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Zhao Y, Xie S, Zheng H, Zhang K, Gao X, Liu W, Dai W, Yu H, Shi Q, Hu B, Li Q, Xie T, Wei X. Extended radical resection and chest wall reconstruction for a pulmonary sarcomatoid carcinoma: a case report. Surg Case Rep 2024; 10:64. [PMID: 38494556 PMCID: PMC10944816 DOI: 10.1186/s40792-024-01866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly malignant type of non-small cell lung cancer (NSCLC), for which the treatment of choice is surgery. For peripheral PSC growing outward and invading the chest wall, a complete resection of the affected lung lobes and the invaded chest wall can improve long-term prognosis. However, when the extent of the resected chest wall is large, reconstruction is often required to reduce the risk of postoperative complications. Here, we present a case of PSC invading the chest wall treated with successful extended radical resection for lung cancer and chest wall reconstruction. CASE PRESENTATION A 58-year-old male patient with a nodule in the right upper lobe that had been identified on physical examination 2 years before presentation presented to our hospital with a recent cough, expectoration, and chest pain. Imaging revealed a mass in the right upper lobe that had invaded the chest wall. Preoperative puncture pathology revealed poorly differentiated NSCLC. We performed extended radical resection for lung cancer under open surgery and reconstructed the chest wall using stainless steel wire and polypropylene meshes. The procedure was uneventful, and the patient was discharged 7 days postoperatively. Furthermore, the final pathology revealed PSC. CONCLUSIONS This case underscores the feasibility of surgical R0 resection in patients with PSC with chest wall invasion and no lymph node metastasis, potentially enhancing long-term outcomes. The novel aspect of this case lies in the individualized chest wall reconstruction for a large defect, using cost-effective materials that offered satisfactory structural support and postoperative recovery, thereby providing a valuable reference for similar future surgical interventions.
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Affiliation(s)
- Yingzhi Zhao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Haoqian Zheng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Kaixin Zhang
- Graduate School, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xin Gao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wenwu Liu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Hongfan Yu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Bin Hu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
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Joel RK, Benjamin SR, Rao VM, Kodiatte TA, Gnanamuthu BR, Mohammad A, Sameer M, David N. Surgical management of sternal tumours-a decade of experience from a tertiary care centre in India. Indian J Thorac Cardiovasc Surg 2024; 40:184-190. [PMID: 38389767 PMCID: PMC10879054 DOI: 10.1007/s12055-023-01583-8] [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: 05/14/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 02/24/2024] Open
Abstract
Tumours of the sternum can be either primary or secondary with malignancy being the most common etiology. Wide local excision of these tumours results in a midline defect which pose a unique challenge for reconstruction. As limited data on the management of these tumours exists in the literature, we hereby report 14 consecutive patients who were treated at our institute between January 2009 to December 2020. Most of them were malignant with majority of them, 11 (78%) patients, with manubrial involvement requiring partial sternectomy. Overall, the average defect size was 75 cm2. Reconstruction of the chest wall defect was done using a semi-rigid fixation: mesh and suture stabilization in 3 (21%) or suture stabilization in 7 (50%) and without mesh or suture stabilization in 3 (21%) patients. Rigid fixation with polymethyl methacrylate (PMMA) was done for one patient (7%). Pectoralis major advancement flap was most commonly used for soft tissue reconstruction with flap necrosis noted in one patient (7%). There was no peri-operative mortality and one patient required prolonged post-operative ventilation. On a median follow-up of 37.5 months, one patient (7%) had a recurrence. Sternal defects after surgical resection reconstructed with semi-rigid fixation and suture stabilization render acceptable post-operative outcomes.
