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Malignant Chest Wall Tumors: Complex Defects and Their Management—A Review of 181 Cases

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chest wall tumors are a heterogeneous group of tumors that are managed by surgeons from diverse specialties. Due to their rarity, there is no consensus on their diagnosis and management.

Materials

This retrospective, descriptive analysis includes patients with malignant chest wall tumors undergoing chest wall resection. Tumors were classified as primary, secondary, and metastatic tumors. The analysis includes clinicopathological characteristics, resection-reconstruction profile, and relapse patterns.

Results

A total of 181 patients underwent chest wall resection between 1999 and 2020. In primary tumors (69%), the majority were soft tissue tumors (59%). In secondary tumors, the majority were from the breast (45%) and lung (42%). Twenty-five percent of patients received neoadjuvant chemotherapy, and 98% of patients underwent R0 resection. Soft tissue, skeletal + soft tissue, and extended resections were performed in 45%, 70%, and 28% of patients, respectively. The majority of patients (60%) underwent rib resections, and a median of 3.5 ribs were resected. The mean defect size was 24 cm2. Soft tissue reconstruction was performed in 40% of patients, mostly with latissimus dorsi flaps. Rigid reconstruction was performed in 57% of patients, and 18% underwent mesh-bone cement sandwich technique reconstruction. Adjuvant radiotherapy and chemotherapy were given to 29% and 39% of patients, respectively.

Conclusions

This is one of the largest single-institutional experiences on malignant chest wall tumors. The results highlight varied tumor spectra and multimodality approaches for optimal functional and survival outcomes. In limited resource setting, surgery, including reconstructive expertise, is very crucial.

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Authors and Affiliations

  1. Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India

    Jyoti Sharma MCh, S. V. S. Deo MS, Sunil Kumar MS, Sandeep Bhoriwal MCh, Naveen Gupta MCh & Jyoutishman Saikia MCh

  2. Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India

    Sushma Bhatnagar MD, Seema Mishra MD & Sachidanand Bharti MD

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Sanjay Thulkar MD

  4. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India

    Sameer Bakhshi DM

  5. Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India

    D. N. Sharma MD

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  1. Jyoti Sharma MCh
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  2. S. V. S. Deo MS
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Correspondence to S. V. S. Deo MS.

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Sharma, J., Deo, S.V.S., Kumar, S. et al. Malignant Chest Wall Tumors: Complex Defects and Their Management—A Review of 181 Cases. Ann Surg Oncol 31, 3675–3683 (2024). https://doi.org/10.1245/s10434-023-14765-w

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