A suitable system of reconstruction with titanium rib prosthesis after chest wall resection for Ewing sarcoma

Outcomes of chest wall resections in pediatric sarcoma patients

PURPOSE

Chest wall tumors in pediatric patients are rare. This study evaluates outcomes in pediatric patients who have undergone chest wall resections secondary to sarcomas.

METHODS

A retrospective review was performed for patients <19years old who underwent chest wall resections for sarcoma 1999-2014 at the University of Texas MD Anderson Cancer Center.

RESULTS

Of 44 patients, Ewing's sarcoma (n=18) and osteosarcoma (n=16) were most common. Other sarcomas included synovial sarcoma, chondrosarcoma, and rhabdomyosarcoma. Gore-Tex® or a Marlex™ mesh and methyl methacrylate sandwich was used in 22 patients, and 9 children did not require reconstruction. Twenty-four (54.5%) patients had normal activity, 3 (6.8%) had occasional discomfort, 2 (4.5%) had pain impairing function, 7 (15.9%) required medication or physical therapy for impairment, and 8 (18.2%) needed additional surgery. Five children (11.4%) developed scoliosis, and all of these patients had posterior rib tumors. Median overall survival for the entire cohort was 41.9±11.82months. Histology (p=0.003), location of tumor on the ribs (p=0.007), and surgical margins (p=0.011) were significantly associated with overall survival. Tumors on the middle and posterior (p=0.003) portions of the ribs had a lower chance of death.

CONCLUSION

Scoliosis is more common in posterior rib resections. Histology, location of the tumor, and surgical margins impact survival, but, type of reconstruction does not.

LEVEL OF EVIDENCE

III.

TYPE OF STUDY

Treatment Study.

Polylactide bioabsorbable struts for chest wall reconstruction in a pediatric patient

Chest wall reconstruction after pediatric tumor resection is challenging. Children have unique characteristics related to growth and prosthetic material for reconstruction must be chosen carefully. Poly-L-Lactide (PLA), a bioabsorbable prosthetic material, has been used in the plate form for reconstruction after tumor resection in children. Recently developed PLA struts have been successfully used to reconstruct pediatric chest wall deformities. This is the first description of the use of PLA rib struts to reconstruct chest wall defects after a pediatric chest wall tumor resection.