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Malignant primary chest-wall tumours: techniques of reconstruction and survival

^a Thoracic Surgery Unit, University Hospital Careggi, Viale Morgagni 1, Florence 50139, Italy
^b Orthopaedic Oncology, University Hospital Careggi, Florence, Italy
^c Plastic Surgery, University Hospital Careggi, Florence, Italy
^d Service of Thoracic Anaesthesiology, University Hospital Careggi, Florence, Italy
^e Department of Human Pathology and Oncology, University Hospital Careggi, Florence, Italy

Received 30 September 2009; received in revised form 4 December 2009; accepted 17 December 2009.

^_* Corresponding author. Tel.: +39 0 55 7947935; fax: +39 0 55 7947935. (Email: agonfiotti{at}hotmail.com).

Objectives: We analysed our experience in primary malignant chest-wall tumours (PMCWTs) with an emphasis on a new reconstruction technique and on survival. Methods: From 1998 to 2008, 41 patients (23 (56%) male, mean age 48 years) with PMCWT were operated in our unit: chondrosarcoma n = 25; osteosarcoma n = 8; Ewing's sarcoma n = 2; other n = 6. We performed nine sternectomies and 32 lateral chest-wall resections (median number of ribs resected = 3.5). Resections were extended to the lung (n = 2), diaphragm (n = 3), vertebral body (n = 3), scapula (n = 1) and upper limb (n = 1). Stability was obtained by a prosthetic material, rigid and non-rigid and a muscular flap. As non-rigid material, we mostly used a polytetrafluoroethylene patch (n = 24). In the past 2 years, two patients (one total sternectomy and one wide anterior chest-wall resection) were reconstructed with a rigid system composed of mouldable titanium connecting bars and rib clips (Strasbourg Thoracic Osteosyntheses System – STRATOS, MedXpert GMbH, Heitersheim, Germany). A muscular flap was added in 12 patients (29.3%). Results: There was no perioperative mortality or significant morbidity and all patients were extubated within first 24 h. At a mean follow-up of 60.5 months (range 4–130 months), the overall 5- and 10-year survival was 61% and 47%, respectively. In the chondrosarcoma group, 5- and 10-year survival was 80%. Conclusions: Wide resection with tumour-free margins is necessary in PMCWT to minimise local recurrence and to contribute to long-term survival. The STRATOS system, developed for chest-wall replacement, allows a firm reconstruction, simple to handle and to fix, avoiding instability or paradoxical movement also in wide chest-wall resections.

Key Words: Chest wall • Primary tumours • Chest-wall primary tumours • Surgery