The 2026 American Association for Thoracic Surgery (AATS) expert consensus document: Surgical management of primary...

The management of chest wall primary malignancies is challenging for thoracic surgeons because of the rarity and diversity of disease processes requiring nuanced knowledge. This document reviews the existing literature and provides multidisciplinary consensus recommendations for evaluation and treatment of chest wall primary malignancies.

The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary panel of medical oncologists, radiation oncologists, orthopedic surgeons, plastic and reconstructive surgeons, and thoracic surgeons with significant expertise in the management of chest wall malignancies. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with a class of recommendations and level of evidence for 6 themes: (1) diagnosis and staging, (2) tumors treated with primary resection, (3) tumors treated with resection after induction therapy, (4) tumors not treated with primary surgical resection, (5) technical surgical principles, and (6) postoperative management.

Consensus was achieved on 34 statements on the basis of extensive literature review and current clinical experience spanning 11 high-volume institutions. These statements provide a standard for initial evaluation of a suspected chest wall neoplasm, histology directed management of a diverse group of malignancies, surgical management principles, and postoperative management.

This multidisciplinary expert consensus document provides a framework upon which thoracic surgeons can approach the management of primary chest wall malignancies. Accurate diagnosis and staging, multidisciplinary treatment planning, and careful attention to surgical techniques to achieve an R0 (microscopically negative margin) resection are all vital elements. Furthermore, multi-institutional efforts are required to advance our understanding of chest wall malignancies.