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Affiliation(s)
- Raj Kumar Joel
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Vinay Murahari Rao
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Thomas Alex Kodiatte
- The Department of Pathology, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Birla Roy Gnanamuthu
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Aamir Mohammad
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Mallampati Sameer
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Nishok David
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
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Aranda JL, Gomez MT, Fuentes M, Rivas C, Forcada C, Jimenez MF. Sternal resection and reconstruction: a review. J Thorac Dis 2024; 16:708-721. [PMID: 38410553 PMCID: PMC10894421 DOI: 10.21037/jtd-23-450] [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: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Sternal resection and reconstruction is a rare but sometimes challenging procedure due to its profound anatomical and functional implications. For these reasons, an adequate preoperative evaluation is crucial in each patient, especially when we are faced with malignant lesions that sometimes require extensive radical resections, thus demanding an integrated reconstructive strategy that allows stabilizing the chest wall, protecting the underlying mediastinum and minimize resulting deformity. The large number of available reconstruction techniques and the lack of quality studies for their analysis mean that sternal reconstruction depends to a great extent on the consensus of experts or, more frequently, on the simple preference of each surgical team. This article aims to provide an overview of sternal resection and reconstruction. Indications for partial versus total or subtotal sternectomy are suggested and their surgical and oncological outcomes are presented. The use of rigid or semi-rigid prostheses is an ongoing debate, although recent functional data advise reserving rigid reconstructions for extensive defects. Sternectomy for primary tumors or local tumor involvement has a good prognosis with an overall survival of 5 and 10 years: 67% and 58%, respectively, provided that a radical resection with free surgical margins is performed. Breast cancer is the most common secondary sternal tumor, and surgery can offer 5-year overall survival ranging from 20% to 50% provided an R0 resection is achieved, although radical surgery does not appear to decrease rates. of recurrence. Metastases of origin other than the breast give the worst results (less than 40% at 36 months and 0% at 5 years) and although the data available on these cases are limited, the radicality of the resection does not seem to modify the survival or recurrence rates, so a conservative approach is probably more appropriate.
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Affiliation(s)
- Jose L Aranda
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - María T Gomez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marta Fuentes
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Cristina Rivas
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Clara Forcada
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marcelo F Jimenez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
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Lampridis S, Minervini F, Scarci M. Management of complications after chest wall resection and reconstruction: a narrative review. J Thorac Dis 2024; 16:737-749. [PMID: 38410587 PMCID: PMC10894423 DOI: 10.21037/jtd-23-621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/27/2023] [Indexed: 02/28/2024]
Abstract
Background and Objective Chest wall resection and reconstruction procedures carry high postoperative morbidity. Therefore, successful outcomes necessitate prevention, prompt identification, and appropriate management of ensuing complications. This narrative review aims to provide a comprehensive overview of evidence-based strategies for managing complications following chest wall resection and reconstruction. Methods A literature search was conducted using the PubMed database for relevant English-language studies published since 1980. Key Content and Findings Complications following chest wall resection and reconstruction can be broadly classified into surgical site-related, respiratory, or other systemic complications. Surgical site and respiratory complications are the most common, with reported incidence rates of approximately 40% across some series. Predisposing factors for respiratory morbidity include greater numbers of resected ribs and concurrent pulmonary lobectomy. Definitive correlations between specific prosthetic materials and complications remain elusive. Management should be tailored to the type and severity of the complication, surgical variables, and patient factors. Specific approaches for managing common complications are discussed in detail. Emerging preventive approaches, such as minimally invasive surgical techniques, are also briefly highlighted to help guide future research. Conclusions An emphasis on anticipating and judiciously managing complications of chest wall resection and reconstruction, alongside a coordinated multidisciplinary approach, can optimize outcomes for patients undergoing this intrinsically complex surgery.
