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Mughal AZ, El-Zeki A, Oliemy A, Habib AM. Manubriectomy made easy. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38690721 DOI: 10.1510/mmcts.2024.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Bone metastasis is the most common form of distant metastasis encountered within the breast cancer population. Surgical resection of bone metastases is a curative treatment option in patients who present with an isolated solitary lesion and no other associated disease. This decision is typically made following a multidisciplinary discussion. Patients can also be put forward for surgical excision of bone metastases following inadequate response to chemotherapy or radiotherapy. With tumours located in the manubrium of the sternum, surgery serves not only to resect the bone metastasis but to provide suitable chest wall reconstruction. The goal of this approach is to maintain the structural and bony stability of the chest wall as well as that of associated structures, e.g. rib insertion or articulation of the shoulder girdle. A widely utilized approach involves excising the area of metastasis within the manubrium followed by implanting a bone cement prosthesis. Titanium plates are used to fix the bone prosthesis to the sternal body inferiorly and to the remainder of the manubrium superiorly. We present a step-by-step video tutorial for performing a lower hemi-manubriectomy in a patient with triple-negative breast cancer. Our goal is to describe the fundamental principles and surgical techniques used to perform this procedure followed by the postoperative outcomes.
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Affiliation(s)
- Aishah Z Mughal
- Cardiothoracic Surgery Department, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, United Kingdom
| | - Ahmed El-Zeki
- Cardiothoracic Surgery Department, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, United Kingdom
| | - Ahmed Oliemy
- Cardiothoracic Surgery Department, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, United Kingdom
| | - Ahmed M Habib
- Cardiothoracic Surgery Department, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, United Kingdom
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2
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Yoon DW, Kim TH, Cha MJ, Kim GH, Lee B, Kim HG, Kwon M, Jang D, Park B. Three-dimensional printed pure-titanium implantation for chest wall reconstruction involving the sternum and ribs: a novel approach. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae037. [PMID: 38561175 PMCID: PMC11009014 DOI: 10.1093/icvts/ivae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
Chest wall reconstruction is challenging due to the complex shape and large defect size. The three-dimensional printing technology enables the fabrication of customized implants, and 3D-printed pure-titanium could provide superior mechanical properties to conventional materials. The aim of this study was to evaluate long-term outcomes of patients undergoing chest wall reconstruction with a 3D-printed pure-titanium implant. Between August 2018 and May 2021, 5 patients underwent surgery due to sternal metastasis (n = 3), postoperative sternal wound infection (n = 1) and deformity (n = 1). The customized implant was designed and constructed based on the size and shape of the chest wall defect measured on computed tomography. All patients demonstrated uneventful recovery without complications during the hospital course. During the median follow-up of 20 months, 1 patient underwent revision surgery due to implant breakage, and 1 removed the implant due to trauma-related chest wall infection. One patient died from cancer progression, while 3 patients are alive without any implant-related complications. Chest wall reconstruction using a 3D-printed pure-titanium implant could be a novel alternative for patients with various conditions affecting the sternum and ribs.
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Affiliation(s)
- Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Gun-Hee Kim
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | - ByoungSoo Lee
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | - Hyung Giun Kim
- Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Republic of Korea
| | | | | | - Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Mandishona T, Asemota N, Alqudah O, Saad H, Fuentes-Warr J, Rhodes L, Kouritas V. Chest wall resection with robotic-assisted thoracoscopic surgery for a Pancoast tumour: a case report. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38526520 DOI: 10.1510/mmcts.2023.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.
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Affiliation(s)
- Tarisai Mandishona
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicole Asemota
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Obadah Alqudah
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Haisam Saad
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Joanna Fuentes-Warr
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Lydia Rhodes
- Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasileios Kouritas
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
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Kaiser LR. Is there an 'ideal' material for chest wall reconstruction? Eur J Cardiothorac Surg 2023; 64:ezad397. [PMID: 38014755 DOI: 10.1093/ejcts/ezad397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Larry R Kaiser
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Vanstraelen S, Bains MS, Dycoco J, Adusumilli PS, Bott MJ, Downey RJ, Huang J, Isbell JM, Molena D, Park BJ, Rusch VW, Sihag S, Allen RJ, Cordeiro PG, Coriddi MR, Dayan JH, Disa JJ, Matros E, McCarthy CM, Nelson JA, Stern C, Shahzad F, Mehrara B, Jones DR, Rocco G. Biologic versus synthetic prosthesis for chest wall reconstruction: a matched analysis. Eur J Cardiothorac Surg 2023; 64:ezad348. [PMID: 37846030 PMCID: PMC11032705 DOI: 10.1093/ejcts/ezad348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare postoperative outcomes between biologic and synthetic reconstructions after chest wall resection in a matched cohort. METHODS All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors. RESULTS In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50-142) for the biologic group and 90 cm2 (48-146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00-1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00-1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00-0.42; P = 0.024) were associated with lower rates. CONCLUSIONS The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions.
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Affiliation(s)
- Stijn Vanstraelen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter G Cordeiro
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle R Coriddi
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph H Dayan
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph J Disa
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen M McCarthy
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie Stern
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Farooq Shahzad
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak Mehrara
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kocher G, Deckarm S, Flury D. Completely portal robotic Pancoast tumour resection with en bloc resection of the left upper lobe and chest wall. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37970683 DOI: 10.1510/mmcts.2023.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The current gold standard for the treatment of Pancoast tumours is considered to be neoadjuvant chemoradiation followed by radical resection of the affected upper lobe en bloc with resection of the chest wall. Shaw and Paulson first described the most commonly used approach in 1961 via an extended posterolateral thoracotomy. However, because this approach comes with significant soft tissue damage and occasionally provides only suboptimal exposure, especially for anterior superior sulcus tumours, other approaches have been published in recent years, including open anterior approaches (Dartevelle and Gruenenwald) in addition to rare case reports of minimally invasive assisted hybrid procedures. Because we routinely perform robotic anatomical lung resections as well as three-port robotic first rib resections for thoracic inlet/outlet syndrome in our department, combining both techniques with our accumulated experience seemed to be the next logical step. We describe step-by-step what is (to our knowledge) one of the first reported cases of a fully portal robotic-assisted Pancoast tumour resection consisting of a left upper lobe resection en bloc with the first rib after neoadjuvant chemoradiation therapy. This approach proved to be safe and allowed for excellent exposure, especially of the thoracic outlet.
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Affiliation(s)
- Gregor Kocher
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
| | - Sarah Deckarm
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
| | - Dominik Flury
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
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Rojo M, Abdelsattar Z. Robotic resection of a second rib osteochondroma. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37942805 DOI: 10.1510/mmcts.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
A 43-year-old man presented with a several-month history of worsening left shoulder pain. On imaging, he was found to have an osseous mass arising from his left second rib and protruding into the soft tissues of his chest. The mass had radiographic characteristics consistent with those of an osteochondroma. He had point tenderness over the mass, and the area of point tenderness was consistent with his description of the location of his pain over the past several months. Based on his symptoms, he was taken to the operating room for robotic excision of this mass. He was placed in a right lateral decubitus position, and three robotic ports were inserted. The mass was identified based on landmarks and was dissected free. The bony attachment of the mass to the second rib was transected using a Kerrison rongeur. The mass was delivered into the chest and removed using an endobag. The patient was discharged the following day after removal of his Blake drain. His pain had completely resolved at the postoperative follow-up examination, and his final pathological report confirmed the benign diagnosis of osteochondroma.
