Malignant primary chest-wall tumours: techniques of reconstruction and survival.
OBJECTIVE
We analysed our experience in primary malignant chest-wall tumours (PMCWTs) with an emphasis on a new reconstruction technique and on survival.


METHODS
From 1998 to 2008, 41 patients (23 (56%) male, mean age 48 years) with PMCWT were operated in our unit: chondrosarcoma n=25; osteosarcoma n=8; Ewing's sarcoma n=2; other n=6. We performed nine sternectomies and 32 lateral chest-wall resections (median number of ribs resected=3.5). Resections were extended to the lung (n=2), diaphragm (n=3), vertebral body (n=3), scapula (n=1) and upper limb (n=1). Stability was obtained by a prosthetic material, rigid and non-rigid and a muscular flap. As non-rigid material, we mostly used a polytetrafluoroethylene patch (n=24). In the past 2 years, two patients (one total sternectomy and one wide anterior chest-wall resection) were reconstructed with a rigid system composed of mouldable titanium connecting bars and rib clips (Strasbourg Thoracic Osteosyntheses System--STRATOS, MedXpert GMbH, Heitersheim, Germany). A muscular flap was added in 12 patients (29.3%).


RESULTS
There was no perioperative mortality or significant morbidity and all patients were extubated within first 24h. At a mean follow-up of 60.5 months (range 4-130 months), the overall 5- and 10-year survival was 61% and 47%, respectively. In the chondrosarcoma group, 5- and 10-year survival was 80%.


CONCLUSIONS
Wide resection with tumour-free margins is necessary in PMCWT to minimise local recurrence and to contribute to long-term survival. The STRATOS system, developed for chest-wall replacement, allows a firm reconstruction, simple to handle and to fix, avoiding instability or paradoxical movement also in wide chest-wall resections.
Gonfiotti
Alessandro
A
Thoracic Surgery Unit, University Hospital Careggi, Viale Morgagni 1, Florence 50139, Italy. agonfiotti@hotmail.com
Santini
Paolo Ferruccio
PF
Campanacci
Domenico
D
Innocenti
Marco
M
Ferrarello
Sante
S
Caldarella
Adele
A
Janni
Alberto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012512:Sarcoma, Ewing / Q000473:pathology / Q000601:surgery; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps; D013899:Thoracic Neoplasms / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult