Chest wall resection and reconstruction for lung cancer: surgical techniques and example of integrated multimodality approach

Loi, Mauro; Mazzella, Antonio; Desideri, Isacco; Fournel, Ludovic; Hamelin, Emelyne Canny; Icard, Philippe; Bobbio, Antonio; Alifano, Marco

doi:10.21037/jtd.2019.07.81

Cited by 10 publications

(12 citation statements)

References 43 publications

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“…Our surgical treatment of chest wall tumors accords well, in all cases, with an approach on the reconstruction procedure of a post-excision defect in the sternocostal framework reported in [ 1 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Artificial rib constructs for thoracic osteosynthesis prepared pursuant to a 3D model were a proper fit when the defect was being reconstructed and did not require any intraoperative correction ( Figure 1 ), and thus the surgery time was shortened, as indicated in Table 3 .…”

Section: Resultssupporting

confidence: 70%

“…Despite the significant progress made in various areas of oncosurgery, the surgical stage in treating chest wall tumors occupies the leading position [ 3 , 4 , 5 , 6 , 7 ]. Radical surgical intervention for chest wall tumors is typically accompanied by the lesion of osteochondral structures and the appearance of complex post-resection defects, which result in functional and aesthetic impairment.…”

Section: Introductionmentioning

confidence: 99%

“…Radical surgical intervention for chest wall tumors is typically accompanied by the lesion of osteochondral structures and the appearance of complex post-resection defects, which result in functional and aesthetic impairment. Progressive surgical and intensive care technologies have enabled extended combination surgeries in which not only the tumor-affected chest wall fragment, but also the adjacent anatomical structures involved are excised as a single piece [ 3 , 7 ]. After extensive resection of the chest wall, it is vitally important that it is simultaneously repaired, including restoring the osteochondral framework and the integrity of the integumentary tissues as well as maintaining the anatomical and physiological volume of the mediastinum and the pleural cavities.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

Topolnitskiy

Chekalkin

Марченко

et al. 2021

JFB

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In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T3N0M0, two were T3N1M0, and one was T3N2M0. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.

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Section: Resultssupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

Topolnitskiy

Chekalkin

Марченко

et al. 2021

JFB

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“…Moreover, the tolerability of surgery following induction chemoradiotherapy may be decreased and the risk of postoperative complications increased because of impaired respiratory function (16). Although the morbidity rate associated with chest wall resection and reconstruction ranges from 24% to 46% and that for mortality ranges from 2% to 7% (11)(12)(13)(14), there was no mortality in our study and Clavien-Dindo grade >IIIa postoperative complications occurred at a rate of 16.7%, which might be tolerable.…”

Section: Discussionmentioning

confidence: 58%

“…In one study, the 5-year survival rate was reported to be 32% in 175 patients with complete resection and 4% in 94 patients with incomplete resection (10). Furthermore, the survival rate ranges from 8.0% to 21.0% for patients with pN2 disease and from 25.0% to 67.0% for those with pN0 disease (11)(12)(13)(14). Therefore, in addition to complete resection, preoperative mediastinal lymph node staging is recommended to exclude N2 disease, and if pathologically proven, the patient should receive multimodal therapy in view of the otherwise poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of pathologically confirmed rib invasion in patients with lung cancer requiring chest wall resection

Yutaka¹,

Terada²,

Tanaka³

et al. 2022

J Thorac Dis

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Background: Primary lung cancer that invades the chest wall is classified as T3 regardless of the depth of invasion. This study assessed the prognostic impact of pathologically confirmed rib invasion in patients with pT3N0-1 lung cancer requiring chest wall resection. Methods:We retrospectively analyzed the records of patients with non-small cell lung cancer (NSCLC) who underwent combined lung and chest wall resection with rib involvement from 2006 to 2019. The median follow-up period was 64.0 months. Results:In total, 42 patients (41 men, 1 woman) were enrolled. The median patient age was 64 years (range, 42-79 years). The median tumor size before treatment was 56.5 mm (range, 21-80 mm), and an osteolytic sign was identified on computed tomography (CT) in 42.9% (18/42). Among 27 patients who received induction chemoradiotherapy, 5 (18.5%) achieved a complete pathological response. The operations comprised 36 lobectomies, 5 segmentectomies, and 1 wedge resection with resection of 2.5 ribs on average.Pathological examination revealed rib invasion in 18 (42.9%) patients. The 5-year disease-free and overall survival rates with pathological rib invasion were 44.4% and 77.4% (P=0.0114), respectively and those without pathological rib invasion were 44.7% and 81.3% (P=0.0222), respectively. Pathologically confirmed rib invasion was the only factor identified to have a prognostic impact in the univariate and multivariate analyses (hazard ratio, 5.98; 95% confidence interval: 1.37-26.1). Locoregional recurrence and distant metastases were more common in patients with than without pathologically confirmed rib invasion [4 (22.2%) and 6 (33.3%), respectively, among 18 patients with pathological rib invasion; 2 (8.3%) and 3 (12.5%), respectively, among 24 patients without pathological rib invasion] (P=0.0073).Conclusions: Pathologically confirmed rib invasion was found to have a significant unfavorable prognostic impact in patients with pT3N0-1 lung cancer requiring chest wall resection. Multimodal therapy may be preferable in these patients to prevent local and distant relapse.

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The oncologic efficacy of extended thoracic resections

Kader

Watkins

Servais

2023

Journal of Surgical Oncology

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Locally invasive lung cancers pose unique challenges for management. Surgical resection of these tumors can pose high morbidity due to the invasion into surrounding structures, including the spine, chest wall, and great vessels. With advances in immunotherapy and chemoradiation, the role for radical resection of these malignancies and associated oncologic outcomes is evolving. This article reviews the current literature of extended thoracic resections with a focus on technical approach, functional outcomes, and oncologic efficacy.

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Chest wall resection and reconstruction for lung cancer: surgical techniques and example of integrated multimodality approach

Abstract: wall resection and reconstruction for lung cancer: surgical techniques and example of integrated multimodality approach. J

Cited by 10 publications

References 43 publications

Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

Prognostic impact of pathologically confirmed rib invasion in patients with lung cancer requiring chest wall resection

The oncologic efficacy of extended thoracic resections

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