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Affiliation(s)
- Manuel Rojo
- Department of Cardiovascular and Thoracic Surgery, Loyola University Medical Center, Chicago, IL, USA
| | - Zaid Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago IL
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8
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Deville R, Issard J, Vayssette A, Assouad J. Operative Resection of a Chronic Flail Chest Nonunion Revealing Septic Pseudarthrosis: A Case Report. J Chest Surg 2023; 56:449-451. [PMID: 37696779 PMCID: PMC10625966 DOI: 10.5090/jcs.23.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 09/13/2023] Open
Abstract
We report a case of chest wall resection for painful chest wall nonunion, 5 years after traumatic flail chest and a first attempt at surgical treatment. The decision was made to perform surgery again after 2 years of unsuccessful well-conducted analgesic treatment. During surgery, we found the same sites of pseudarthrosis and decided to perform parietectomy of the fifth, sixth, and seventh ribs. A Gore-Tex patch was used to bridge the gap created by the resection. In immediate postoperative care, the patient's pain was quickly and sufficiently eased by stage 1 and 2 pain killers. The results of bone samples taken from the pseudarthrosis sites all found Propionibacterium acnes. Five months after surgery, the patient had considerable improvement in pain sensations. Computed tomography showed healing of ribs, the plate in place, and no sign of complications.
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Affiliation(s)
- Robin Deville
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Justin Issard
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Anna Vayssette
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
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Tedesco J, Nakahama H, Abdelsattar Z. Totally robotic en bloc left upper lobectomy and chest wall resection after neoadjuvant chemoradiation. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37921749 DOI: 10.1510/mmcts.2023.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
This patient presented with a stage IIIB advanced lung cancer with chest wall invasion. She was treated with neoadjuvant chemoradiation therapy and had an excellent treatment response. The management of T3N2 disease is controversial, but given her treatment response and age, she was discussed by the multidisciplinary tumour board and referred for surgical evaluation. She was offered a robotic en bloc lobectomy and chest wall dissection.
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Affiliation(s)
- John Tedesco
- Department of Cardiothoracic Surgery, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Hiroko Nakahama
- Department of General Surgery, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Zaid Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago IL
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Egyud MRL, Holmes S, Burt BM. Technical Aspects of Robotic First Rib Resection. Thorac Surg Clin 2023; 33:265-271. [PMID: 37414482 DOI: 10.1016/j.thorsurg.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Robot-assisted thoracoscopic surgery for the treatment of thoracic outlet syndrome is a novel approach that continues to increase in popularity due to advantages compared with traditional open first rib resection. Following publication of the Society of Vascular Surgeons expert statement in 2016, the diagnosis and management of thoracic outlet syndrome is favorably evolving. Technical mastery of the operation requires precise knowledge of anatomy, comfort with robotic surgical platforms, and understanding of the disease.
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Affiliation(s)
- Matthew R L Egyud
- Division of Thoracic Surgery, The Michael E. Debakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Scott Holmes
- The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bryan M Burt
- Division of Thoracic Surgery, The Michael E. Debakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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Melek H, Özkan B, Volkan Kara H, Evrim Sevinç T, Kaba E, Turna A, Toker A, Gebitekin C. Minimally invasive approaches for en-bloc anatomical lung and chest wall resection. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:374-380. [PMID: 37664764 PMCID: PMC10472457 DOI: 10.5606/tgkdc.dergisi.2023.23850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 09/05/2023]
Abstract
Background The aim of this study was to evaluate the feasibility of en-bloc anatomical lung and chest wall resection via minimally invasive surgery. Methods Between January 2013 and December 2021, a total of 22 patients (18 males, 4 females; mean age: 63±6.9 years; range, 48 to 78 years) who underwent anatomical lung and chest wall resection using minimally invasive surgery for non-small cell lung cancer were retrospectively analyzed. Demographic, clinical, intra- and postoperative data of the patients, recurrence, metastasis, mortality, and overall survival rates were recorded. Results The surgical technique was robot-assisted thoracic surgery in two, multiport video-assisted thoracoscopic surgery in 18, and uniport video-assisted thoracoscopic surgery in two patients. Upper lobectomy was performed in 17 (77.3%) patients, lower lobectomy in three (13.6%) patients, and upper lobe segmentectomy in two (9.1%) patients. Five different techniques were used for chest wall resection. Nine (40.9%) patients had one, eight (36.4%) patients had two, four (18.2%) patients had three, and one (4.5%) patient had four rib resections. Chest wall reconstruction was necessary for only one of the patients. The mean operation time was 114±36.8 min. Complete resection was achieved in all patients. Complications were observed in seven (31.8%) patients without mortality. The mean follow-up was 24.4±17.9 months. The five-year overall survival rate was 55.3%. Conclusion Segmentectomy/lobectomy and chest wall resection with minimally invasive surgery are safe and feasible in patients with nonsmall cell lung cancer. In addition, the localization of the area where chest wall resection would be performed should be considered the most crucial criterion in selecting the ideal technique.
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Affiliation(s)
- Hüseyin Melek
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Hasan Volkan Kara
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Tolga Evrim Sevinç
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Erkan Kaba
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Akif Turna
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Alper Toker
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Cengiz Gebitekin
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
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Miyamoto E, Seki K, Katsuragawa H, Yoshimoto Y, Ohsumi Y, Fukui T, Gotoh M, Nakagawa T. Thoracic composite hemangioendothelioma with neuroendocrine marker expression. Surg Case Rep 2021; 7:249. [PMID: 34837560 PMCID: PMC8627540 DOI: 10.1186/s40792-021-01331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Composite hemangioendothelioma is an extraordinarily rare form of vascular neoplasm which develops predominantly in the skins and soft tissues of the adults. Neuroendocrine marker expression in composite hemangioendothelioma is considered as specifically relevant to the more aggressive behavior. CASE PRESENTATION The patient was a 71-year-old man complaining continuous back pain. Computed tomography (CT) showed that 10 cm of contrast-enhanced soft tissue mass was occurring on the right posterior chest wall and developing adjacent to the spinal canal. Via the laminectomy, the tumor end was identified and separated from the dura mater. Then, via the posterolateral thoracotomy, the en bloc resection was achieved by separating the tumor from the diaphragm and vertebras. Histologic examination showed a complex combination of epithelioid and retiform hemangioendothelioma areas which were positive for anti-synaptophysin staining. At 12-month follow-up, there were no signs of tumor recurrence on CT, and the patient had no symptom. CONCLUSIONS We achieved the complete resection of a huge thoracic neuroendocrine composite hemangioendothelioma developing adjacent to the spinal canal. The combination of the posterior lumbar laminectomy and the following posterior thoracotomy is a viable approach to radically resect a thoracic neuroendocrine composite hemangioendothelioma involving chest wall.
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Affiliation(s)
- Ei Miyamoto
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan.
| | - Kenji Seki
- Division of Orthopedic Surgery, Department of Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Pathologist, Tenri Hospital, Tenri, Nara, Japan
| | - Yuji Yoshimoto
- Division of Plastic Surgery, Department of Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Ohsumi
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Takamasa Fukui
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Masashi Gotoh
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
| | - Tatsuo Nakagawa
- Division of Thoracic Surgery, Department of Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 6328552, Japan
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Nayak R, Choe SI, Shargall Y. Complications of Chest Wall Resection in Conjunction with Pulmonary Resection. Thorac Surg Clin 2021; 31:393-8. [PMID: 34696851 DOI: 10.1016/j.thorsurg.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Techniques for chest wall resection and reconstruction have evolved over the years. Chest wall resection in conjunction with pulmonary resection has several complications, including pulmonary and infectious. Risk factors for complications are related to the size of the defect, number of ribs resected, and the addition of a pulmonary resection. Material used for reconstruction does not impact the overall complication rate.
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14
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Schirren M, Jefferies B, Safi S, Wörtler K, Hoffmann H. [Surgical treatment of chest wall tumors]. Chirurg 2021; 93:623-632. [PMID: 34636942 DOI: 10.1007/s00104-021-01499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
The term chest wall tumor summarizes a heterogeneous group of malignant and benign tumors, whereby primary and secondary chest wall tumors are differentiated. The incidence of secondary chest wall tumors is higher than that of primary tumors. Primary chest wall tumors can arise from any anatomic structure of the chest wall. Surgical resection is usually the treatment of choice. Resection status and tumor differentiation are relevant prognostic factors. Treatment of secondary chest wall tumors is performed depending on the patient's symptoms and prognosis of the underlying disease. Lung carcinomas infiltrating the chest wall can be resected primarily or secondarily as part of multimodal therapeutic strategies. Anatomic lung resections combined with chest wall resection have a higher mortality than standard resections. Chest wall reconstruction after resection has the goal of reducing paradoxical respiratory motion, although not every chest wall defect requires reconstruction.
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Affiliation(s)
- Moritz Schirren
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Benedikt Jefferies
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Seyer Safi
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Klaus Wörtler
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Hans Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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15
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Witte ZW, Mahoney JM, Harris JA, Sheikh HP, Haghshenas V, Bucklen BS, Marco RA. Biomechanical investigation of potential prophylactic scoliosis treatments following various sizes of chest wall resection. Clin Biomech (Bristol, Avon) 2021; 87:105416. [PMID: 34171652 DOI: 10.1016/j.clinbiomech.2021.105416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND A well-known problematic sequela of chest wall resections is development of scoliosis. Despite the seriousness and frequency of scoliosis following chest well resection, the etiology and biomechanical information needed to understand this progression aren't well-known. METHODS Range of motion of six specimen (C7-L2) was captured using a custom-built six degrees-of-freedom machine in each of three physiological rotation axes. Left posterior ribs were sequentially resected 7cm from the rib head, starting at the 5th rib and continuing until the 10th rib. Injured specimen were instrumented with unilateral anterior rod fixation and then with additional unilateral posterior fixation, each starting at T4 and then extended distally as ribs were resected. Relative motion between the constructs' proximal and distal ends was measured in all three axes for the intact, injured, unilateral anterior, and unilateral anterior with unilateral posterior constructs. FINDINGS Raw motion of the injured specimen increased in a stepwise manner as ribs were resected. Averaged across all injury sizes, the unilateral anterior construct significantly reduced motion by 47.0±13.4% in lateral bending (P=.001). The combined anterior-posterior construct significantly reduced motion by 57.6±15.9% in flexion/extension (P<.001), 70.3±12.2% in lateral bending (P<.001), and 51.1±14.5% in axial rotation (P<.001). Combined anterior-posterior fixation was significantly more stable than anterior-only fixation in flexion/extension (P=.002). INTERPRETATION Regardless of injury size, posterior rib resection did not create significant immediate instability of the thoracic spine. Concurrent spinal stabilization was shown to maintain thoracic spine stability. Combined anterior-posterior fixation proved to be significantly more rigid than an anterior-only construct.
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Affiliation(s)
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Hassaan P Sheikh
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Varan Haghshenas
- Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Rex A Marco
- Spine Surgery and Musculoskeletal Oncology, Houston Methodist Hospital, Houston, TX, USA
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16
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Prisciandaro E, Hustache-Castaing R, Michot A, Jougon J, Thumerel M. Chest wall resection and reconstruction for primary and metastatic sarcomas: an 11-year retrospective cohort study. Interact Cardiovasc Thorac Surg 2021; 32:744-752. [PMID: 33532842 DOI: 10.1093/icvts/ivab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chest wall sarcomas are rare, aggressive malignancies, the management of which mainly revolves around surgery. Radical tumour excision with free margins represents the optimal treatment for loco-regional clinically resectable disease. The objective of this study was to review our 11-year experience with chest wall resection for primary and metastatic sarcomas, focusing on surgical techniques and strategies for reconstruction. METHODS Retrospective analysis of a comprehensive database of patients who underwent chest wall resection for primary or secondary sarcoma at our Institute from January 2009 to December 2019. RESULTS Out of 26 patients, 21 (81%) suffered from primary chest wall sarcoma, while 5 (19%) had recurring disease. The median number of resected ribs was 3. Sternal resection was performed in 6 cases (23%). Prosthetic thoracic reconstruction was deemed necessary in 24 cases (92%). Tumour recurrence was observed in 15 patients (58%). The median overall survival was 73.6 months. Primary and secondary tumours showed comparable survival (P = 0.49). At univariate analysis, disease recurrence and infiltrated margins on pathological specimens were associated with poorer survival (P = 0.014 and 0.022, respectively). In patients with primary sarcoma, the median progression-free survival was 13.3 months. Associated visceral resections were significantly associated to postoperative complications (P = 0.02). CONCLUSIONS Chest wall resection followed by prosthetic reconstruction is feasible in carefully selected patients and should be performed by experienced surgeons with the aim of achieving free resection margins, resulting in improved long-term outcomes.
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Affiliation(s)
- Elena Prisciandaro
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Romain Hustache-Castaing
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Audrey Michot
- Division of Surgery, Bergonié Institute, Bordeaux, France
| | - Jacques Jougon
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Matthieu Thumerel
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
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Noda D, Abe M, Takumi Y, Anami K, Miyawaki M, Takeuchi H, Osoegawa A, Sugio K. Resection and postoperative radiation therapy for desmoid fibromatosis of the chest wall in a young woman. Surg Case Rep 2021; 7:28. [PMID: 33471222 DOI: 10.1186/s40792-020-01006-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022] Open
Abstract
Background Surgery is an effective treatment for desmoid fibromatosis, but it may be difficult, depending on the location or local spread of the tumor, and the decision to perform surgery must be made carefully. We herein report a case of desmoid fibromatosis of the chest wall in a young woman suspected of having invasion to the 1st, 2nd and 3rd ribs. Case presentation A 35-year-old woman had been aware of dry cough and right chest pain, so she was referred to our hospital. Chest computed tomography showed a localized pleural tumor mainly at the first rib. Magnetic resonance imaging revealed a 75 × 65 × 27-mm tumor with a smooth surface, with partial contact from the first rib to third rib and partial extension to the 1st intercostal space. The tumor showed growth in the two months after the first visit, so resection was performed. The tumor was completely resected, and adjuvant radiation therapy (50 Gy) was performed for the small margin. The pathological diagnosis was desmoid fibromatosis. The postoperative course has been uneventful, without recurrence at 14 months after surgery. Conclusions In chest wall tumors located ventral of the pulmonary apex, we suggest that a combination of the Grunenwald method and Masaoka anterior approach may be a useful option. In cases where margin is not enough, adjuvant radiation therapy should be considered.
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18
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Goldsmith I, Evans PL, Goodrum H, Warbrick-Smith J, Bragg T. Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant. 3D Print Med 2020; 6:26. [PMID: 32975713 DOI: 10.1186/s41205-020-00079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. METHOD To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient's chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. RESULTS Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. CONCLUSION Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.
