Massive chest wall resection and reconstruction for malignant disease

Our plain-English summary of Massive chest wall resection and reconstruction for malignant disease, by C.N. Foroulis, A.D. Kleontas, G. Tagarakis, et al (OncoTargets and Therapy, 2016).

The study

• Authors: C.N. Foroulis, A.D. Kleontas, G. Tagarakis, C. Nana, I. Alexiou, V. Grosomanidis, P. Tossios, E. Papadaki, I. Kioumis, S. Baka, P. Zarogoulidis, K. Anastasiadis
• Journal: OncoTargets and Therapy
• Published: 2016;9:2349-58
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Malignant chest wall tumors are rare neoplasms. Resection with wide-free margins is an important prognostic factor, and massive chest wall resection and reconstruction are often necessary. A recent case series of 20 consecutive patients is reported in order to find any possible correlation between tumor histology, extent of resection, type of reconstruction, and adjuvant treatment with short- and long-term outcomes.

Methods: Twenty patients were submitted to chest wall resection and reconstruction for malignant chest wall neoplasms between 2006 and 2014. The mean age (ten males) was 59±4 years. The size and histology of the tumor, the technique of reconstruction, and the short- and long-term follow-up records were noted.

Results: The median maximum diameter of tumors was 10 cm (5.4-32 cm). Subtotal sternal resection was performed in nine cases, and the resection of multiple ribs was performed in eleven cases. The median area of chest wall defect was 108 cm(2) (60-340 cm(2)). Histology revealed soft tissue, bone, and cartilage sarcomas in 16 cases (80%), most of them chondrosarcomas. The rest of the tumors was metastatic tumors in two cases and localized malignant pleural mesothelioma and non-Hodgkin lymphoma in one case. The chest wall defect was reconstructed by using the "sandwich technique" (propylene mesh/methyl methacrylate/propylene mesh) in nine cases of large anterior defects or by using a 2 mm polytetrafluoroethylene (e-PTFE) mesh in nine cases of lateral or posterior defects. Support from a plastic surgeon was necessary to cover the full-thickness chest wall defects in seven cases. Adjuvant oncologic treatment was administered in 13 patients. Local recurrences were observed in five cases where surgical reintervention was finally necessary in two cases. Recurrences were associated with larger tumors, histology of malignant fibrous histiocytoma, and initial incomplete resection or misdiagnosis made by nonthoracic surgeons. Three patients died during the study period because of recurrent disease or complications of treatment for recurrent disease.

Conclusion: Chest wall tumors are in their majority mesenchymal neoplasms, which often require major chest wall resection for their eradication. Long-term survival is expected in low-grade tumors where a radical resection is achieved, while big tumors and histology of malignant fibrous histiocytoma are connected with the increase rate of recurrence.

In plain English

This retrospective case series came from one hospital in Thessaloniki, Greece. It described 20 consecutive patients (ten men, ten women, mean age 59) who had large parts of the chest wall removed and rebuilt for cancer from 2006 to 2014. The article does not study asbestos exposure. Sixteen of the 20 tumors (80%) were sarcomas, seven of them chondrosarcomas; one patient had a localized malignant mesothelioma. No patient died from the operation; 4 of 20 (20%) had major complications. Tumors came back in five patients (25%) within 6 to 18 months, all locally, meaning in or next to the operated area; one later also had a single lung metastasis. Survival was limited to one year in three of those five; three patients died during the study. The patient with localized malignant mesothelioma was free of recurrence 6 years after surgery. The authors linked recurrence to large tumors, malignant fibrous histiocytoma, and incomplete first operations or misdiagnosis by non-thoracic surgeons. The authors reported results descriptively, without statistical testing, and named the small, mixed group and varied follow-up treatment as limitations.

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-institution case series, reported descriptively without statistical analysis
• Who was studied: 20 consecutive patients (10 male, 10 female; mean age 59 plus or minus 4 years, range 15 to 80) who had massive chest wall resection and reconstruction for malignant chest wall tumors at AHEPA University Hospital, Thessaloniki, Greece, January 2006 to December 2014. Patients with primary non-small-cell lung cancer invading the chest wall were excluded.
• Exposure: No asbestos or other environmental or occupational exposure was studied. The article describes surgical removal of chest wall tumors and reconstruction with either a polypropylene mesh and methyl methacrylate 'sandwich' or a 2 mm e-PTFE mesh.
• Main results:
  • Tumor maximum diameter ranged from 5.4 cm to 32 cm (median 10 cm).
  • 16 of 20 patients (80%) had primary chest wall sarcomas, most of them chondrosarcomas (7 cases). One patient had a localized malignant mesothelioma.
  • No patient died from the procedures. Major complications occurred in 4 of the 20 patients (20%).
  • Tumors recurred in 5 of 20 patients (25%). All recurrences were local, and one of these patients later also developed a solitary lung metastasis.
  • Local recurrence was defined as tumor within or adjacent to the chest wall resection and reconstruction area.
  • All five local recurrences occurred 6 to 18 months after resection.
  • All three malignant fibrous histiocytoma (MFH) cases recurred locally within a short time.
  • Survival was limited to 1 year in three of the five patients with recurrent tumors. Three patients died during the study period.
  • The 15 patients without recurrence remained alive, with a median survival of 62.5 months.
  • The patient with localized malignant mesothelioma was free of local or any other recurrence 6 years after chest wall resection.
  • Severe limitation of daily activities occurred in one patient.
• The authors' conclusion: The authors concluded that poor survival after massive chest wall resection was related to large tumor size, tumor histology (MFH tends to recur), and inappropriate initial management by non-thoracic surgeons.
• Limitations the authors state:
  • The authors named the small number of patients, the mix of tumor types and the variation in adjuvant treatment as the main limitations.
  • The authors stated that the data were not suitable for statistical analysis.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Histology, Sarcoma, Pleural Mesothelioma, Misdiagnosis.

Related studies

• En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report — C. Qin, Q. Xia, et al. (2023)
• Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) — M.F. Nunez, A. Sardi, et al. (2015)
• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery — A. Barua, J.A. Catton, et al. (2012)
• Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review — P. Bertoglio, E. Garelli, et al. (2021)
• Chest Wall Reconstruction Using a Titanium Mesh Plate and an Expanded Polytetrafluoroethylene Sheet: A Case Report — T. Toyoda, T. Suzuki, et al. (2025)

Browse more research in OncoTargets and Therapy, or return to medical research.