Outcomes after surgical treatment of chest wall sarcomas

Chest wall sarcomas are very rare even within an already rare disease and can arise from soft tissue, cartilaginous, or osseous components of the thoracic wall. Various locations can be affected needing different types of oncologic and reconstructive surgeries. Hence, treatment is challenging and requires a multidisciplinary specialized team.

All patients with diagnosis of localized chest wall sarcomas between January 2014 and June 2025 primarily operated at our center or referred after treatment elsewhere were included. Demographic data and tumor characteristics were evaluated (type of sarcoma, size, FNCLCC grade, neo/adjuvant treatment) as well as surgical outcomes (R classification). Overall survival (OS), local recurrence- (LRFS) and distant metastasis free survival (DMFS) were analyzed only for the chest wall soft tissue sarcoma (CWSTS) subgroup.

A total of 17 patients with chest wall sarcomas underwent surgical resection, out of which 14 were primarily resected and 3 had previous resections elsewhere. Twelve patients (70%) had soft-tissue sarcomas (STS) and 5 (30%) bony sarcomas. All patients had macroscopic complete en bloc resections (94% R0 and 6% planned R1 margins). Four (24%) patients had superficial tumors and 13 (76%) had deep-seated sarcomas requiring 10 of them full-thickness resections. Median number of resected ribs per surgery was 3 (range, 1 - 3). For CWSTS subgroup, 5-years OS and LRFS were 81%.

In localized chest wall sarcomas, multidisciplinary en bloc surgical resection with clear margins by a specialized team is key and led to good rates of local control.