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Elmi M, Wakeam E, Azin A, Presutti R, McCready DR, Cil TD, Keshavjee S. Surgical Morbidity of Full-Thickness Chest Wall Resection for Breast Cancer: A Retrospective Study of a National Database. J Surg Res 2021; 257:161-6. [PMID: 32829000 DOI: 10.1016/j.jss.2020.07.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Full-thickness chest wall resection (FTCWR) is an underused modality for treating locally advanced primary or recurrent breast cancer invading the chest wall, for which little data exist regarding morbidity and mortality. We examined the postoperative complication rates in breast cancer patients undergoing FTCWR using a large multinational surgical outcomes database. METHODS A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. All patients undergoing FTCWR for breast cancer between 2007 and 2016 were identified (n = 137). Primary outcome measures included 30-d postoperative morbidity, composite respiratory complications, and hospital length of stay (LOS). The secondary aim was to compare the postoperative morbidity of FTCWR to those of patients undergoing mastectomy. One-to-one coarsened exact matching was conducted between two groups, which were then compared with respect to morbidity, mortality, reoperations, readmissions, and LOS. RESULTS The overall rate of postoperative morbidity was 11.7%. Two patients (1.5%) had respiratory complications requiring intubation. Median hospital LOS was 2 d. In the coarsened exact matching analysis, 122 patients were included in each of the two groups. Comparison of matched cohorts demonstrated an overall morbidity for the FTCWR group of 11.5% compared with 8.2% for the mastectomy group (8.2%) (P = 0.52). CONCLUSIONS FTCWR for the local treatment of breast cancer can be performed with relatively low morbidity and respiratory complications. This is the largest study looking at postoperative complications for FTCWR in the treatment of breast cancer. Future studies are needed to determine the long-term outcomes of FTCWR in this patient population.
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Abstract
Chest wall sarcoma is a rare and challenging pathology best managed by a multidisciplinary team experienced in the management of a multiple different pathologies. Knowledge of the management sequence is important for each sarcoma type in order to provide optimal treatment. Surgical resection of chest wall resections remains the primary treatment of disease isolated to the chest wall. Optimal margins of resection and reconstruction techniques have yet to be determined.
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21
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Dharmaraj B, Diong NC, Shamugam N, Sathiamurthy N, Mohd Zainal H, Chai SC, Koh KL, Mat Zain MA, Haji Basiron N. Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia. Indian J Thorac Cardiovasc Surg 2020; 37:82-88. [PMID: 33442211 DOI: 10.1007/s12055-020-00972-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022] Open
Abstract
Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients' demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.
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Affiliation(s)
- Benedict Dharmaraj
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nguk Chai Diong
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Navindra Shamugam
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Narasimman Sathiamurthy
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Hamidah Mohd Zainal
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Siew Cheng Chai
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Khai Luen Koh
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohammad Ali Mat Zain
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Normala Haji Basiron
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Wald O, Islam I, Amit K, Ehud R, Eldad E, Omer O, Aviad Z, Moshe SO, Uzi I. 11-year experience with Chest Wall resection and reconstruction for primary Chest Wall sarcomas. J Cardiothorac Surg 2020; 15:29. [PMID: 31992336 PMCID: PMC6988268 DOI: 10.1186/s13019-020-1064-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background & Objectives Primary chest wall sarcomas are rare and therapeutically challenging tumors. Herein we report the outcomes of a surgery-based multimodality therapy for these pathologies over an 11-year period. In addition, we present a case that illustrates the surgical challenges that extensive chest wall resection may pose. Methods Using the Society of Thoracic Surgeons general thoracic surgery database, we have prospectively collected data in our institute on all patients undergoing chest wall resection and reconstruction for primary chest wall sarcomas between June 2008–October 2019. Results We performed 28 surgical procedures on 25 patients aged 5 to 91 years (median age 33). Eleven tumors were bone- and cartilage-derived and 14 tumors originated from soft tissue elements. Seven patients (7/25, 28%) received neo-adjuvant therapy and 14 patients (14/25, 56%) received adjuvant therapy. The median number of ribs that were resected was 2.5 (range 0 to 6). In 18/28 (64%) of surgeries, additional skeletal or visceral organs were removed, including: diaphragm [1], scapula [2], sternum [2], lung [2], vertebra [1], clavicle [1] and colon [1]. Chest wall reconstruction was deemed necessary in 16/28 (57%) of cases, polytetrafluoroethylene (PTFE) Gore-Tex patches was used in 13/28 (46%) of cases and biological flaps where used in 4/28 (14%) of cases. R0, R1 and R2 resection margins were achieved in 19/28 (68%), 9/28 (32%) and 0/28 (0%) of cases, respectively. The median follow up time was 33 months (range 2 to 138). During the study period, disease recurred in 8/25 (32%) of patients. Of these, 3 were re-operated on and are free of disease. At date of last follow up, 5/25 (20%) of patients have died due to their disease and in contrast, 20/25 (80%) were alive with no evidence of disease. Conclusions Surgery-based multimodality therapy is an effective treatment approach for primary chest wall sarcomas. Resection of additional skeletal or visceral organs and reconstruction with synthetic and/or biological flaps is often required in order to obtain R0 resection margins. Ultimately, long-term survival in this clinical scenario is an achievable goal.
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Affiliation(s)
- Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
| | - Idais Islam
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Korach Amit
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rudis Ehud
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Erez Eldad
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Or Omer
- Department of Orthopedics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Zik Aviad
- Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Shapira Oz Moshe
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Izhar Uzi
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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Menon A, Khalil H, Naidu B, Bishay E, Steyn R, Kalkat MS. Chest wall resection and reconstruction for recurrent breast cancer - A multidisciplinary approach. Surgeon 2020; 18:208-213. [PMID: 31917085 DOI: 10.1016/j.surge.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered. METHODS Between 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22-77 years). RESULTS The median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1-24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66-97) and 61% (95% CI 31-81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45-86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7-65.7) and 24.5 months (95% CI 7.3-41.7) for patients with distant metastatic recurrence. CONCLUSION A multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival.
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Affiliation(s)
- Ashvini Menon
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Haitham Khalil
- Plastic and Reconstructive Surgery Division, Good Hope Hospital, Sutton Coldfield, Birmingham, West Midlands, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK.
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24
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Sandri A, Donati G, Blanc CD, Nigra VA, Gagliasso M, Barmasse R. Anterior chest wall resection and sternal body wedge for primary chest wall tumour: reconstruction technique with biological meshes and titanium plates. J Thorac Dis 2020; 12:17-21. [PMID: 32055419 DOI: 10.21037/jtd.2019.06.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).
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Affiliation(s)
- Alberto Sandri
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Victor Auguste Nigra
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Matteo Gagliasso
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Yoshiyasu N, Kojima F, Takahashi O, Ishikawa Y, Bando T. The impact of surgical chest wall damage caused by classic thoracotomy on pulmonary function and morphology. Gen Thorac Cardiovasc Surg 2020; 68:508-15. [PMID: 31728835 DOI: 10.1007/s11748-019-01250-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Postoperative changes in pulmonary function (PF) and morphology due to surgical chest wall damage by thoracotomy with rib resection are unclear. Therefore, we evaluated the effects of surgical damage on PF and morphology at > 6 months postoperatively by comparing different lung lobectomy approaches. METHODS A total of 140 patients who underwent lobectomy for lung diseases between January 2006 and March 2016 were analyzed. Patients who underwent PF tests and computed tomography (CT) scans preoperatively and postoperatively were divided into posterolateral thoracotomy with one rib resection (PT) group and video-assisted thoracoscopic surgery (VATS) group. A 1:1 propensity score-matched (PSM) analysis was used to balance clinically important confounders between the groups. Regarding morphology, lung volume was measured semi-automatically using image analysis software and reconstructed three-dimensional (3D) images. RESULTS After PSM, 31 patients in each group were compared. Perioperative reduction ratios in forced vital capacity (FVC) (- 23% vs. - 13%; P = 0.006) and forced expiratory volume in 1 s (FEV1) (- 19% vs. - 12%; P = 0.02) were significantly larger for the PT group. No significant differences in lung volume values based on 3D CT volumetry (PT vs. VATS; total lung volume: - 7.9% vs. - 7.2%, P = 0.82; non-resected ipsilateral lung volume: + 36% vs. + 40%, P = 0.69; contralateral lung volume: + 9.3% vs. + 9.4%, P = 0.98) were found in either group. CONCLUSIONS Among the patients underwent lobectomy, classic thoracotomy decreased PF by an additional FVC loss of 10% and FEV1 loss of 7% compared with VATS, without affecting residual lung volume.
