Thoracopleuropneumonectomy with riblike reconstruction for recurrent thoracic sarcomas.
BACKGROUND
Large intrathoracic tumors may occasionally present with massive infiltration of the lung and chest wall that would require pneumonectomy and total removal of the rib cage to obtain radical surgical excision, but this operation carries a prohibitive risk of death for cardiopulmonary failure in the absence of adequate chest wall reconstruction.


METHODS
We report here four consecutive cases of thoracopleuropneumonectomy (TPP) with en-bloc resection of the entire lung, chest wall, and diaphragm and immediate riblike reconstruction for recurrent thoracic sarcomas. Patients had undergone the initial thoracic surgical resection with curative intent 2-14 years before TPP. There was no postoperative mortality, and all patients were alive and free of disease 8-21 months after TPP.


RESULTS
To our knowledge, this is the first report in the medical literature of such an extensive operation, demonstrating technical feasibility, tolerability, and efficacy of one-stage resection and reconstruction by a semirigid three-dimensional riblike prosthesis modeled on a human-derived aluminum cast.


CONCLUSIONS
Selected patients with advanced low-intermediate thoracic sarcomas are the ideal candidates for this extreme procedure, to maximize the chance of long-term tumor control and possibly cure.
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, ugo.pastorino@istitutotumori.mi.it.
Ugo
U
Pastorino
Leonardo
L
Duranti
Paolo
P
Scanagatta
Francesco
F
Leo
Federico
F
Piccioni
Paola
P
Collini
Alessandro
A
Gronchi
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010997:Pleural Neoplasms / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012272:Ribs / Q000473:pathology / Q000601:surgery*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D013899:Thoracic Neoplasms / Q000473:pathology / Q000601:surgery*; D019616:Thoracic Surgical Procedures; D035441:Thoracic Wall / Q000473:pathology / Q000601:surgery*