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Affiliation(s)
- Savvas Lampridis
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Marco Scarci
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Zhang K, Wang L, He Z. Pedicled myocutaneous flap transplantation for a large chest wall defect with infection in a 72-year-old female. Heliyon 2024; 10:e24038. [PMID: 38268577 PMCID: PMC10805759 DOI: 10.1016/j.heliyon.2024.e24038] [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: 06/13/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
Background In the realm of thoracic surgery, addressing chest wall defects accompanied by infections remains a formidable task. Despite the availability of a spectrum of surgical options, attaining clinical resolution is particularly challenging in intricate cases involving extensive chest wall defects in elderly patients. Thorough debridement followed by the utilization of autologous tissue for repair and reconstruction has emerged as a prevalent approach in current clinical practice. Case presentation Herein, we present a 72-year-old female patient with a large chest wall defect and infection. She has experienced left breast cancer surgery, multi cycle radiotherapy and chemotherapy. Nine months ago, there was yellow purulent fluid in the left chest wall. She had undergone debridement in other hospital, and the treatment effect was poor. At our hospital, Chest computed tomography (CT) imaging revealed a soft tissue anomaly on the left side of the chest wall, along with partial rib bone deterioration. Considering the patient's clinical presentation and radiological findings, a tentative diagnosis of an infected chest wall defect and chronic osteomyelitis was established. Consequently, daily dressing changes were deemed necessary for the patient's infected chest wound. Surgery for chest wall repair and reconstruction was scheduled once the wound area exhibited cleanliness with emerging granulation tissue. Preoperatively, a myocutaneous flap of an appropriate size was meticulously planned. During the surgical procedure, initial debridement of the infected chest wall area was conducted, followed by the strategic placement of a harvested pedicled latissimus dorsi myocutaneous flap to rectify the defect. Postoperative care involved stringent anti-infective measures, anti-spasmodic treatment, and preventive anticoagulation, accompanied by vigilant monitoring of the myocutaneous flap's viability and the healing progress of the defect site. Conclusions Utilizing the pedicled latissimus dorsi myocutaneous flap for repairing extensive defects in the chest wall presents a viable and efficient strategy. This technique preserves cardiopulmonary functionality and maintains the thoracic contour. The outcomes observed in the short to medium term postoperatively have been consistently gratifying.
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Affiliation(s)
- Kang Zhang
- Department of Cardiothoracic Surgery, The Affiliated Hosptail of Shaoxing University (Shaoxing Municipal Hosptail), Shaoxing, Zhejiang, 312000, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, 310012, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, 310012, China
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Leivaditis V, Hofmann A, Haaf B, Wiegand A, Papatriantafyllou A, Grapatsas K, Koletsis E, Charokopos N, Verras GI, Tasios K, Skevis K, Panagiotopoulos I, Antzoulas A, Mulita F, Dahm M. Extensive chest wall stabilization after cardiopulmonary resuscitation and urgent cardiac surgery. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2023; 20:205-209. [PMID: 37937167 PMCID: PMC10626408 DOI: 10.5114/kitp.2023.131937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | - Alexander Hofmann
- Department of Orthopedics and Traumatology, Westpfalz Klinikum, Kaiserslautern, Germany
| | - Bernd Haaf
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | - Anke Wiegand
- Department of Radiology, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen – Ruhrlandklinik, Essen, Germany
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | | | | | | | | | - Andreas Antzoulas
- Department of General Surgery, Patras University Hospital, Patras, Greece
| | - Francesk Mulita
- Department of General Surgery, Patras University Hospital, Patras, Greece
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
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7
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Wang L, Liu Z, He Z, Zhang C. Autologous myocutaneous flap implantation for chronic refractory chest wall sinus with infection: a case report. J Cardiothorac Surg 2023; 18:121. [PMID: 37038229 PMCID: PMC10084654 DOI: 10.1186/s13019-023-02205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Chest wall sinus with infection is a refractory disease caused by a variety of susceptible factors, and the treatment is still challenging. For clinically complex cases, although there are various surgical methods to choose from, it is still very difficult to achieve clinical cure, especially for patients with older age and many underlying diseases. Complete resection of chest wall sinus and application of repair and reconstruction technology may bring hope to refractory cases. CASE PRESENTATION Herein, we report a case of a 67 year-old woman who had undergone breast cancer surgery and a history of multiple cycles of radiotherapy and chemotherapy. One year ago, she had a fistula in the left chest wall with yellow purulent fluid. After admission to our hospital, chest computed tomography (CT) showed the formation of the left chest wall sinus, accompanied by high-density images of the left clavicle, part of the ribs and part of the sternu. According to the patient's symptoms, signs and imaging examination, we preliminarily diagnosed the patient as chest wall sinus with infection and chronic osteomyelitis. Therefore, in the first-stage operation, the patient underwent left chest wall sinus resection, left partial rib resection, left partial clavicular resection and left partial sternal resection, After surgery, the wound surface was changed with gauze dressing with sensitive antibiotic solution every day until the wound surface was clean and new granulation was formed. In the second-stage operation, the wound surface was appropriately expanded, and the pedicled latissimus dorsi myocutaneous flap was transferred to the chest wall defect. Finally, the skin paddle was sutured without tension to the normal skin around the chest, and two drainage tubes were placed. Anti-infection, anti-spasm, anti-coagulation and other treatments were given after operation, and the survival of myocutaneous flap, wound healing and sinus disappearance were observed. CONCLUSION The application of pedicled latissimus dorsi myocutaneous flap in the treatment of intractable chronic chest wall sinus is an effective method. It does not change the shape of the thorax. The clinical effect is satisfactory in the near and medium term, which is worthy of clinical promotion.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd., Hangzhou, 310012, Zhejiang, China
| | - Zhijun Liu
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd., Hangzhou, 310012, Zhejiang, China.
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd., Hangzhou, 310012, Zhejiang, China
| | - Chun Zhang
- Department of Traumatology and Orthopedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, Zhejiang, China
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Sugawara M, Takatsugu K, Kondo Y, Watanabe M, Matsumiya G, Kobayashi Y. Subcutaneous implantable cardioverter-defibrillator implantation in a patient with an axillary bifemoral bypass and past sternectomy. HeartRhythm Case Rep 2022; 9:80-83. [PMID: 36860744 PMCID: PMC9968905 DOI: 10.1016/j.hrcr.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan,Address reprint requests and correspondence: Dr Masafumi Sugawara, Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Kajiyama Takatsugu
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience. J Clin Med 2022; 11:jcm11195516. [PMID: 36233384 PMCID: PMC9573184 DOI: 10.3390/jcm11195516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from not only bone or cartilage of the chest wall but also from associated subcutaneous tissue from muscle and blood vessels. Secondary tumors refer to a direct invasion of the chest wall by neoplasms located elsewhere in the body, mainly metastases from breast cancer and lung cancer. En-bloc surgical excision of the lesion should ensure adequate negative margins to avoid local recurrence, and a full thickness surgical resection is often required, and it can result in important chest-wall defects such as skeletal instability or impaired breathing dynamics. The reconstruction of large defects of the chest wall can be complex and often requires the use of prosthetic and biologic mesh materials. This article aims to review the literature on these tumor entities, focusing on the main surgical techniques and the most recent advances in chest-wall resection and reconstruction. We also report on the institutional experience our center.
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Clermidy H, Fadel G, De Lemos A, Pradere P, Mitilian D, Girault A, Menager JB, Fabre D, Mussot S, Leymarie N, Fadel E, Mercier O. Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates. Front Surg 2022; 9:950177. [PMID: 36157422 PMCID: PMC9489911 DOI: 10.3389/fsurg.2022.950177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives En-bloc complete resection remains the treatment of choice for localized chest wall (CW) tumors. Titanium bars reconstruction demonstrated encouraging results with satisfactory early outcomes. However, long-term outcomes remain under-reported. The purpose of this study is to evaluate long-term outcomes after CW resection and repair with titanium devices. Methods From June 2012 to December 2018, we retrospectively reviewed all patients with CW tumors who underwent surgical resection and repair using titanium. Long-term outcomes were assessed. Results We identified 87 patients who underwent CW tumor resections and titanium reconstruction. Sixty-eight patients were included in the study (excluding benign tumors, Pancoast tumors, palliative surgeries, or clavicle reconstruction). There were 29 sarcomas, 20 isolated CW metastases, eight lung cancers, four breast cancers, three thymic malignancies, two sarcomatoid mesothelioma, and one desmoid tumor. Complete resection was achieved in 64 patients (94%), while R1 resection in four patients (6%). Resection involved one rib in two patients, two ribs in thirteen, three ribs in eighteen, four ribs in nine, five ribs in two, seven ribs in one, partial sternum in fifteen, and full sternum in sixteen patients. No patient experienced flail chest. The 1-year, 3-year, and 5-year overall survival rates and disease-free survivals were 82.3%, 61.4%,57.3%, and 67.6%,57.3%,52.6%, respectively. Surgical site infection occurred in 18% (n = 12) of cases. Eleven of twelve patients had an early infection (<1 year), which required material removal in six patients. Asymptomatic connector unsealing occurred in 6% (n = 4), with only one re-intervention. Titanium allergy has never been reported. Chronic chest pain (lasting more than 3 months after surgery, with daily use of pain killer) was reported in 24% of patients.
Conclusion CW resections with titanium reconstruction are associated with long-term survivors. Titanium devices were safe, reliable, and achieved satisfactory oncological results with low morbidity and implant-related complication rates.
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Affiliation(s)
- Hugo Clermidy
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Guillaume Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Alexandra De Lemos
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Pauline Pradere
- Department of Pneumology, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Le Plessis Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Antoine Girault
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Jean-Baptiste Menager
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy, Villejuif, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, International Center for Thoracic Cancers, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
- Correspondence: Olaf Mercier
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11
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Abdelrahman A, Ismail M, Ghaly G, Abulkheir IL, Hanafy A. Oncological Outcome of Surgically Resected Sternal Tumors, 16 Years’ Experience. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.6604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Tumors of the sternum are rare and can develop from primary bone pathology or through metastatic spread. Sternal resection with immediate reconstruction of the anterior chest wall defect was recommended for both primary and secondary sternal tumors as curative treatment.
AIM: The purpose of our study was to examine the perioperative outcomes, recurrence rate, and OS in patients undergoing partial, subtotal, and total sternectomy.
METHODS: We retrospectively reviewed our experience with sternal resections in 29 patients during a 16-year period. The purpose of our study was to examine the perioperative outcomes, recurrence rate, and overall survival (OS) in patients undergoing partial, subtotal, and total sternectomy.
RESULTS: We found that 5-year OS was 26.0%, Univariate analysis of predictors of survival revealed that, there was a trend toward prolonged 5-year survival at R0 resection (35.5% vs. 0%, p = 0.058). Post resection defect size associated with prolonged 5-year OS (42.1% vs. 0%, p < 0.001). The absence of post-operative complications associated with prolonged 5-year OS (40.4% vs. 0%, p = 0.012), with special attention to absence of post-operative flail chest which was associated with prolonged 5-year OS (36.2% vs. 0%, p < 0.001). On multivariable analysis, R0 resection (HR, 3.692 [95% CI, 1.190–11.456], p = 0.024) and absence of post-operative flail chest (HR, 52.204 [95% CI, 5.908–461.289], p < 0.001) were associated with improved OS.
CONCLUSIONS: We have shown that sternal resection of benign and primary malignant tumors can yield long-term survival. The completeness of resection and absence of postoperative flail chest are the strongest predictors of survival.
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Fernández-Trujillo L, Sangiovanni S, Morales EI, Marin V, Sua LF, Velasquez M. Sternal cavernous hemangioma and reconstruction of the anterior chest wall: a case report. BMC Surg 2020; 20:288. [PMID: 33213427 PMCID: PMC7678184 DOI: 10.1186/s12893-020-00961-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The sternum is considered an unusual tumor site, corresponding to 15% of all thoracic wall tumors. Primary sternal tumors are even rarer and most commonly malignant. We present the case of a young man who consulted with a painful sternal mass, which after its resection is confirmed to be a cavernous hemangioma. Case presentation A 39-year-old man, with unremarkable medical history besides a 2-year-long sternal pain, non-irradiated, which worsens over the last few months and is accompanied by the appearance of a sternal palpable mass. On physical exam, there was a bulging of the sternal manubrium, with no inflammatory changes. Thoracic CT scan shows an expansive and lytic lesion of the sternum, compromising the manubrium and extending to the third sternocostal joint, without intrathoracic compromise nor cleavage plane with mediastinal vascular structures. The patient is taken to resection of the mass and sternal reconstruction using prosthetic material and pectoral and fasciocutaneous muscular flaps. Histopathological findings: cavernous hemangioma with negative borders and no other malignant findings. Conclusions Sternal hemangiomas can cause defects in the bone structure and show an expansive growth, challenging the differentiation between a benign or malignant lesion. Therefore, they should be considered malignant until shown otherwise. Management involves radical surgery with curative purposes and posterior reconstruction to improve quality of life, as shown with our patient.