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Abstract
The optimal surgical reconstruction of chest wall defects especially in the context of posttraumatic, oncological and congenital etiologies has a large impact on the recovery of the patients. Regardless of the etiology, various complications, such as a generally impaired respiratory physiology in an unstable thorax or decreased pulmonary clearance associated with acute and chronic pulmonary infections, may impair the recovery of affected patients. The postoperative occurrence of an intrathoracic dead space may lead to a difficult to treat empyema. Each thoracic wall defect must be accurately assessed and treated according to size, depth and location on the chest. The complexity of this condition and the resulting complications require the highest degree of surgical care which should be interdisciplinary both preoperatively and postoperatively.
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Affiliation(s)
- M Heldwein
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - F Doerr
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schlachtenberger
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - K Hekmat
- Klinik für Herz und Thoraxchirurgie, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Marqués C, Pizones J, Sánchez-Márquez JM, Martín-Baldan M, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ. Surgical Treatment of Scoliosis Developed After Extended Chest Wall Resection Due to Askin Tumor During Childhood. Spine Deform 2019; 7:180-185. [PMID: 30587315 DOI: 10.1016/j.jspd.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Report of four cases. OBJECTIVE To describe a series of pediatric patients with surgical scoliosis after chest wall resections due to Askin tumors. SUMMARY OF BACKGROUND DATA Askin tumors are a rare type of chest wall solid tumors that can develop in children. Treatment involves chemotherapy and extensive surgical resection, including disarticulation of several ribs. This can cause thoracogenic scoliosis, with very scarce data found in the literature regarding its treatment and prognosis. MATERIALS AND METHODS Retrospective descriptive series of four cases of scoliosis in pediatric patients, secondary to extensive chest resections due to Akin's tumors. We analyzed the results of the surgical treatment. RESULTS Three girls and one boy with a mean age of 8.7 ± 2.2 years and 7 ± 3.6 years of follow-up were included. In all cases, the convexity of the thoracic curvature was toward the area of chest resection, occurring a mean of 1.9±1.3 years after thoracic surgery. A distraction-based system (two vertically expandable prosthetic titanium rib [VEPTR], two traditional growing rods) was used to correct the scoliosis. The preoperative Cobb angle (68.7° ± 22.9°) was corrected to 32.6° ± 9.7° at final follow-up. Preoperative coronal imbalance was 2.95 ± 1.86 cm and was corrected to 0.3 ± 0.6 cm at final follow-up. No changes were observed regarding preoperative kyphosis 30° ± 8.7° (33°±8° final). T1-S1 initial length was 29.65 cm changing to 40.65 cm. T1-T12 height went from 18.25 to 23.67 cm. There was one complication secondary to the proximal anchoring. CONCLUSIONS For treatment of scoliosis secondary to extensive chest resection in the growing children with Askin tumors, distraction-based growth-friendly treatment is an available surgical option. Seven years of follow-up showed more than 50% improvement of the Cobb angle, and an average thoracic and trunk growth of 5.42 and 11 cm, respectively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Carlos Marqués
- Department of Orthopaedic Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 58, Salamanca 37007, Spain.
| | - Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, Spain
| | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, Spain
| | - Montserrat Martín-Baldan
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, Spain
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, Spain
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Oyebanji TN, Oseni GO, Inuwa IM, Ahmad JI, Garba S, Yusuf L. Refractory bleeding from a giant de-differentiated liposarcoma of the chest wall: An indication for neoadjuvant chemotherapy and palliative resection? - A case report. Int J Surg Case Rep 2018; 50:135-9. [PMID: 30121442 DOI: 10.1016/j.ijscr.2018.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/28/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022] Open
Abstract
Dedifferentiated Liposarcoma (DDLPS) occur rarely in the chest. Response to chemotherapy is believed to be minimal. Neoadjuvant chemotherapy plays a role in stopping refractory bleeding from a chest wall DDLPS. Palliative resection may be used to improve quality of life even in the face of incurable disease.
Introduction Dedifferentiated liposarcoma (DDLPS) is a heterogenous neoplasm of variable histological grade. DDLPS uncommonly arises from the chest wall. There are limited data available about the tumor’s response to chemotherapy and accessible reports indicate minimal benefits. Surgery is thus the cornerstone of management. Here, we demonstrate an uncommon situation where chemotherapy was used to arrest bleeding from a giant DDLPS that was refractory to all available hemostatic agents. This case also presents an uncommon indication for palliative chest wall resection and reconstruction (CWRR). Presentation of case A 55-year old woman presented with refractory bleeding from an ulcerated and foul-smelling mass on the anterior chest wall, confirmed histologically to be DDLPS. Chemotherapy with Doxorubicin and Ifosfamide was used to control the bleeding. She subsequently had CWRR to improve her quality of life. The patient made an uneventful recovery but later died from pulmonary embolism. Discussion The dedifferentiated component of DDLPS is vascular and may account for why we were able to exhibit a hemostatic response to chemotherapy. CWRR was then employed to improve the quality of life in an advanced, ulcerated and infected tumor of the chest wall. Conclusion We were able to demonstrate a hemostatic response of DDLPS to neoadjuvant chemotherapy and anticipate that this report may serve as a reference for further studies. Furthermore, we believe that palliative resection may be carried out to improve a patient’s quality of life even in the face of advanced disease.
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Kapdagli M, Erus S, Tanju S, Dilege S. Extensive chest wall resection, reconstruction and right pneumonectomy in a 24-week pregnant patient. Lung Cancer 2018; 122:7-9. [PMID: 30032848 DOI: 10.1016/j.lungcan.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/29/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
A 23-year-old pregnant patient was evaluated with a mass lesion located on the right sided chest wall. A MRI of the chest showed a lesion of approximately 18 × 16 × 17.5 cm originating from ribs. A tru-cut biopsy revealed the diagnosis of chondrosarcoma. The patient underwent an extended chest wall resection, reconstruction and right pneumonectomy operation in the 24th gestation week. After the recovery period, two cycles of chemotherapy were administrated. The patient delivered a healthy baby in 34th week of her pregnancy.
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Affiliation(s)
| | - Suat Erus
- Koç University School of Medicine, Istanbul, Turkey
| | - Serhan Tanju
- Koç University School of Medicine, Istanbul, Turkey
| | - Sukru Dilege
- Koç University School of Medicine, Istanbul, Turkey
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Rajesh A, Farooq M. Resection and reconstruction following recurrent malignant phyllodes-Case report and review of literature. Ann Med Surg (Lond) 2017; 16:14-18. [PMID: 28275427 PMCID: PMC5331157 DOI: 10.1016/j.amsu.2017.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Phyllodes tumors are uncommon biphasic fibroepithelial neoplasms of the breast of varying malignant potential occurring in middle aged women. They exhibit diverse biological behavior. Margin free excision is the mainstay of treatment. CASE PRESENTATION A 27 year-old lady was referred with a painless ulceroproliferative right breast lesion which had rapidly progressed over six months. Three years back, she had been diagnosed with a borderline phyllodes tumor and underwent a wide local excision followed by a right mastectomy for recurrence. The resection margins were positive hence she underwent postoperative radiation. We performed a radical resection of the chest wall and reconstruction using a composite mesh (inner PTFE and outer vypro), pedicled latissimus dorsi flap and a split skin graft for the recurrent malignant tumor. She recovered uneventfully thereafter. DISCUSSION Malignant phyllodes tumor is uncommon and treatment principles are from case reports and retrospective studies. Aggressive resection of the lesion and reconstruction of the chest wall with bone cement and two meshes-a composite mesh (inner layer -polytetrafluroethylene and outer layer of polypropylene) and a Vypro mesh is a possibility. This case highlights the challenges encountered in managing these patients and presents a radical solution. CONCLUSION Treatment of phyllodes tumor necessitates adequate excision of the tumor and adjacent tissues to ensure tumor free margins. Pathological evolution from intermediate to malignant histology may be exhibited. A full-thickness chest wall resection and reconstruction although radical is a feasible option as these tumors rarely respond to other modalities of cancer management.
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Affiliation(s)
- Aashish Rajesh
- Madras Medical College & Rajiv Gandhi Government General Hospital, No. 3 EVR Periyar Salai, Chennai, 600003, Tamil Nadu, India
| | - Mohammed Farooq
- Madras Medical College & Rajiv Gandhi Government General Hospital, No. 3 EVR Periyar Salai, Chennai, 600003, Tamil Nadu, India
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Liu M, Wampfler JA, Dai J, Gupta R, Xue Z, Stoddard SM, Cassivi SD, Jiang G, Yang P. Chest wall resection for non-small cell lung cancer: A case-matched study of postoperative pulmonary function and quality of life. Lung Cancer 2017; 106:37-41. [PMID: 28285692 DOI: 10.1016/j.lungcan.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND To assess the pulmonary function and quality of life (QOL) after chest wall resection for non-small cell lung cancer. MATERIAL AND METHODS One hundred and thirty-five patients (cases) who underwent pulmonary resection with chest wall removal were identified from January 1997 to December 2015. Propensity score matching (1:3) was applied to balance known confounders for pulmonary function and QOL between the cases and the control group who underwent pulmonary resection without chest wall invasion. Matched analyses were performed to compare perioperative mortality and morbidity, postoperative pulmonary function, overall QOL, and specific symptoms. RESULTS Perioperative mortality and morbidity did not differ significantly between cases and controls, but the hospital stay was longer in cases than in controls (mean, 12.8 vs 8.9days; p<0.001), The decline of postoperative pulmonary forced vital capacity (FVC) and the percentage of predicted FVC (FVC%) was more obvious in cases than in controls at 6 months and 2 years after surgery, but there was no obvious decline in the forced expiratory volume in one second (FEV1), the percentage of predicted FEV1 (FEV1%), the diffusion capacity of the lung for carbon monoxide (DLCO) and the percentage of predicted DLCO (DLCO%) in cases compared with controls. No significant difference was observed between the two groups in scores for overall QOL, pain, fatigue, cough, dyspnea, appetite, hemoptysis, lung cancer symptoms, and normal activities. CONCLUSIONS When chest wall resection is inevitable, it does not worse the QOL and pulmonary function of patients who underwent pulmonary resection with chest wall removal obviously compared with patients underwent pulmonary resection without chest wall invasion.
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Affiliation(s)
- Ming Liu
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, United States; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Jie Dai
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, United States; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ruchi Gupta
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Zhiqiang Xue
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, United States; The General Hospital of People's Liberation Army (301 Hospital), Beijing, China
| | - Shawn M Stoddard
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, United States
| | - Stephen D Cassivi
- Divisionof General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, United States.
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Ueda Y, Nakagawa T, Toyazaki T, Chiba N, Gotoh M. Rib resection using a pneumatic high-speed power drill system for lung cancer with chest wall invasion: our clinical experience. Surg Today 2017; 47:476-80. [PMID: 27826728 DOI: 10.1007/s00595-016-1437-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/08/2016] [Indexed: 10/20/2022]
Abstract
Rib resection for chest wall tumors, including lung cancer with chest wall invasion, is usually performed through open thoracotomy. Resection of part of the external rib cage requires an elongated or additional incision depending on the location and extension of the tumor, eventually becoming more invasive to patients. We recently introduced a technique of rib resection using a pneumatic high-speed power drill system known as "air tome". This novel technique is easy to perform through a small incision or even via video-assisted thoracoscopic surgery (VATS) in selected patients. We present our clinical experience and discuss the usefulness of this technique for rib resection in patients with lung cancer and chest wall invasion.
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Bertoglio P, Fanucchi O, Ricciardi S, Chella A, Lucchi M, Mussi A. Chest wall resection for mesothelioma recurrence after surgery. Asian Cardiovasc Thorac Ann 2016; 24:893-895. [PMID: 27926466 DOI: 10.1177/0218492316674861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malignant pleural mesothelioma is an aggressive and usually fatal disease, and its optimal management is still under debate. Surgery for recurrent malignant mesothelioma has been reported rarely in highly selected cases. We report a case of chest wall resection for local recurrence of epithelioid mesothelioma 3 years after cytoreductive surgery. Our patient experienced a 6-month disease-free survival after redo surgery, with complete resolution of his chest pain and discomfort.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Sara Ricciardi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Division of Pneumonology, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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Abstract
Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lucia Battistella
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Francesca Calabrese
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Gaucher S, Lococo F, Guinet C, Bobbio A, Magdeleinat P, Bouam S, Regnard JF, Alifano M. Indications and Results of Reconstructive Techniques with Flaps Transposition in Patients Requiring Complex Thoracic Surgery: A 12-Year Experience. Lung 2016; 194:855-63. [PMID: 27395425 DOI: 10.1007/s00408-016-9921-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Flap transposition is an infrequent but far from exceptional thoracic surgical procedure. The aim of this retrospective study was to report our experience in a referral unit of general thoracic surgery analyzing the early results after flap transposition. METHODS We retrospectively analyzed the clinical records, surgical notes, and postoperative results of a cohort of patients who underwent flap transposition in our unit from November 2000 to February 2013. RESULTS Overall, a surgical approach adopting flap reconstruction techniques was performed in 81 patients (54 males, 27 females) with a median age of 62 years (range 20-87). Flap transposition was necessary to reconstruct chest wall after resection for malignancy (27 patients), to repair intrathoracic viscera perforation (15 patients), and to fill residual cavities secondary to pulmonary/pleural infection (39 patients). A pedicle muscle flap was transposed in most of cases (64 pts, 79 %), while in the remaining 17 cases (11 %), an omental flap was used. There were no immediate postoperative complications, while three in-hospital deaths occurred due to respiratory or multiorgan failure. Among patients undergone flap transposition to fill a residual cavity, we observed a recurrent bronchopleural fistula in three patients (7.7 %); such patients were treated by repeat flap transposition (2 cases) and by repeat cavernostomy (1 case). CONCLUSION Flap transposition may be indicated as part of a multimodal treatment for severely ill patients requiring complex thoracic surgery.
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Affiliation(s)
- Sonia Gaucher
- Faculté de Médecine, Université Paris Descartes, Paris, France. .,Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France. .,Service de Chirurgie Générale, Plastique et Ambulatoire, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75 014, Paris, France.
| | - Filippo Lococo
- Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Claude Guinet
- Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Antonio Bobbio
- Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Pierre Magdeleinat
- Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Samir Bouam
- Département d'Information Médicale, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Jean-François Regnard
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Marco Alifano
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service de Chirurgie Thoracique, AP-HP, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
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Abstract
The main indications for chest wall resection continue to be tumors, infection, and radiation injury. Complications surrounding chest wall resection procedures include respiratory failure, wound complications, and prosthetic complications. The main risk factors for complications are size of defect, age, and concomitant lung resection. Most complications related to either the wound or the prosthesis are late postoperative events. The identification of complications related to chest wall reconstruction requires clinical examination and the use of detailed imaging studies. The management of both prosthetic and wound complications often requires reoperation and removal of the prosthesis combined with soft tissue wound management.
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Affiliation(s)
- Kweku Hazel
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, MS C310, Aurora, CO 80045, USA
| | - Michael J Weyant
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, MS C310, Aurora, CO 80045, USA.
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Kawaguchi T, Tojo T, Kawai N, Watanabe T, Yasukawa M, Taniguchi S. A new minimally invasive technique of combined chest wall resection for lung cancer. Surg Today 2016; 46:1348-51. [PMID: 26860273 DOI: 10.1007/s00595-016-1311-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/05/2016] [Indexed: 01/02/2023]
Abstract
We describe our technique of minimally invasive chest wall resection for primary lung cancer. We used this technique to perform two lobectomies combined with chest wall resection using thoracoscopic assistance. The intercostal muscles and vessels were divided using a vessel-sealing device, which was easy to maneuver through the access incision, achieving reliable hemostasis. In one patient, adding the utility port just over the dorsal edge of the chest wall proved useful for dissecting the distal area of the chest wall. This approach required only minimal incision without cutting the uninvolved extrathoracic musculature of the chest.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takashi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Anderson CJ, Spruiell MD, Wylie EF, McGowan CM, Deleyiannis FW, Donaldson NJ, Heare TC. A technique for pediatric chest wall reconstruction using custom-designed titanium implants: description of technique and report of two cases. J Child Orthop 2016; 10:49-55. [PMID: 26782367 DOI: 10.1007/s11832-015-0709-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/26/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We present a surgical technique for chest wall reconstruction using custom-designed titanium implants developed for two female patients to provide both chest wall symmetry and adequate stability for staged breast reconstruction. METHODS A retrospective review was performed for two adolescent female patients with large chest wall defects who underwent the described technique. The etiology of the chest wall deficiency was secondary to Poland's syndrome in one patient, and secondary to surgical resection of osteosarcoma in the other patient. For each patient, a fine-cut computed tomography scan was obtained to assist with implant design. After fabrication of the prosthesis, reconstruction was performed though a curvilinear thoracotomy approach with attachment of the implant to the adjacent ribs and sternum. Wound closure was obtained with use of synthetic graft material, local soft tissue procedures, and flap procedures as necessary. RESULTS The two patients were followed post-operatively for 35 and 38 months, respectively. No intra-operative or post-operative complications were identified. Mild scoliosis that had developed in the patient following chest wall resection for osteosarcoma did not demonstrate any further progression following reconstruction. CONCLUSIONS We conclude that this technique was successful at providing a stable chest wall reconstruction with satisfactory cosmetic results in our patients.
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Wee HE, Akbar FA, Rajapaksha K, Aneez DBA. Anterior chest wall resection and reconstruction for locally advanced breast cancer. Multimed Man Cardiothorac Surg 2015; 2015:mmv025. [PMID: 26362545 DOI: 10.1093/mmcts/mmv025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/05/2015] [Indexed: 11/12/2022]
Abstract
With breast cancer awareness, the incidence of large invasive tumours is rare. We present a video of locally advanced breast cancer invading the anterior chest wall requiring en bloc resection that resulted in a large chest wall defect with exposed pleural and pericardial surface. Skeletal reconstruction and provision of adequate soft tissue coverage in order to avoid respiratory failure was challenging. A 58-year-old female presented with a 3-year history of locally invasive breast carcinoma with contiguous spread to sternum, clavicles, sternoclavicular joints and bilateral second to fifth ribs. She underwent total sternectomy, bilateral second to fifth ribs and chest wall resection resulting in a 21 × 18 cm chest wall defect. Reconstruction of her sternum was with methyl-methacrylate cement prosthesis. Ribs were reconstructed with titanium plates. Soft tissue coverage was achieved with left vertical rectus abdominis pedicle flap, right external oblique transposition flap and a right latissimus dorsi free flap. Flap failure necessitated a right vastus lateralis free flap. She was discharged ambulant without respiratory compromise. Resection and reconstruction of large chest wall defects is possible due to new bioprosthetic materials and is possible with acceptable morbidity and mortality.
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Affiliation(s)
- Hide Elfrida Wee
- Department of Thoracic Surgery, Tan Tock Seng Hospital, Singapore
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Gonzalez-Rivas D, Xie B, Yang Y, Jiang G. Uniportal video-assisted thoracoscopic lobectomy with en bloc chest wall resection. J Vis Surg 2015; 1:7. [PMID: 29075597 DOI: 10.3978/j.issn.2221-2965.2015.07.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lobectomy with chest wall resection was traditionally performed by thoracotomy or by conventional video-assisted thoracoscopic surgery (VATS) during the last decade. However, this procedure can be performed by using only a single incision thoracoscopic approach. METHODS The publications of uniportal VATS lobectomy requiring chest wall resection describes the use of one incision for the lobectomy (uniportal approach) and a posterior or lateral incision for the chest wall resection. This additional incision ensures a better control from outside and inside to achieve a costal resection with good oncologic margins. RESULTS This video shows a total uniportal VATS lobectomy with en bloc chest wall resection through a single 5-cm incision with no rib spreading. The total surgical time was 150 minutes. The postoperative course of the patient was uneventful. CONCLUSIONS Uniportal VATS lobectomy with en-bloc chest wall resection is a feasible and safe technique. The full procedure can be performed by using only a single incision in selected cases.
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Affiliation(s)
- Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña Hospitals, Coruña, Spain
| | - Boxiong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Abstract
Reconstruction of large chest wall defects after resection remains a significant undertaking. Obtaining a negative margin is of paramount importance for long-term survival. While reconstructing the chest wall, recreating a stable chest wall with adequate functional capacity and reasonable cosmesis are always the end goals. Morbidity from these procedures is significant, and mortality continues to hover around 5%. With continued advancement in reconstructive techniques and improved perioperative management, these procedures will continue to result in improved outcomes for patients.
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Affiliation(s)
- Daine T Bennett
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, School of Medicine, 12631 East 17th Avenue, MS 302, Aurora, CO 80045, USA
| | - Michael J Weyant
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, 12631 East 17th Avenue, MS C310, Aurora, CO 80045, USA.
