39 - Freie Mitteilung
Clinical works I
16. Mai 2019, 08:30 - 10:00, Bellavista 2, 6. OG
Chest wall resections and reconstructions for malignant diseases: A single center experience in 158 cases
L. Elahi-Rausis, E. Abdelnour, M. Gonzalez, D. Hasselbach, T. Krueger, W. Raffoul, H.-B. Ris, J. Y. Perentes, Presenter: L. Elahi-Rausis (Lausanne)
The surgical management of tumors involving the chest wall is challenging and should achieve complete resection and insure stability/function. Here we reviewed 158 chest wall resections performed in one center for diverse malignancies over a 15-year period and report in-hospital morbidity/mortality and oncological outcome.
The records of 158 chest wall reconstructions performed in 150 patients between 2003 and 2018 by a joint team of reconstructive and thoracic surgeons were reviewed. We determined, for each patient, the extent of resection, the reconstruction type, the postoperative surgical and non-surgical complications and the oncological long-term outcome.
Chest wall resections were performed in the context of lung cancer (31%), primary chest wall tumors (33%), breast cancer (15%) or metastasis (20%). Full thickness (skin, muscle, ribs±sternum±clavicule) chest wall resection was performed in 66 cases while the other 92 cases involved bony chest wall with no superficial soft tissue. Associated lung resections were required in 72 patients (wedge 43%, lobectomy 43%, pneumonectomy 14%). Chest wall reconstructions were performed using pedicled muscle flaps (15%) prosthetic chest wall subsitutes (mesh with and without methyl methacrylate reinforcement, 38%) or a combination of both (47%). The postoperative mortality was of 2.5% and related to septic/hemorrhagic shock (n=3) and pulmonary embolism (n=1). Postoperative morbidity consisted of pneumonia (21%), arrhythmia (10%), pleural effusion (15%) and pulmonary embolism (2%). A complete tumor resection was obtained in 123 patients (78%) and chest wall stability and integrity was achieved in all patients. Mean patient follow-up was of 44 ± 43 months Overall and disease free survival were 46±44 and 31±41months, respectively.
Chest wall resections and reconstructions performed in the context of a multimodal approach can offer rewarding overall and disease free survivals while preserving the chest wall integrity and functionality. Postoperative morbidity and mortality rates are acceptable.