title: Primary chest wall chondrosarcomas: results of surgical resection and analysis of prognostic factors.
abstract: OBJECTIVE
  Wide surgical excision with tumour-free margins is the mainstay of therapy for primary chest wall chondrosarcoma (PCWC). Few studies on treatment outcome and prognostic factors of PCWC requiring chest wall resection are available. We analysed our experience on surgical treatment of PCWC with emphasis on survival and recurrence prognostic factors.
  
  
  METHODS
  From 1986 to 2012, 89 patients (65.2% males, median age 55 years) with PCWC were operated on. The median tumour maximum diameter was 7 cm (range 2-30 cm).
  
  
  RESULTS
  We performed 23 sternectomies and 66 lateral chest wall resections (median ribs resected: 2; range 1-7). Resections were extended to lung (n = 19), diaphragm (n = 13), vertebral body (n = 6) or clavicle (n = 1). Negative margins were obtained in 85.4% of cases. Chest wall reconstruction was obtained mainly by prosthetic non-rigid or rigid materials and muscle flap coverage. In the last years, 3 patients received a sternal replacement with cadaveric allograft, and 2 had a chest wall reconstruction with titanium bars and 17 with a rib-like prosthesis. Perioperative mortality and morbidity rates were 0 and 12.4%, and 5- and 10-year overall and disease-free (on R0 resections) survival rates were 67.1 and 57.8%, and 70 and 52%, respectively. A favourable outcome (univariate analysis) was seen for G1 tumours (P < 0.0001), negative surgical margins (P < 0.0001), age ≤55 years (P = 0.005), no adjuvant treatment (P < 0.001) and diameter ≤6 cm (P = 0.005). Independent predictors of better survival (multivariate analysis) were negative surgical margins (P = 0.0001), G1 tumours (P = 0.02), age ≤55 years (P = 0.006) and diameter ≤6 cm (P = 0.006). A predictive risk factor for recurrence was histological grade.
  
  
  CONCLUSIONS
  Surgical resection of PCWC leads to good oncological outcome. Wide surgical margins and G1 tumours predicted a better prognosis and a lower recurrence rate. The evolution of surgical technique and the introduction in clinical practice of new prosthetic materials allowed larger resections, and safe and anatomical reconstruction.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy giuseppe.marulli@unipd.it beppemarulli@libero.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Duranti
authors.affiliation: Division of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Luzzi
authors.affiliation: Division of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Carbone
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gotti
authors.affiliation: Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Division of Thoracic Surgery, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Pastorino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002813:Chondrosarcoma / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D013899:Thoracic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D055815:Young Adult
keywords: Chest wall reconstruction; Chest wall resection; Chest wall tumour; Chondrosarcoma