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Marulli G, Duranti L, Cardillo G, Luzzi L, Carbone L, Gotti G, Perissinotto E, Rea F, Pastorino U. Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors. Eur J Cardiothorac Surg 2014; 45:e194-201. [PMID: 24616390 DOI: 10.1093/ejcts/ezu095] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Wide surgical excision with tumour-free margins is the mainstay of therapy for primary chest wall chondrosarcoma (PCWC). Few studies on treatment outcome and prognostic factors of PCWC requiring chest wall resection are available. We analysed our experience on surgical treatment of PCWC with emphasis on survival and recurrence prognostic factors. METHODS From 1986 to 2012, 89 patients (65.2% males, median age 55 years) with PCWC were operated on. The median tumour maximum diameter was 7 cm (range 2-30 cm). RESULTS We performed 23 sternectomies and 66 lateral chest wall resections (median ribs resected: 2; range 1-7). Resections were extended to lung (n = 19), diaphragm (n = 13), vertebral body (n = 6) or clavicle (n = 1). Negative margins were obtained in 85.4% of cases. Chest wall reconstruction was obtained mainly by prosthetic non-rigid or rigid materials and muscle flap coverage. In the last years, 3 patients received a sternal replacement with cadaveric allograft, and 2 had a chest wall reconstruction with titanium bars and 17 with a rib-like prosthesis. Perioperative mortality and morbidity rates were 0 and 12.4%, and 5- and 10-year overall and disease-free (on R0 resections) survival rates were 67.1 and 57.8%, and 70 and 52%, respectively. A favourable outcome (univariate analysis) was seen for G1 tumours (P < 0.0001), negative surgical margins (P < 0.0001), age ≤55 years (P = 0.005), no adjuvant treatment (P < 0.001) and diameter ≤6 cm (P = 0.005). Independent predictors of better survival (multivariate analysis) were negative surgical margins (P = 0.0001), G1 tumours (P = 0.02), age ≤55 years (P = 0.006) and diameter ≤6 cm (P = 0.006). A predictive risk factor for recurrence was histological grade. CONCLUSIONS Surgical resection of PCWC leads to good oncological outcome. Wide surgical margins and G1 tumours predicted a better prognosis and a lower recurrence rate. The evolution of surgical technique and the introduction in clinical practice of new prosthetic materials allowed larger resections, and safe and anatomical reconstruction.
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Affiliation(s)
- Giuseppe Marulli
- Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Leonardo Duranti
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Cardillo
- Division of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Luca Luzzi
- Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy
| | - Luigi Carbone
- Division of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Giuseppe Gotti
- Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy
| | - Egle Perissinotto
- Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Ugo Pastorino
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Al Ameri O, Chaouat M, Marco O, Azoulay B, Hersant B, Mimoun M. [Major chest wall resection for the treatment of invasive breast carcinoma: A series of 33 patients]. ANN CHIR PLAST ESTH 2013; 59:115-22. [PMID: 24230974 DOI: 10.1016/j.anplas.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Breast cancer can spread to the chest wall. It is an aggressive stage of poor prognosis. We have developed a technique of major chest wall resection extended beyond the breast area in order to reduce the recurrence. PATIENTS AND METHODS This is a retrospective single-center series of 33 patients with breast cancer spread to the chest wall without metastasis (13 patients present with primary breast cancer and 20 patients present with recurrent breast cancer) treated by major chest wall resection between January 1993 and January 2013, by the same surgeon. Analysis of the results was made by another surgeon. RESULTS Patients aged between 27-83years with an average of 55years. The removed parts measured 350cm(2) to 1200cm(2), and the average duration of complete healing was 7.9months. The mean follow-up time was 122months (6months-240months). The 1 year survival was 84.4%, at 2years 72.6%, at 3years 69.5% and at 5 years of 66.4%. CONCLUSION The technique of major chest wall resection is simple and reproducible. Breast cancer with chest wall extension has a poor prognosis. At the end of the study, 20 of 33 patients who benefit from this technique are still alive.
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Affiliation(s)
- O Al Ameri
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - M Chaouat
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - O Marco
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - B Azoulay
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - B Hersant
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - M Mimoun
- Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
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Turna A, Kavakli K, Sapmaz E, Arslan H, Caylak H, Gokce HS, Demirkaya A. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection. Interact Cardiovasc Thorac Surg 2013; 18:234-6. [PMID: 24227881 DOI: 10.1093/icvts/ivt408] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours.
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Affiliation(s)
- Akif Turna
- Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
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45
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Abstract
BACKGROUND DATA There has been an increased focus on the role of rib abnormalities in the development of scoliosis. Rib resection may influence the development of scoliosis. Although scoliosis has been identified in patients after thoracotomy, most of the currently available information is from case reports. METHODS We examined records of 37 patients who underwent a chest wall or rib resection for rib lesions at our institution during the period of 1992 to 2005. Adequate data was available in 21 patients. We gathered data on demographic information, location of resection, and changes in curvature after resection based on radiograph or scout CT films at the latest follow-up appointment. RESULTS Fourteen of 21 patients developed scoliosis with a mean Cobb angle of 25.8° (10°-70°). Eleven of these 14 patients had a progressive spinal deformity after chest wall resection with an average change in curvature of 29° (10°-70°). Eight of those 11 developed a convex toward the resection, while 3/11 developed a convex away from the resection. Seven of the eight patients with resections that included a rib superior to the sixth rib developed scoliosis, while four of 13 with resections below the sixth rib developed scoliosis. CONCLUSION Patients who have had a rib or chest wall resection are at risk for developing scoliosis, particularly if the resection is performed above the sixth rib.
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Affiliation(s)
- Michael P. Glotzbecker
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
| | - Meryl Gold
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
| | - Mark Puder
- />Department of Surgery, Children’s Hospital Boston, Boston, MA 02115 USA
| | - M. Timothy Hresko
- />Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA
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Levy Faber D, Fadel E, Kolb F, Delaloge S, Mercier O, Mussot S, Fabre D, Dartevelle P. Outcome of full-thickness chest wall resection for isolated breast cancer recurrence. Eur J Cardiothorac Surg 2013; 44:637-42. [PMID: 23460724 DOI: 10.1093/ejcts/ezt105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Local breast cancer recurrence is often viewed as an early sign of rapidly progressive metastatic disease for which chest wall resection (CWR) can provide no benefits. We retrospectively reviewed our experience with full-thickness CWR to determine whether long-term outcomes warranted this aggressive procedure. METHODS Between 2001 and 2012, 33 women (mean age, 50.7 years; range, 33-72 years) underwent en-bloc CWR with curative intent. Mean disease-free interval from initial tumour resection was 90.5 months (range, 2-252 months). Resection included skin, muscle and an average of 2.7 ribs (range, 1-8 ribs) and was extended to the sternum (n = 21), subclavian vessels (n = 9), lung (n = 8), pericardium (n = 8), phrenic nerve (n = 2) or T1 nerve root (n = 1). Complete R0 resection was achieved in 31 (94%) patients. Chest wall reconstruction was performed in 28 patients, with polytetrafluoroethylene mesh (n = 17) or titanium ribs (n = 11). A musculocutaneous flap was used in 17 (52%) patients. RESULTS Postoperative morbidity was 36%, with no deaths. Median follow-up was 33 months (range, 3-96 months). Median survival was 69 months and 1-, 3- and 5-year survival rates were 100, 81 and 63%, respectively. Recurrence developed in 13 patients, including 12 with distant metastases. Disease-free survival rates were 77, 57 and 50% after 1, 3 and 5 years, respectively. By univariate analysis, only resection extended to intrathoracic structures was associated with better survival (P = 0.033). CONCLUSIONS En-bloc full-thickness CWR eventually extended to adjacent structures provides acceptable morbidity and excellent long-term survival and should be considered the treatment of choice in locally recurrent breast cancer.
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Affiliation(s)
- Dan Levy Faber
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
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