P. Sugarbaker1, K. S. Mehta1, I. Christie1, W. E. Gooding2, O. Awais1, M. J. Schuchert1, J. D. Luketich1, A. Pennathur1 1University Of Pittsburgh Medical Center,Deparment Of Cardiothoracic Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh Cancer Institute Biostatistics Facility,Department Of Biostatistics,Pittsburgh, PA, USA
Introduction:
Chest wall tumors are rare thoracic malignancies that present a unique set of challenges to the surgeon. Primary chest wall tumors are uncommon (1-2% of all primary neoplasms), and are frequently malignant. The treatment of chest wall tumors includes resection with wide negative margins. These resections can leave significant defects that require reconstruction. The goal during reconstruction is to restore proper respiratory function, prevent anatomical deformity and protect/support intrathoracic structures. Reconstruction adds to the complexicities of the operation and often involves a multidisciplinary team including thoracic surgery, plastic surgery, neurosurgery, and physical medicine and rehabilitation. The primary objective of our study was to review our experience with resection of primary chest wall tumors and the oncological results
Methods:
We reviewed our experience with resection of primary chest wall tumors over a 11 year period. We reviewed the tumor characteristics, surgical technique, perioperative outcomes and oncological results. Patients were followed in the thoracic surgery clinic. Kaplan-Meier curves were constructed to evaluate the recurrence-free survival and overall survival
Results:
Twenty-eight patients (15 women,13 men; median age 52.5 years) underwent chest wall resection and reconstruction for primary chest wall neoplasm (median size 5.05 cms (2.0-15.0 cm). The most common tumor resected was sarcoma (n=14), and the predominant histology was chondrosarcoma (n=6). Chest wall reconstruction was performed on all 28 patients. A synthetic Polytetrafluoroethylene (PTFE) mesh was the most frequently used method of reconstruction (n=14). Methyl methacrylate for chest wall reconstruction was used in 6 patients, while primary closure was achieved in 8 patients. The median length of stay was 4 days. Perioperative morbidity occurred in 6 patients and the 30 day operative mortality was 0%. During follow-up (median follow-up 67 months), there were 8 deaths. The estimated 3-year overall-survival was 72% (95% confidence interval (CI) 56% to 92%) and the estimated 5-year overall-survival was 68% (95% confidence interval 51% to 94%) (Figure). There were 6 recurrences noted during follow-up. The 3-year and 5-year recurrence-free survival was 72% (95% CI 55% – 94%).
Conclusion:
Primary chest wall neoplasms are rare tumors that pose unique clinical challenges, requiring complex resection with wide margins and reconstruction. These tumors can be safely resected with appropriate reconstruction techniques. The overall survival results are encouraging following successful resection and reconstruction. Further follow-up is required and is ongoing to fully evaluate the oncological results.
