Complications in Wound Healing after Chest Wall Resection in Cancer Patients; a Multivariate Analysis of 220 Patients

Lans, Titia E.; Pol, Carmen van der; Wouters, Michel W. J. M.; Schmitz, Paul; Geel, A.N. van

doi:10.1097/jto.0b013e31819d18c9

Cited by 36 publications

(29 citation statements)

References 15 publications

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“…These patients may be debilitated, frail, and immune-compromised as a result of both physiological factors and treatment-related side-effects from chemo-and radiotherapy [3,7]. In addition, it has been suggested that cancer patients have poor woundhealing ability, leading to greater susceptibility to infection and other complications [15,16]. These factors potentially explain why wound infection/dehiscence was the most common complication in our study and in other cohorts [7].…”

Section: Discussionmentioning

confidence: 63%

Independent predictors of complication following surgery for spinal metastasis

et al. 2013

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Purpose Surgery for spinal metastasis is often associated with significant morbidity. Despite a number of preoperative scoring systems/scales and identified variables that have been reported to predict complication risk, clinical studies that directly evaluate this issue using multivariate analysis are scarce. The goal of our study was to assess independent predictors of complication after surgery for spinal metastasis. Methods We queried electronic medical records to identify a consecutive population of adult patients who underwent surgery for spinal metastasis for the period June 2005 through June 2011. Utilizing multivariate logistic regression, we assessed independent predictors of perioperative and postoperative adverse events. Results A total of 106 patients were included in the final analysis. Overall complication rate was 21.7 %. Independent predictors for higher rates of complication were age greater than 40 years [40-65 years had odds ratio (OR) 1.91, 95 % confidence interval (CI) 1.02-16.78 and [65 years had OR 5.17, 95 % CI 1.54-29.81] and metastatic lesions involving three or more contiguous levels of the spine (OR 2.76, 95 % CI 1.09-9.61). Conclusions Patients older than 40 years or patients who have metastatic lesions involving three or more contiguous vertebral levels appear to be at higher risk for complication. Patients older than 65 years have the greatest likelihood of complication.

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Section: Discussionmentioning

confidence: 63%

Independent predictors of complication following surgery for spinal metastasis

et al. 2013

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“…This was probably the result of postoperative radiotherapy in patients with a R1 resection. In discussions on the best local treatment, CWR is preferable to radiotherapy as the first choice because unsuccessful radiotherapy proved to be an important predictive factor for complications at the time of CWR 40. Also, the effect of radiotherapy is less in extended and multifocal LRR, reflected in decreased survival 41…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in 77 Curative Chest Wall Resections for Isolated Breast Cancer Recurrence

et al. 2009

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BackgroundFull-thickness chest wall resection (CWR) is the preferred treatment for breast cancer (BC) patients with extensive isolated locoregional recurrence. It remains a challenge to select patients that will benefit most from this treatment. The aim of this study was to define prognostic factors in patients who undergo CWR with curative intent.MethodsBC patients who underwent a CWR with curative intent for recurrence of disease between 1986 and 2006 were included in this retrospective study. Twenty-two factors were studied in a univariate analyses, and multivariate stepwise Cox regression analyses was performed.ResultsSeventy-seven patients were included in this study. The 5-year overall survival was 25%. There was one postoperative death. Univariate analyses showed that three prognostic factors were significantly correlated with OS and disease-free survival: (1) interval between primary treatment and CWR (P = .02 and .004, respectively), (2) chemotherapy for recurrence (P = .05 and .05, respectively), and (3) resection specimen smaller than 150 cm2 (P = .03 and .009, respectively). An interval lasting >10 years between primary treatment and CWR remained statistically significantly correlated with better overall survival and disease-free survival after multivariate analyses.ConclusionsCWR is a safe treatment in patients who have isolated extensive BC recurrence. The best survival outcome was seen in patients after a disease-free interval of ≥10 years. Existing data show that adjuvant radiotherapy and adjuvant hormone therapy for estrogen-positive tumors improves overall survival. Neoadjuvant chemotherapy may be considered in individual patients.

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“…B. Delir) als Risiken für sternale Wundheilungsstörungen und Infekte beschrieben [28][29][30]. Für Sternumresektionen bei onkologischen Erkrankungen zählen zu den Risikofaktoren das Alter, postoperative Chemo-oder Strahlentherapie, die Größe des Brustwanddefekts, zusätzliche Lungenresektionen, eingebrachtes Fremdmaterial sowie die Qualität der Weichteildeckung [13,14]. Essenziell ist eine spannungsfreie und gut durchblutete Weichteildeckung.…”

Section: Risikofaktoren Und Präventionunclassified

“…Minderdurchblutete und geschädigte Weichteile (z. B. nach Bestrahlungen) stellen ein Risiko dar [13,14]. Auch Eingriffe am Sternum bei vorbestehenden lokalen Infektionen des Knochens oder der benachbarten Weichteile sind mit einem erhöhten Risiko für postoperative Sternuminfektionen verbunden [2].…”

Section: Risikofaktoren Und Präventionunclassified

Behandlungsstrategien bei postoperativen Sternuminfektionen

2015

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Postoperative sternal infections are associated with significant morbidity and mortality. An incidence of up to 8 % has to be expected. Typically, a highly inflammatory acute infection with a marked soft tissue component is observed. However, the infection may also be present as a less symptomatic reaction and localised chronic osteomyelitis with fistula formation. The treatment strategy for a deep sternal wound infection consists of several steps. A radical debridement of the wound requires the opening of all abscesses, the resection of non-vital bone and the removal of all infected allomaterial. This is followed by a period of VAC therapy (Vacuum-Assisted Closure Therapy) for infection treatment and conditioning of the wound. Secondary closure of the wound may be planned only after the infection is completely controlled. The sternum is stabilised by osteosynthesis. Sternal defects are covered. In most cases adequate soft tissue coverage is achieved by mobilisation of both pectoral muscles together with the precostal soft tissues. Following resection of the sternum, the reconstruction of the thoracic wall requires the implantation of material for stabilisation as well as soft tissue coverage. For complicated or large defects various muscle flaps and the omentum majus have been advocated. The latissimus dorsi muscle with skin is the muscle flap most frequently used.

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Complications in Wound Healing after Chest Wall Resection in Cancer Patients; a Multivariate Analysis of 220 Patients

Cited by 36 publications

References 15 publications

Independent predictors of complication following surgery for spinal metastasis

Independent predictors of complication following surgery for spinal metastasis

Prognostic Factors in 77 Curative Chest Wall Resections for Isolated Breast Cancer Recurrence

Behandlungsstrategien bei postoperativen Sternuminfektionen

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