Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors

Marulli, Giuseppe; Duranti, Leonardo; Cardillo, Giuseppe; Luzzi, Luca; Carbone, Luigi; Gotti, Giuseppe; Perissinotto, Egle; Rea, Federico; Pastorino, Ugo

doi:10.1093/ejcts/ezu095

Cited by 52 publications

(66 citation statements)

References 26 publications

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“…They identified the anterior location of chest wall resection and the presence of three or more implant as a significant risk factors of failure (18). Similarly other titanium rigid reconstruction systems are effectively used and reported in literature (6).…”

Section: A B a B Cmentioning

confidence: 99%

“…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%

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Short and long-term results of sternectomy for sternal tumours

et al. 2017

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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.

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Section: A B a B Cmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short and long-term results of sternectomy for sternal tumours

et al. 2017

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“…They need broad tumor-free margins that often lead to complex chest wall resection and reconstruction techniques, especially when the tumor is large in diameter or located posteriorly adjacent to the vertebrae or involves the sternum. Consequently, an early diagnosis of a small tumor increases the possibility of a curative therapy and decreasing the need for extended resections (4).…”

Section: Introductionmentioning

confidence: 99%

Contributing factors to the outcome of primary malignant chest wall tumors

et al. 2017

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Background: Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors.They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods: A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years.

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“…This tumour appears as a radiolucent mass originating from the medullary region of the bone and is usually associated with cortical destruction and stippled calcification. Surgery in the form of radical en bloc excision and immediate reconstruction is the key to the management of primary sarcomas of the sternum [2][3][4][5][6][7]. Surgery alone is potentially curative in a majority of the cases, with the 10-year survival rate approaching 97 %.…”

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confidence: 99%

“…Sternal resection can potentially result in large defects requiring complex reconstructions and various reconstruction techniques using prosthetic or homologous materials that have been described [2][3][4][5][6][7]. Skeletal reconstruction is considered not necessary for defects <5 cm in diameter.…”

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confidence: 99%

A Novel Clinical Application of the Classical Bakamjian Flap in the Reconstruction of a Sternal Chondrosarcoma Defect

Krishnamurthy

2014

Indian J Surg

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The deltopectoral flap also called the Bakamjian flap was originally described as a two-stage procedure for p h a r y g o e s o p h a g e a l r e c o n s t r u c t i o n f o l l o w i n g laryngopharyngectomy. It became the "workhorse" flap for head and neck reconstruction in the 1960s, but its popularity gradually faded with the introduction of pedicled myocutaneous flaps and subsequently microvascular free flaps. However, the technical simplicity of raising the Bakamjian flap along with its predictable vascular supply has ensured that the flap continues to remain as a time-tested salvage option in head and neck reconstruction. The use of this flap for sternal reconstruction, to the best of our knowledge, has not been described before. We present a rare case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting as a single-stage procedure. Keywords Deltopectoral flap . Bakamjian flap . Sternal chondrosarcoma . Sternal reconstructionChondrosarcomas are a heterogeneous group of malignant mesenchymal tumours derived from a cartilaginous origin. These tumours are generally known to involve the pelvis and the long bones. They account for about 20 % of the primary tumours of the chest wall, of which 20 % are believed to arise from the sternum [1]. Although chondrosarcoma is a commonly described malignant tumour of the chest wall and sternum, its relative occurrence is rare. We present a case of a primary sternal chondrosarcoma and discuss its management challenges and also present, possibly for the first time, a novel application for the well-described Bakamjian flap in this setting.A 68-year-old male without any comorbid illness was referred to our centre for evaluation of a progressively enlarging swelling of his anterior chest wall for over a year. Clinical examination revealed a mildly tender, well circumscribed, 5×4-cm bony swelling in relation to the middle third of the sternum, 3 cm below the sternal notch. There was no significant axillary adenopathy. A chest X-ray and a subsequent computerised tomography of the chest revealed a 5×4×7-cm expansile lytic lesion involving the middle third of the sternum and the adjoining left fourth and fifth costochondral junctions with a large soft tissue component on either sides of the sternum, reaching up to the pericardium posteriorly and up to the skin anteriorly. The pulmonary parenchyma was however normal (Fig. 1a). A bone scan revealed an isolated hot spot in the sternum corresponding to the lytic lesion, as visualised on the CT scan (Fig. 1b). A trucut biopsy from the mass lesion revealed a tumour composed of lobules of atypical cartilage cells, suggesting a diagnosis of chondrosarcoma grade I. A radical en bloc resection of the sternal lesion preserving the manubrium and the xiphoid was subsequently performed; which resulted in a large full thickness skin, soft tissue and bony defect (Fig. 2a, b). The resultant bony de...

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Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors

Cited by 52 publications

References 26 publications

Short and long-term results of sternectomy for sternal tumours

Short and long-term results of sternectomy for sternal tumours

Contributing factors to the outcome of primary malignant chest wall tumors

A Novel Clinical Application of the Classical Bakamjian Flap in the Reconstruction of a Sternal Chondrosarcoma Defect

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