Surgical treatment of chest wall tumors

Chest wall tumors have long represented challenging clinical entities for surgeons. Until recently, incorrect diagnosis, incomplete resection, or inability to perform successful reconstruction of large thoracic wall defects led to high rates of perioperative morbidity and mortality. The latter were primarily associated with infections of the pleural cavity, respiratory failure, and paradoxical breathing. The long-term prognosis was also poor owing to a high percentage of local relapse. During the same operating procedure wide resection and reconstruction of the thoracic wall are performed successfully. Improvement of the prognosis reported in large series of patients with resection leads to surgical treatment being considered the best option for primary tumors and for selected secondary tumors of the chest wall. Because positive margins are the most important risk factor for local recurrence, adequate margins of healthy tissue surrounding the tumors have a considerable impact on disease-free and overall survival. Involvement of ribs, sternum, superior sulcus, or spine is not considered a technical limitation to surgical resection. Nowadays correct management cannot be precluded by tumor size, site, or contiguous structure involvement because concurrent reconstruction with prosthetic materials and myocutaneous flaps is feasible. Surgery provides the best chance of cure in patients with chest wall tumors. Therefore the surgical strategy must be based on the features of the individual's disease.