Chest Wall Resection and Reconstruction for Primary and Metastatic Sarcomas: an 11-year Retrospective Cohort Study

Overview

Journal Interact Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2021 Feb 3

PMID 33532842

Citations 4

Authors

Elena Prisciandaro

Romain Hustache-Castaing

Audrey Michot

Jacques Jougon

Matthieu Thumerel

Affiliations

Soon will be listed here.

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.

Citing Articles

Surgical Outcomes after Full Thickness Chest Wall Resection Followed by Immediate Reconstruction: A 7-Year Observational Study of 42 Cases.

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Oncological results in primary and secondary malignant chest wall tumors.

Kocaman G, Kahya Y, Konuk Balci B, Yenigun B, Ozkan M, Ozakinci H Turk Gogus Kalp Damar Cerrahisi Derg. 2024; 32(1):55-61.

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Outcome Analysis of Treatment Modalities for Thoracic Sarcomas.

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The sternum reconstruction: Present and future perspectives.

Aramini B, Masciale V, Radaelli L, Sgarzani R, Dominici M, Stella F Front Oncol. 2022; 12:975603.

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References

Foroulis C, Kleontas A, Tagarakis G, Nana C, Alexiou I, Grosomanidis V . Massive chest wall resection and reconstruction for malignant disease. Onco Targets Ther. 2016; 9:2349-58. PMC: 4846065. DOI: 10.2147/OTT.S101615. View

Shewale J, Mitchell K, Nelson D, Conley A, Rice D, Antonoff M . Predictors of survival after resection of primary sarcomas of the chest wall-A large, single-institution series. J Surg Oncol. 2018; 118(3):518-524. DOI: 10.1002/jso.25162. View

Mansour K, Thourani V, Losken A, Reeves J, Miller Jr J, Carlson G . Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002; 73(6):1720-5; discussion 1725-6. DOI: 10.1016/s0003-4975(02)03527-0. View

Khullar O, Fernandez F . Prosthetic Reconstruction of the Chest Wall. Thorac Surg Clin. 2017; 27(2):201-208. DOI: 10.1016/j.thorsurg.2017.01.014. View

Casali P, Abecassis N, Aro H, Bauer S, Biagini R, Bielack S . Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018; 29(Suppl 4):iv51-iv67. DOI: 10.1093/annonc/mdy096. View

King R, Pairolero P, Trastek V, Piehler J, Payne W, BERNATZ P . Primary chest wall tumors: factors affecting survival. Ann Thorac Surg. 1986; 41(6):597-601. DOI: 10.1016/s0003-4975(10)63067-6. View

Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G . STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019; 72:156-165. DOI: 10.1016/j.ijsu.2019.11.002. View

Thomas M, Shen K . Primary Tumors of the Osseous Chest Wall and Their Management. Thorac Surg Clin. 2017; 27(2):181-193. DOI: 10.1016/j.thorsurg.2017.01.012. View

Stiller C, Trama A, Serraino D, Rossi S, Navarro C, Chirlaque M . Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project. Eur J Cancer. 2012; 49(3):684-95. DOI: 10.1016/j.ejca.2012.09.011. View

10.

Wouters M, van Geel A, Nieuwenhuis L, van Tinteren H, Verhoef C, Van Coevorden F . Outcome after surgical resections of recurrent chest wall sarcomas. J Clin Oncol. 2008; 26(31):5113-8. DOI: 10.1200/JCO.2008.17.4631. View

11.

Berthet J, Wihlm J, Canaud L, Joyeux F, Cosma C, Hireche K . The combination of polytetrafluoroethylene mesh and titanium rib implants: an innovative process for reconstructing large full thickness chest wall defects. Eur J Cardiothorac Surg. 2012; 42(3):444-53. DOI: 10.1093/ejcts/ezs028. View

12.

McMillan R, Sima C, Moraco N, Rusch V, Huang J . Recurrence patterns after resection of soft tissue sarcomas of the chest wall. Ann Thorac Surg. 2013; 96(4):1223-1228. DOI: 10.1016/j.athoracsur.2013.05.015. View

13.

Kachroo P, Pak P, Sandha H, Lee C, Elashoff D, Nelson S . Single-institution, multidisciplinary experience with surgical resection of primary chest wall sarcomas. J Thorac Oncol. 2012; 7(3):552-8. DOI: 10.1097/JTO.0b013e31824176df. View

14.

Scarnecchia E, Liparulo V, Capozzi R, Ceccarelli S, Puma F, Vannucci J . Chest wall resection and reconstruction for tumors: analysis of oncological and functional outcome. J Thorac Dis. 2018; 10(Suppl 16):S1855-S1863. PMC: 6035939. DOI: 10.21037/jtd.2018.05.191. View

15.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

16.

Widhe B, Bauer H . Surgical treatment is decisive for outcome in chondrosarcoma of the chest wall: a population-based Scandinavian Sarcoma Group study of 106 patients. J Thorac Cardiovasc Surg. 2009; 137(3):610-4. DOI: 10.1016/j.jtcvs.2008.07.024. View

17.

Tsukushi S, Nishida Y, Sugiura H, Nakashima H, Ishiguro N . Soft tissue sarcomas of the chest wall. J Thorac Oncol. 2009; 4(7):834-7. DOI: 10.1097/JTO.0b013e3181a97da3. View