal resection is a safe and effective treatment, which may improve the patient's quality of life and achieve a long-term survival not only in primary tumors but also in selected secondary malignant tumors of the sternum.
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Affiliation(s)
- M Incarbone
- Division of Thoracic Surgery, Istituto Nazionale Tumori, Milan, Italy
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Abstract
This synthesis of the literature on radiotherapy for sarcomas originating in the body's soft, supportive tissues, ie, muscle, connective tissue, and fatty tissue is based on 71 scientific articles, including 4 randomized studies, 5 prospective studies, and 26 retrospective studies. These studies involve 3,444 patients. Over 90% of patients with soft tissue sarcomas in the arms and legs can be treated in a way that preserves the extremities. Subcutaneous and intramuscular sarcomas can be treated surgically with little functional loss or risk for local recurrence without adjuvant radiotherapy. To avoid amputation, surgery is often combined with radiotherapy for treatment of local relapse. Adequate surgical margins are usually difficult to achieve for head/neck tumors and retroperitoneal tumors, and therefore surgery is often combined with radiotherapy to reduce the risk for local relapse. Pre- and postoperative radiotherapy are similar. A disadvantage of preoperative radiotherapy is that it reduces the opportunity for exact diagnosis and determining morphobiologic sarcoma parameters. To further improve treatment results for advanced sarcomas, it is necessary to introduce other fractionation schedules, mainly hyperfractionation. This places greater demands on radiotherapy, mainly for staff resources. Combining radiotherapy and local intraarterial chemotherapy involves greater risks for complications and has not shown better treatment results than pre- or postoperative radiotherapy alone, and it is not recommended as standard treatment for soft tissue sarcomas. Intraoperative treatment methods should be targeted for further study and development.
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Martini N, Huvos AG, Burt ME, Heelan RT, Bains MS, McCormack PM, Rusch VW, Weber M, Downey RJ, Ginsberg RJ. Predictors of survival in malignant tumors of the sternum. J Thorac Cardiovasc Surg 1996; 111:96-105; discussion 105-6. [PMID: 8551793 DOI: 10.1016/s0022-5223(96)70405-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
From 1930 to 1994, 54 patients with primary malignant tumors of the sternum were seen. Fifty patients were first seen with a mass, and one half of them also had pain in the sternal region. Two patients had no symptoms at presentation. Among 39 solid tumors were 26 chondrosarcomas, 10 osteosarcomas, 1 fibrosarcoma, 1 angiosarcoma, and 1 malignant fibrous histiocytoma. Of these, 25 were low-grade and 14 were high-grade tumors. Among 15 small cell tumors were 8 plasmacytomas, 6 malignant lymphomas, and 1 Ewing's sarcoma. Partial or subtotal sternectomy was done in 37 patients and total sternectomy in 3. Of the remaining 14 patients, 3 had local excision; 10 had external radiation or chemotherapy without operation, or both; and 1 had no treatment. All but one patient treated by wide resection (N = 40) had some form of skeletal reconstruction of the chest wall defect. Thirty-one (78%) underwent repair with Marlex mesh, and in 25 this was combined with methyl methacrylate. The skin edges were closed per primum in 32 patients; 8 required muscle, omentum, or skin flaps. Resection in chondrosarcomas yielded a 5-year survival (Kaplan-Meier) of 80% (median follow-up, 17 years). The 5-year survival in osteosarcomas was 14%. Resection was curative in 64% of low-grade sarcomas but in only 7% of high-grade sarcomas. In small cell tumors, resection and radiation were helpful for local control; all failures were a result of distant metastases. We conclude that primary sarcomas of the sternum though uncommon are potentially curable by wide surgical excision. With rigid prostheses to repair the skeletal defects, the surgical complication rates are low. Overall survival after complete surgical resection is related to tumor histologic type and grade.
