Results of chest wall resection and reconstruction with and without rigid prosthesis.
BACKGROUND
Chest wall resections are associated with significant morbidity, with respiratory failure in as many as 27% of patients. We hypothesized that our selective use of a rigid prosthesis for reconstruction reduces respiratory complications.


METHODS
The records of all patients undergoing chest wall resection and reconstruction were reviewed. Patient demographics, use of preoperative therapy, the location and size of the chest wall defect, performance of lung resection if any, the type of prosthesis, and postoperative complications were recorded. Predictor of complications were identified by chi2 and logistic regression analyses.


RESULTS
From January 1, 1995, to July 1, 2003, 262 patients (median age, 60 years) underwent chest wall resection for tumor in 251 (96%), radiation necrosis in 7 (2.7%); and infection in 4 patients (1.3%). The median defect size was 80 cm2 (range, 2.7 to 1,200 cm2) and the median number of ribs resected was 3 (range, 1 to 8). Major lung resection was performed in 85 patients (34%). Prosthetic reconstruction was rigid (polypropylene mesh/methylmethacrylate composite) in 112 (42.7%), nonrigid (polytetrafluoroethylene or polypropylene mesh) in 97 (37%), and none in 53 patients. Postoperatively, 10 patients died (3.8%), 4 of whom had pneumonectomy plus chest wall resection. Respiratory failure occurred in 8 patients (3.1%). By multivariate analysis, the size of the chest wall defect was the most significant predictor of complications.


CONCLUSIONS
Our incidence of respiratory failure is lower than previously reported and may relate to our use of rigid repair for defects likely to cause a flail segment. Pneumonectomy plus chest wall resection should be performed only in highly selected patients.
Weyant
Michael J
MJ
Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
Bains
Manjit S
MS
Venkatraman
Ennapadam
E
Downey
Robert J
RJ
Park
Bernard J
BJ
Flores
Raja M
RM
Rizk
Nabil
N
Rusch
Valerie W
VW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005409:Flail Chest / Q000517:prevention & control; D006801:Humans; D007239:Infections / Q000601:surgery; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D011013:Pneumonectomy; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000209:etiology; D011855:Radiodermatitis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D013526:Surgical Mesh; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000556:secondary / Q000601:surgery; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome
D011126:Polypropylenes; D020366:Methylmethacrylate; D011138:Polytetrafluoroethylene