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Affiliation(s)
- Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Avenida Simón Bolívar, Carrera 98 # 18-49, Tower 6, 4th Floor, Cali, 7600032, Colombia. .,Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.
| | - Saveria Sangiovanni
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Eliana I Morales
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Valeria Marin
- Faculty and Postgraduate School of Dentistry, Universidad del Valle, Calle 4B # 36-00, Cali, Colombia.,Department of Innovation and Technology, HUMANBX S.A.S, Carrera 65 # 1A-93, Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
| | - Mauricio Velasquez
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 7600032, Colombia.,Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 7600032, Colombia
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13
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Mohamed S, Mazhar K, Osman A, Patel A, Srinivasan L, Ghosh S. Excision of metastatic breast cancer from sternum and reconstruction in two patients with solitary metastatic spread. J Surg Case Rep 2020; 2020:rjaa272. [PMID: 32904681 PMCID: PMC7458144 DOI: 10.1093/jscr/rjaa272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
Metastatic breast carcinoma is a relatively common clinical entity. However, the prognosis of oligometastatic and polygometastatic disease differs considerably pertaining to five-year survival. Metastatic breast carcinoma to the sternum has been described as early as 1988. We describe two cases in our institution who presented with solitary sternal metastases with a previous history of treated breast cancer. In both cases, there had been a history of previous left breast cancer treated aggressively with surgical resection and adjuvant oncological therapy and maintenance hormonal therapy. Partial sternectomy or total sternectomy for solitary metastatic sternal deposits is well established with relatively low morbidity and mortality and improvement in quality of life and possible improvement in long-term survival. Furthermore, reconstructive options are inherently dependent on extent of resection performed. These techniques can incorporate the use of sternal plates in order to approximate defects and reinforce the sternum in the setting of partial sternectomy.
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Affiliation(s)
- Saifullah Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
| | - Khurum Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
| | - Ahmed Osman
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
| | - Akshay Patel
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
| | - Lakshmi Srinivasan
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
| | - Shilajit Ghosh
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, UK
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Reconstruction of Oncologic Sternectomy Defects: Lessons Learned from 60 Cases at a Single Institution. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2351. [PMID: 31942367 PMCID: PMC6952121 DOI: 10.1097/gox.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
Oncologic sternectomy results in complex defects where preoperative planning is paramount to achieve best reconstructive outcomes. Although pectoralis major muscle flap (PMF) is the workhorse for sternal soft tissue coverage, additional flaps can be required. Our purpose is to evaluate defects in which other flaps beside PMF were required to achieve optimal reconstruction.
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Collaud S, Stork T, Valdivia D, Tokuishi K, Aigner C. Sternectomy for primary chondrosarcoma. J Thorac Dis 2020; 12:31-35. [PMID: 32055421 DOI: 10.21037/jtd.2019.06.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Keita Tokuishi
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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Vendramin I, Frigatti P, Piani D, Sponza M, Bortolotti U, Livi U. Successful repair of an ascending aorta injured by a displaced sternal plate. J Thorac Cardiovasc Surg 2019; 159:e151-e154. [PMID: 31604635 DOI: 10.1016/j.jtcvs.2019.07.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
| | - Paolo Frigatti
- Vascular Division, Department of Surgery, University Hospital of Udine, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Massimo Sponza
- Interventional Division, Department of Radiology, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
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Dudek W, Schreiner W, Horch RE, Sirbu H. Sternal resection and reconstruction for secondary malignancies. J Thorac Dis 2018; 10:4230-4235. [PMID: 30174868 DOI: 10.21037/jtd.2018.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Limited data on sternal and/or anterior chest wall resections for secondary malignancies exist. The purpose of this study was to examine the perioperative outcomes and postoperative overall survival (OS) in patients who underwent sternal and/or anterior chest wall resections for secondary sternal tumors (SSTs). Methods A retrospective analysis of all patients who underwent resection of SSTs at single institution between 2000 and 2016 has been performed. OS was estimated using the Kaplan-Meier method. Results Ten patients underwent sternal and/or anterior chest wall resection for SSTs with curative (70%) or palliative (30%) intent. Two (20%) patients underwent complete and 8 (80%) partial sternal and/or anterior chest wall resection. There were no perioperative deaths, major complications occurred in 3 (30%) patients. Tumor resection was complete (R0) in 5 (50%) patients. The 5-year OS rate was 40%. No OS difference in R0 vs. R1 resections was observed. Conclusions Sternal and/or anterior chest wall resections for SSTs can be performed with low morbidity and mortality. Complete SST resection does not assure favorable OS. Sternal resections can be considered palliative treatment option in patients with stable stage IV disease with isolated sternal involvement.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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