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Affiliation(s)
- N Martini
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y., USA
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34
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Affiliation(s)
- L P Faber
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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35
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Lise M, Rossi CR, Alessio S, Foletto M. Multimodality treatment of extra-visceral soft tissue sarcomas M0: state of the art and trends. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1995; 21:125-35. [PMID: 7720882 DOI: 10.1016/s0748-7983(95)90039-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We here outline principles and trends in the treatment of soft tissue sarcomas without distant metastases (M0). Over the last 15 years significant advances have been made in the diagnostic imaging and histological classification of these tumors as well as in their treatment. Magnetic resonance imaging (MRI) has essentially replaced computerized tomography (CT) for the evaluation of the local growth pattern, although the latter is still preferred for the detection of pulmonary metastases. Immunohistochemistry techniques and electron microscopy have improved the histological diagnosis, although the results obtained should always be interpreted in the context of routine light microscopy. Adequate surgical resection and radiotherapy can reduce the incidence of local recurrence, which is still high for head-neck and retroperitoneal sarcomas. Limb-sparing surgery in combination with irradiation and/or intra-arterial or perfusion chemotherapy is considered the treatment of choice in 90% of limb sarcomas, with a local recurrence rate of less than 20%. New radiotherapeutical techniques and anti-neoplastic agents are now under investigation in an attempt to improve local control. There is also a need for a more effective adjuvant chemotherapy. Randomized clinical trials using doxorubicin/ifosfamide and growth factors are now underway.
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Affiliation(s)
- M Lise
- Istituto di Clinica Chirurgica II, Università di Padova, Italy
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36
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Abstract
A 48-year-old man who presented with chest pain was found to have a spontaneous hemothorax caused by a large grade II chondrosarcoma. This was diagnosed on the basis of the findings from thoracotomy. After chest tube drainage of the hemothorax, the tissue obtained by two computed tomography-guided biopsies of a residual mass did not yield findings that allowed diagnosis of the tumor. This unusual case illustrates the importance of a systematic workup whenever a spontaneous hemothorax is encountered.
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Affiliation(s)
- J H Karlawish
- Department of Internal Medicine, Francis Scott Key Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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37
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Fernández-Trigo V, Sugarbaker PH. Sarcomas Involving the Head and Neck, Trunk and Breast. TUMORI JOURNAL 1994; 80:157-68. [PMID: 8053071 DOI: 10.1177/030089169408000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcomas of the head, neck, trunk and breast are biologically similar to and behave like the soft tissue tumors found in other anatomic areas. In the past and still today, radical surgical resection with negative margins is the only reliable treatment for these sarcomas. The opportunity to use chemotherapy, surgery, and radiation therapy in selected patients as a multi-modality approach may improve the likelihood of long-term, disease-free survival. Added experience with radiologic evaluation of patients to accurately define the anatomic location of the tumor, more definitive pathology to assess the biologic aggressiveness of the lesion, and more conservative wide excisions have allowed patients to retain function and cosmesis. In addition, the development of new surgical techniques has made it feasible to reconstruct large surgical defects.
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Abstract
From 1975 to 1990, eighty-nine primary tumors of the thoracic skeleton; ribs, sternum, scapula, clavicle, and thoracic spine, were treated. Forty-four tumors (49%) were benign lesions. Forty-five tumors were malignant and were proportionately distributed amongst the five sites. The most common malignancies were Ewing's sarcomas, chondrosarcomas, plasmacytomas, osteogenic sarcomas, and lymphomas. All patients with Ewing's sarcomas were treated with combination chemotherapy, surgical resection, and radiation therapy for those with residual disease after surgery. Only one patient has died of disease. Patients with primary chondrosarcomas were treated by surgery alone and all are free of disease or have died without disease. Patients with solitary plasmacytomas or primary lymphomas of bone were treated with radiation therapy initially. Half the patients developed systemic disease. The patients with osteogenic sarcomas included several with radiation induced lesions and Paget's osteosarcoma and all but one died of disease.
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Affiliation(s)
- N D Bloom
- Division of Surgical Oncology, Metropolitan Hospital Center, New York, New York
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39
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Burt M, Karpeh M, Ukoha O, Bains MS, Martini N, McCormack PM, Rusch VW, Ginsberg RJ. Solitary plasmacytoma and Ewing's sarcoma. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33852-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Abstract
A retrospective study of one decade of rib biopsy in four hospitals in Nashville, Tenn, showed 61 biopsies were done in 60 patients. The typical patient was a male in his seventh decade. Preferred operative technique was open biopsy with general anesthesia. One half of the patients had metastatic malignancy; most of the known primary tumors were lung cancer. About one fifth of specimens were normal ribs. Biopsy was done in nine of these because of false-positive scintigraphy. Accurate preoperative chest wall localization is critical in order to minimize intraoperative decision-making problems. Yield of rib biopsy should be increased by more careful clinical observation, including critical evaluation of bone scans, avoiding overinterpretation of physical findings and observing for healing of possible rib fractures.
