title: Surgical approach to primary tumors of the chest wall in children and adolescents: 30 years of mono-institutional experience.
abstract: OBJECTIVE
  Chest wall reconstruction after surgical resection for malignancies in children is a challenge for surgeons because of growth-related complications. The aim of this study is to analyze the surgical treatment and outcomes of 30 pediatric and adolescent patients treated at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, over a 30-year period.
  
  
  METHODS
  Pediatric patients undergoing chest wall resection were retrospectively reviewed and selected for malignant primary tumor. Endpoints were survival, recurrences, and long-term results. We also reported the use of the innovative rib-like technique in 2 young patients.
  
  
  RESULTS
  Twenty-one patients were male. Median age was 13.7 years. Eleven patients (37%) presented with a chest wall mass. Twenty-six (87%) had Ewing sarcoma family tumors. Twenty-eight (94%) received neoadjuvant chemotherapy after histologic diagnosis. One rib was resected in 13 cases; 2 or 3 contiguous ribs in 8 cases. No postoperative mortality was observed and the complication rate was 40%. Overall survival was 85.2% (95% confidence interval [CI] 65.2%-94.2%) at 5 and 10 years. Relapse occurred in 7 patients. The 5-year disease-free survival rate was 82% (95% CI 62%-92%).
  
  
  CONCLUSIONS
  Long-term survival is achievable for chest wall tumors in a high-volume referral center where a multimodal treatment should be set to reach the best result. As advances in medical treatment have increased survival, surgical techniques must ensure a lasting functional result. When refining the reconstruction techniques, such as the rib-like approach, it is necessary to expand the options of curative surgery for young patients.
authors.affiliation: Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Girelli
authors.affiliation: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luksch
authors.affiliation: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Marta G
authors.initials: MG
authors.lastname: Podda
authors.affiliation: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Meazza
authors.affiliation: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Puma
authors.affiliation: Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scanagatta
authors.affiliation: Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Pecori
authors.affiliation: Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Diletto
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Galeone
authors.affiliation: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.affiliation: Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Pastorino
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000601:surgery* / Q000628:therapy; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000601:surgery* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000601:surgery* / Q000628:therapy; D013899:Thoracic Neoplasms / Q000601:surgery; D035441:Thoracic Wall / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome