Chest wall reconstruction following resection of large primary malignant tumors

Chapelier, Alain; Macchiarini, Paolo; Rietjens, Mario; Lenot, Bernard; Margulis, A; Jy, Petit; Dartevelle, Philippe

doi:10.1016/1010-7940(94)90028-0

Cited by 89 publications

(58 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…able to seal the pleural space, to protect the mediastinum and to prevent infections (5,15,16). The importance of a radical surgery has been demonstrated by several authors (5,13,15,16): by intraoperative examination of soft tissue margin and the limit of 2 cm on the bone, in our series, we obtained a radical resection in all cases of PST; however, in case of SST we considered as acceptable a marginal resection, but always excluding an intralesional resection.…”

Section: A B a B Cmentioning

confidence: 80%

“…The reconstruction of the anterior chest wall is basilar to restore the integrity and rigidity of the anterior thoracic wall, to prevent respiratory impairment, to isolate the mediastinum from infections and to protect the underlying structures by trauma. Nowadays reconstruction techniques are heterogeneous and often include the use of different prosthetic materials as methylmethacrilate, polytetrafluoroethylene, titanium bars, bone homograft or allograft and musculocutaneous flap (5)(6)(7)(8)(9)(10)(11). We retrospectively reviewed our experience with SRs in 36 patients performed during a 10-year period, to evaluate the techniques of reconstruction, early clinical outcomes and survival.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short and long-term results of sternectomy for sternal tumours

et al. 2017

View full text Add to dashboard Cite

Background: We analyzed our experience in sternal resections (SRs) for primary or secondary neoplasm focusing on technical aspects of reconstruction, post-operative outcomes and long term survival. Methods: From January 2005 to December 2015, 36 patients (24 males, 67%) underwent surgical excision of primary (chondrosarcoma n=18 patients, 50%; osteosarcoma n=2, 6%; Ewing sarcoma n=1, 3%; other n=2, 6%) or secondary (breast cancer n=7, 19%; kidney carcinoma n=2, 6%) sternal tumour. We performed n=30 partial sternectomy and n=6 total sternectomy with en-bloc resection of the sternocostal cartilages in all patient and extended resection in 7 patients. Stability was obtained with prosthetic material, rigid and non-rigid and a muscular flap: rigid material [Strasbourg Thoracic Osteosynthesis System (STRATOS), MedXpert GmbH] and muscle flap n=11 (30.6%); polytetrafluoroethylene patch and muscle flap n=6 (16.7%); muscle flap alone n=19 (52.8%). Results:The 30-day mortality rate was 0, overall complication rate was 19%. The median ICU stay was 1.5 days and mean hospital stay was 10.6±5.9 days. We obtained a complete (R0) resection in all patients. Overall survival (OS) at 5 and 10 years were 59% and 40%; in the group of primary neoplasm OS rate at 5 and 10 years was 79% and 54%. Disease free survival (DFS) rate at 5 years was 61%. Higher grading was identified as negative prognostic factor.Conclusions: Wide radical resections of anterior chest wall are basilar in a multimodality treatment for primary or metastatic neoplasm of the sternum. Stabilization with titanium bars and clips provides rigidity of chest wall with good functional results.

show abstract

Section: A B a B Cmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Short and long-term results of sternectomy for sternal tumours

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Large defects, especially when located at the anterolateral aspects of the ribs, may require prosthetic replacement in order to limit paradoxical chest wall motion. Reconstruction can be accomplished using materials like Marlex-mesh or a GoreTex patch, and reinforced with a muscle¯ap [12,13]. The risks of infection should be balanced against the cosmetic and functional bene®ts of prosthetic replacement.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting long-term survival after en-bloc resection of lung cancer invading the chest wall✩

