Full-thickness chest wall resection for malignant chest wall tumors and postoperative problems

Area of Science:

• Thoracic surgery
• Surgical oncology
• Reconstructive surgery

Background:

• Chest wall malignant tumors are rare, comprising <5% of thoracic malignancies.
• Wide resection is crucial for local control but risks thoracic and pulmonary failure.
• Evidence and guidelines for chest wall reconstruction are lacking.

Purpose of the Study:

• Evaluate outcomes of full-thickness chest wall resection and reconstruction for malignant tumors.
• Identify challenges in current chest wall reconstruction practices.
• Focus on local control, complications, pulmonary function, and scoliosis.

Main Methods:

• Retrospective review of 32 operations on 30 patients.
• Patients underwent full-thickness chest wall resection for primary, recurrent, or metastatic malignant tumors.
• Data collected between 1997 and 2021 at Mie University Hospital.

Main Results:

• 5-year recurrence-free survival rate was 79.3%; tumor diameter ≥5 cm predicted poor survival.
• Postoperative complication rate was 18.8%; flail chest occurred with extensive rib resection.
• Pulmonary function showed significant decrease in %VC with large resections; scoliosis developed in 8/28 patients, particularly after posterior resection.

Conclusions:

• Chest wall reconstruction increases risks of pulmonary impairment, flail chest, and scoliosis.
• Rigid reconstruction strategies and refined indications are necessary.
• Improved approaches are needed to enhance outcomes for chest wall reconstruction patients.