49 - Freie Mitteilung
Clinical works II
16. Mai 2019, 10:15 - 11:45, Bellavista 2, 6. OG
Chest wall resection and reconstruction for thoracic wall malignancies: Induction therapy reduces recurrence rates
M. Sarvan, M. Friess, I. Inci, D. Schneiter, W. Weder, I. Opitz, Presenter: M. Sarvan (Zürich)
Chest wall resections are associated with significant morbidity. The present analysis assesses short-term and long-term outcome of a large series of chest wall tumor resection and –reconstruction in multimodal therapy concept.
Patients with primary and secondary chest wall malignancies were retrieved from our institutional database who underwent chest wall resection and reconstruction. Beside perioperative outcome and histological workup, long-term outcome, recurrence free survival with or without neo- or adjuvant therapeutic modalities in curative or palliative therapeutic settings were analyzed.
The study includes 169 patients, who underwent chest wall resection and reconstruction for primary or secondary chest wall tumors between 1999 and 2018. The median age was 60 (range 10-87) years. 28% (n=48) were primary tumors, whereas 72% (n=121) were secondary tumors. Primary malignancies were predominantly sarcomas 23% (n=39). For secondary malignancies, the largest subgroups were non-small cell lung cancer 38% (n=65), breast cancer 14% (n=24), and mesothelioma 12% (n=20). Resection margins were free in 61% (n=103), R1 in 36% (n=60), R2 in 2% (n=4). Perioperative complications occurred in 40% (n=67). The 30-days mortality was 4% (n=7). 46 patients (27%) received preoperative chemotherapy, 52 patients (31%) preoperative radiotherapy. The median follow-up time was 21 (range 0-218) months. The median OS was 44 months (95% confidence interval (CI): 33-55 months). 71% (n=120) of the patients were recurrent free at the time of last follow-up. Local recurrence rate was significantly lower in patients receiving preoperative therapy (16%) compared to patients receiving postoperative therapy (42%) or pre- and postoperative therapy (44%) (p=0.01). In patients receiving a preoperative chemotherapy, a R0 resection was significantly more often achieved (77%) than in patients receiving no preoperative chemotherapy (56%) (p=0.02). Preoperative radiotherapy had no influence on R0 resection (p=0.2). Defect size and resection status had no influence on OS (p=0.4 and p=0.8, respectively).
Surgical therapy is the cornerstone for the treatment of primary and secondary chest wall malignancies and can be performed with reasonable rates complications. Induction chemo-and/or radiotherapy improves the probability of free resection margin and provides longer survival.