[Chest wall reconstruction for lung cancer patient]

To prevent flail chest after chest wall resection, chest wall reconstruction was performed to 74 primary lung cancer patients during the period between 1975 and 1994, out of 1,435 resected lung cancer patients, while in 29 cases, chest wall resection were performed without reconstruction. Numbers of ribs resected were from 1 to 5, mean 2.7, median 3. Chest wall reconstructions were performed in 66.7% of the patients for 2 ribs resected cases, 83.8% for 3 ribs cases, and 90.9% for more than 4 ribs cases. For chest wall reconstruction double layered Marlex mesh was used since 1982, while Dacron or Teflon felt was used until 1984. There was no flail chest, wound infection or operative death in the patients with chest wall resection and reconstruction. Survival curve of the p-T 3 N 0, 1 M 0 received chest wall reconstruction was compatible to the stage II cases out of 1,435 resected lung cancer patients (47.1% and 43.0% at 5 years). There is no need to perform chest wall reconstruction in cases like 1st to 3rd rib resection, or whose chest wall defect is covered with scapula. If the chest wall defect is lower than that and also lateral or anterior, chest wall reconstruction is indicated, even if resected ribs are less than 3. We should not hesitate to remove chest wall in order to get complete resection of the tumor, if tumor invasion is suspected surgically. Because we can reconstruct the chest wall with satisfactorily low risk of complications.