Complications in wound healing after chest wall resection in cancer patients; a multivariate analysis of 220 patients.
BACKGROUND
Extensive chest wall resections can provoke a wide variety of complications, in particular, complicated wound healing. A lower complication rate will be achieved when local factors contributing to wound healing can be identified and improved. The aim of this study is to describe these factors, irrespective of prognosis, survival, or systemic complications.


METHODS
Retrospectively, the files of all patients undergoing an extended chest wall resection in a single institute during a 20-year period were retrieved. Patient demographics, use of preoperative therapy, tumor histology, the type of prosthesis (if any), and postoperative wound complications were recorded. Univariate and multivariate analysis were performed to identify factors contributing significantly to wound healing problems.


RESULTS
From January 1987 to December 2006, 220 patients underwent a chest wall resection, defined as resection of at least one rib, and/or part of the sternum. In 145 patients (66%) this procedure was uneventful. Multivariate analysis showed that ulceration of tumor and the use of omentum for soft tissue reconstruction comprised independent factors contributing to impaired wound healing.


CONCLUSIONS
Several factors leading to wound healing problems exist preoperatively. In a multidisciplinary setting, these factors should be weighed carefully against the possible benefits of an extended chest wall resection. Especially when ulceration of a tumor exists, or when omentum is considered for soft tissue reconstruction, increased risk on wound healing problems occurs. For the majority of patients chest wall resection will remain a safe and suitable procedure.
Department of Surgical Oncology Erasmus Medical Center/Daniel den Hoed Cancer Center, Rotterdam, the Netherlands. t.lans@erasmusmc.nl
Titia E
TE
Lans
Carmen
C
van der Pol
Michel W
MW
Wouters
Paul I M
PI
Schmitz
Albert N
AN
van Geel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D015996:Survival Rate; D019616:Thoracic Surgical Procedures; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult