Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates

Our plain-English summary of Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates, by H. Clermidy, G. Fadel, A. De Lemos, et al (Frontiers in Surgery, 2022).

The study

• Authors: H. Clermidy, G. Fadel, A. De Lemos, P. Pradere, D. Mitilian, A. Girault, J.B. Menager, D. Fabre, S. Mussot, N. Leymarie, E. Fadel, O. Mercier
• Journal: Frontiers in Surgery
• Published: 2022;9:950177
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: En-bloc complete resection remains the treatment of choice for localized chest wall (CW) tumors. Titanium bars reconstruction demonstrated encouraging results with satisfactory early outcomes. However, long-term outcomes remain under-reported. The purpose of this study is to evaluate long-term outcomes after CW resection and repair with titanium devices.

Methods: From June 2012 to December 2018, we retrospectively reviewed all patients with CW tumors who underwent surgical resection and repair using titanium. Long-term outcomes were assessed.

Results: We identified 87 patients who underwent CW tumor resections and titanium reconstruction. Sixty-eight patients were included in the study (excluding benign tumors, Pancoast tumors, palliative surgeries, or clavicle reconstruction). There were 29 sarcomas, 20 isolated CW metastases, eight lung cancers, four breast cancers, three thymic malignancies, two sarcomatoid mesothelioma, and one desmoid tumor. Complete resection was achieved in 64 patients (94%), while R1 resection in four patients (6%). Resection involved one rib in two patients, two ribs in thirteen, three ribs in eighteen, four ribs in nine, five ribs in two, seven ribs in one, partial sternum in fifteen, and full sternum in sixteen patients. No patient experienced flail chest. The 1-year, 3-year, and 5-year overall survival rates and disease-free survivals were 82.3%, 61.4%,57.3%, and 67.6%,57.3%,52.6%, respectively. Surgical site infection occurred in 18% (n = 12) of cases. Eleven of twelve patients had an early infection (<1 year), which required material removal in six patients. Asymptomatic connector unsealing occurred in 6% (n = 4), with only one re-intervention. Titanium allergy has never been reported. Chronic chest pain (lasting more than 3 months after surgery, with daily use of pain killer) was reported in 24% of patients.

Conclusion: CW resections with titanium reconstruction are associated with long-term survivors. Titanium devices were safe, reliable, and achieved satisfactory oncological results with low morbidity and implant-related complication rates.

© 2022 Clermidy, Fadel, Delemos, Pradere, Mitilian, Girault, Menager, Fabre, Mussot, Leymarie, Fadel and Mercier.

In plain English

This was a retrospective study from one hospital, the Marie Lannelongue Hospital in France. It looked at 68 patients whose chest wall tumors were removed between June 2012 and December 2018. The removed ribs or breastbone were replaced with titanium bars (Thorib) or a titanium sternal plate (Trionyx). Most tumors were sarcomas or metastases. Two patients had sarcomatoid mesothelioma, but the article gave no separate results for them and did not discuss asbestos. The tumor was completely removed in 64 patients (94%). No patient died during surgery or in hospital. Overall survival was 82.3% at 1 year, 61.4% at 3 years and 57.3% at 5 years. Patients with non-small cell lung cancer had significantly worse survival than the other tumor types. Infection at the surgical site occurred in 12 patients (18%), implant failure in 4 (6%), and chronic pain in 24% (16 of 68). No titanium allergy was reported. The authors concluded that the devices were safe and reliable. They noted that the study was small, retrospective and single-center.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center review (case series) of patients treated surgically
• Who was studied: 68 patients (26 men by the text's count) with chest wall tumors treated at Marie Lannelongue Hospital, France, June 2012 to December 2018. The authors describe them as malignancies. They were selected from 87 patients after 19 exclusions. Tumors: 29 sarcomas (30 in the table), 20 chest wall metastases, 8 non-small cell lung cancers, 4 breast cancers, 3 thymic malignancies, 2 localized sarcomatoid mesotheliomas and 1 desmoid tumor.
• Exposure: Not an asbestos study. The intervention studied was chest wall reconstruction with Thorib titanium bars (51 patients, mean 1.35 bars per patient) or the Trionyx titanium sternal plate (17 patients) after rib and/or sternum removal.
• Main results:
  • Complete (R0) resection in 64 patients (94%); R1 resection in 4 patients (6%).
  • No deaths during surgery or the hospital stay.
  • Whole cohort: overall survival 82.3% at 1 year, 61.4% at 3 years and 57.3% at 5 years. Freedom from recurrence 67.6%, 57.3% and 52.6% at the same times.
  • 29 patients died during follow-up, 25 of them from their chest wall tumors.
  • Non-small cell lung cancer had significantly worse survival than the other tumor types (p = 0.013).
  • Surgical site infection in 12 patients (18%). Bars were removed in 6 of these infected patients.
  • Implant failure in 4 patients (6%): 3 with Thorib and 1 with Trionyx.
  • Chronic pain was the most common complication, in 24% (16 of 68).
  • No patient had paradoxical chest movement. Respiratory failure occurred in 6 patients (9%).
  • 49% of patients had a post-operative complication above grade I on the Clavien–Dindo scale.
  • No titanium allergy was reported.
• The authors' conclusion: The authors concluded that the Thorib and Trionyx titanium bars and plates were safe and reliable over time, without paradoxical chest wall motion. They noted a high morbidity rate, especially surgical site infection, and chronic pain in a quarter of surviving patients.
• Limitations the authors state:
  • Single-center, retrospective study.
  • The small number of patients prevented statistical risk-factor analyses for mortality, R1 resection or functional outcomes.
  • The chest wall cancers studied were of mixed types.
  • The Thorib bars changed over the study period, with a stronger second generation.

Topics

Medical terms in this study, explained in our Lexicon: Surgical Resection, Palliative Care, Sarcoma, Lung Cancer, Sarcomatoid, Mesothelioma, Overall Survival, Disease-Free Survival.

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• Chest Wall Reconstruction Using a Titanium Mesh Plate and an Expanded Polytetrafluoroethylene Sheet: A Case Report — T. Toyoda, T. Suzuki, et al. (2025)
• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy — B. Singh, G. Singh, et al. (2020)
• Chest wall stabilization using plate fixation — J.E. Sherman, A. Salzberg, et al. (1988)
• Massive chest wall resection and reconstruction for malignant disease — C.N. Foroulis, A.D. Kleontas, et al. (2016)
• Clinical indications and results after chest wall resection for recurrent mesothelioma — B.M. Burt, S.O. Ali, et al. (2013)

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