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41
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Burt M, Fulton M, Wessner-Dunlap S, Karpeh M, Huvos AG, Bains MS, Martini N, McCormack PM, Rusch VW, Ginsberg RJ. Primary bony and cartilaginous sarcomas of chest wall: results of therapy. Ann Thorac Surg 1992; 54:226-32. [PMID: 1637209 DOI: 10.1016/0003-4975(92)91374-i] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary bony and cartilaginous sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. To assess the results of therapy, we reviewed our 40-year experience. Records of 38 patients with osteosarcoma and 88 with chondrosarcoma arising in chest wall admitted to Memorial Sloan-Kettering Cancer Center from 1949 to 1989 were reviewed. The 88 patients with chondrosarcoma ranged in age from 5 to 86 years (median age, 49 years); the male/female ratio was 1.3:1. Presenting complaint was mass, pain, or both in 93%. Primary therapy was resection (n = 84), radiation therapy (n = 3), or chemotherapy (n = 1). Overall 5-year survival was 64%. Significant adverse prognostic factors included metastases at initial presentation (n = 9), metastases at any time during the course of disease (n = 23), age greater than 50 years (n = 42), incomplete or no resection (n = 13), and local recurrence (n = 24). Sex, grade, and tumor size were not prognostic factors. The 38 patients with osteosarcoma ranged in age from 11 to 78 years (median age, 42 years); the male/female ratio was 1.5:1. Presenting complaint was mass, pain, or both in 95%. Primary therapy included resection (n = 31; alone in 13, with radiation therapy in 3, with chemotherapy in 15), radiation therapy (n = 3), radiation therapy and chemotherapy (n = 2), chemotherapy (n = 1), or no treatment (n = 1). Overall 5-year survival was 15%. Significant adverse prognostic factors included presence of synchronous metastases (n = 13) and metastases at any time during the course of disease (n = 26).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Burt
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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42
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Wallner KE, Nori D, Burt M, Bains M, McCormack P. Adjuvant brachytherapy for treatment of chest wall sarcomas. J Thorac Cardiovasc Surg 1991. [DOI: 10.1016/s0022-5223(19)36661-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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44
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Gabbay S. Reply. Ann Thorac Surg 1990. [DOI: 10.1016/0003-4975(90)90055-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Perry RR, Venzon D, Roth JA, Pass HI. Survival after surgical resection for high-grade chest wall sarcomas. Ann Thorac Surg 1990; 49:363-8; discussion 368-9. [PMID: 2310244 DOI: 10.1016/0003-4975(90)90239-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Indications for chest wall resection of metastatic or locally recurrent sarcoma and for subsequent bony reconstruction are controversial. Twenty-eight patients had chest wall resection for high-grade primary, metastatic, or recurrent sarcoma. In all patients, resection with selective reconstruction of the bony thorax was performed without operative mortality. Since 1980, only patients with four or more ribs resected have had selective bony reconstruction. Follow-up ranged from 8 to 132 months (median follow-up, 42 months). All deaths were related to sarcoma recurrence. The overall actuarial survival rate was 85% at 1 year, 65% at 3 years, and 59% at more than 5 years. The overall actuarial proportion without disease recurrence was 64% at 1 year, 52% at 3 years, and 40% at more than 5 years. There was no significant difference in overall or disease-free survival for patients with primary, metastatic, or recurrent tumors. The most important prognostic factors were positive margins and concomitant pulmonary resection for synchronous lung metastases. These data support aggressive resection to obtain pathologically tumor-free margins for chest wall sarcomas, whether primary, metastatic or recurrent. Reconstruction can be individualized based on the extent of resection.
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Affiliation(s)
- R R Perry
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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Pezzella AT, Fall SM, Pauling FW, Sadler TR. Solitary plasmacytoma of the sternum: surgical resection with long-term follow-up. Ann Thorac Surg 1989; 48:859-62. [PMID: 2688582 DOI: 10.1016/0003-4975(89)90688-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two patients with solitary plasmacytoma of the sternum were treated with primary surgical resection. Good long-term results were obtained. There is no long-term documentation that primary radiotherapy alone is the treatment of choice for solitary plasmacytomas. An individualized approach is warranted, especially when there is an isolated bulky lesion involving the chest wall.
