Expert consensus on resection of chest wall tumors and chest wall reconstruction

Abstract

Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients.Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1-3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V)It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T 3-4 N 0-1 M 0 . As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.

The sternum reconstruction: Present and future perspectives

“…Primary malignant sternal tumors (PMSTs) are infrequent tumors, and most of them present at the stage of infiltration of the sternum and soft tissues ( 32 , 33 ). Radical resection may be the most successful standard treatment, although the local aggressiveness of the tumor makes the surgical approach particularly complex and is associated with a high risk of recurrence ( 4 , 32 , 34 ).…”

Successful reconstruction of the chest wall frame with superelastic nickel-titanium 3D modules in a patient with multiple locally recurrent leiomyosarcoma

“…Радикальное удаление данного новообразования считают основным методом лечения, что позволяет надеяться на выздоровление и длительный безрецидивный период. Важнейшим фактором, определяющим прогноз заболевания, является возможность выполнения радикальной (R0) резекции [4,6].…”

“…При резекции 3 и более ребер или резекции площадью >50 см 2 возникает выраженная флотация грудной стенки, что приводит к парадоксальному дыханию. В этом случае формируется фрагмент грудной стенки в виде нестабильного реберного окна, удерживаемого только кожей и мягким тканями, которое западает при вдохе и выбухает при выдохе [6,7]. Данное состояние грудной клетки является причиной неполного расправления легкого на оперированной стороне.…”

“…Показано, что избыточная подвижность сетчатых и тканевых имплантатов не устраняет флотацию грудной стенки после обширной резекции костно-хрящевого остова [6]. В то же время жесткая фиксация пластинами, спицами, цементными и композитными изделиями, особенно на большой площади, приводит либо к ригидности грудной клетки и тяжелым рестриктивным нарушениям дыхания, либо к закономерному расшатыванию и нестабильности имплантированных конструкций, их миграции и повреждению прилежащих органов и анатомических структур.…”

Fused Deposition Modeling PEEK Implants for Personalized Surgical Application: From Clinical Need to Biofabrication

“…The design and manufacturing process of PEEK implants has also changed with the increase in clinical applications. The surgical methods are constantly improved as the applications increase, and we further establish the surgical standards of 3DP PEEK implants for chest wall reconstruction in Chinese clinical guidelines[ 43 , 44 ]. In addition, new clinical problems, such as incision ulcers and respiratory restriction, have prompted surgeons and engineers to work together to develop new implant designs and fabrication processes.…”