Chapelier

Fadel

Macchiarini

et al. 2000

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: Several reports emphasize the importance of en-bloc resection as the optimal surgical treatment of lung cancer with chest wall invasion. We investigated possible factors which could affect long-term survival following radical resection of these tumors. Methods: Between 1981 and 1998, 100 patients (90 male; ten female), with a median age of 60 years (36±84), underwent radical en-bloc resection of non-small cell lung cancer (NSCLC) with chest wall involvement. Patients with superior sulcus tumors invading the thoracic inlet were excluded from this series. There were 43 squamous and 57 non-squamous tumors. The median number of resected ribs was three (1±5). Lung resection included 73 lobectomies, two bilobectomies, 18 pneumonectomies and seven segmentectomies. Chest wall resection also extended to the sternum in one patient, the transverse process in one, the costotransverse foramen and hemivertebrae in two. All patients had a complete resection. Sixty-three patients received postoperative radiotherapy and 12 received chemotherapy. Histological data, including differentiation and depth of chest wall invasion, were carefully reviewed. The effect of various factors on survival were studied. Results: There were four in-hospital deaths. Lymph node involvement was negative on surgical specimens in 65 patients, and 28 patients had positive N1 nodes; the ®nal histology revealed seven N2 diseases. Chest wall invasion was limited to the parietal pleura in 29 patients and included intercostal muscles, bones and extrathoracic muscles in 67, 24 and seven cases, respectively. The overall 2-year survival rate was 41%. The 5-year survival for patients with N0, N1 and N2 disease was 22, 9 and 0%, respectively. A local recurrence occurred in 13 patients, with four having a new resection and 45 patients developing systemic metastases. The nodal status (N0±1 vs. N2; P 0:026) and the number of resected ribs(,2 vs. .2; P 0:03) were survival predictors in univariate analysis. By multivariate analysis, the two independent factors affecting long-term survival were the histological differentiation (well vs. poorly differentiated; P 0:01) and the depth of chest wall invasion (parietal pleura vs. others; P 0:024). Conclusions: Histological differentiation and depth of chest wall involvement were the main factors affecting long-term survival in this series. The role of induction chemotherapy for tumors with poor prognosis should be investigated. q

show abstract

“…6 An overall wound infection rate of about 5% has been reported by several authors. If the soft tissue, overlying the prosthesis, is inadequately vascularized, the infection rates increases.…”

Section: Discussionmentioning

confidence: 99%

“…F ive-year survival rates between 20 and 90% 1± 5 and local recurrence rates of 15± 40% 3,6 have been achieved. T he key to good long-term results seems to be extensive resection w ith a w ide m argin.…”

Section: Introductionmentioning

confidence: 87%

Chest Wall Sarcoma: Outcome in 22 Patients After Resection Requiring Thoracic Cage Reconstruction

Jönsson

Gyllstedt

Hambraeus

et al. 1998

Sarcoma

View full text Add to dashboard Cite

A bstractPurpose. To evaluate the outcome after resection of m alignant chest wall sarcoma, requiring reconstruction of the chest wall. Subjects. Twenty-two patients, 15 with primary tumours, were operated on in our institution between 1983 and 1996. Four patients underw ent surgery after a previous intralesional or m arginal excision and three patients because of a local recurrence. M eth ods. The tumour was resected`en bloc' , including skin, muscle and thoracic skeleton. When necessary, adjacent organs invaded by the tumour, such as lung, pericardium and diaphragm , were also removed to obtain a wide margin.Reconstruction of the chest wall was performed with M arlex mesh (n 5 9), methylmethacrylate cem ent (n 5 2) or a M arlex m ethylmethacrylate`sandwich' (n 5 11).Results. The m edian tumour size was 9.5 (2± 20) cm . The most comm on type of tumour was chondrosarcom a (12 cases). No patient died in hospital. Five patients required reoperation because of complications, two patients because of loosening of the acrylate prosthesis, two because of necrosis of soft tissue coverage and one was reoperated because of bleeding. Four patients died of generalized tumour disease between 5 and 77 months after surgery and one patient died of a local recurrence 32 months after the prim ary operation. Seventeen patients are alive, with a median follow-up of 36 (4± 162) m onths. M icroscopic radicality (negative margin) was achieved in 17 patients but 5 of these had local recurrences. Two of ® ve patients with positive margins had a local recurrence of the tumour. Of the seven patients with local recurrences, two also developed metastases. D iscussion. Large chest wall sarcomas can be successfully resected and the chest wall reconstructed with low morbidity and mortality.

show abstract

Chest wall reconstruction following resection of large primary malignant tumors

Cited by 89 publications

References 0 publications

Short and long-term results of sternectomy for sternal tumours

Short and long-term results of sternectomy for sternal tumours

Factors affecting long-term survival after en-bloc resection of lung cancer invading the chest wall✩

Chest Wall Sarcoma: Outcome in 22 Patients After Resection Requiring Thoracic Cage Reconstruction

Contact Info

Product

Resources

About