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Affiliation(s)
- A T Pezzella
- Cardiothoracic Surgery Service, Fitzsimons Army Medical Center, Aurora, Colorado
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47
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Abstract
Chest-wall resection can be performed with low morbidity and mortality rates and remains the primary treatment for most chest-wall tumors. However, some lesions are best treated with a multimodality approach including preoperative chemotherapy. Therefore, pretreatment tissue diagnosis is essential in planning. The biopsy should be done at the medical center where the definitive treatment will be undertaken, and frequently, a needle biopsy will be sufficient. Osteosarcoma, rhabdomyosarcoma, Ewing's sarcoma, and other small-cell sarcomas are sensitive to chemotherapy, which should be given preoperatively, continued postoperatively, and modified according to the tumor response. Chondrosarcomas and most adult soft-tissue sarcomas are well controlled by primary excision and selective use of adjuvant irradiation. Better systemic and local therapy is needed for the recurrent soft-tissue sarcomas and the aggressive unclassified sarcomas. Chest-wall resection continues to play a primary role in the management of locally and regionally recurrent breast cancer but is best combined with systemic chemotherapy. Chest-wall resection can provide a long disease-free survival in patients with isolated metastases from sarcomas or carcinomas. In addition, significant palliation can be afforded patients with symptomatic chest-wall metastases and a shortened life expectancy.
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Affiliation(s)
- M B Ryan
- Department of Thoracic Surgery, University of Texas M. D. Anderson Cancer Center, Houston
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48
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Moelleken BR, Mathes SA, Chang N. Latissimus dorsi muscle-musculocutaneous flap in chest-wall reconstruction. Surg Clin North Am 1989; 69:977-90. [PMID: 2675355 DOI: 10.1016/s0039-6109(16)44933-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The latissimus dorsi is a versatile muscle that can be employed in a variety of situations requiring chest-wall reconstruction. Its anatomy is predictable and has within it flexibility for transposition to a number of locations based on its standard or reverse arcs of rotation. It can be transposed with a skin island, and its length and bulk can be used effectively to provide durable coverage for anterior or posterior defects. These factors make the latissimus dorsi an excellent choice for the reconstruction of complex chest-wall defects.
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Affiliation(s)
- B R Moelleken
- Department of Surgery, School of Medicine, University of California, San Francisco
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49
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Azarow KS, Molloy M, Seyfer AE, Graeber GM. Preoperative evaluation and general preparation for chest-wall operations. Surg Clin North Am 1989; 69:899-910. [PMID: 2675351 DOI: 10.1016/s0039-6109(16)44929-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chest-wall reconstruction is a major procedure with a risk of life-threatening complications. Accurate preoperative assessment is therefore critical, as it allows detection and treatment of correctable problems and permits the surgeon to individualize postoperative management. Risk factors may be cardiovascular, pulmonary, or nutritional. The guiding principle of planning for the reconstruction is that there must be absolutely no tension at the site of the full-thickness defect in the chest wall.
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Affiliation(s)
- K S Azarow
- Walter Reed Army Medical Center, Washington, D.C
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50
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el-Tamer M, Chaglassian T, Martini N. Resection and debridement of chest-wall tumors and general aspects of reconstruction. Surg Clin North Am 1989; 69:947-64. [PMID: 2675353 DOI: 10.1016/s0039-6109(16)44931-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The main criterion for adequate local control of a chest-wall malignancy remains wide excision. With the available techniques of skeletal and soft-tissue reconstruction, even large lesions can be resected with safe margins. The primary purpose is to achieve a curative resection, although a significant number of symptomatic patients can benefit from palliative resection provided by such procedures. A key element in the success in treating chest-wall tumors is a multidisciplinary approach by all participating physicians, namely the thoracic surgeon, the plastic and reconstructive surgeon, the radiotherapist, and the medical oncologist.
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Affiliation(s)
- M el-Tamer
- Memorial Sloan-Kettering Cancer Center, New York, New York
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