Surgical treatment of patients with tumors of the upper chest wall

Qbiective. To analyze and estimate the oncological and functional results of surgical treatment of patients with tumors of the upper chest wall Materials and methods. During the period from 2005 to 2011 17 patients, with tumors of the upper part of the chest wall with involvement of bone structures, were treated. Primary tumors of the ribs, sternum or clavicle were found in 8 (46,8%) cases, soft tissues tumors of the of the chest wall with invasion of adjacent bony structures in 5 (30%), metastasis of the chest wall was in 4 (23,2%) cases. Isolated involvement of bone structures diagnosed - in 7 (41%) cases, combined - in 10 (59%) cases. Involvement in the neoplastic process of the chest cavity was in 3 (17,4%) cases. Results. Excellent and good orthopedic and functional results were achieved in 14 patients (82%) and satisfactory in 3 (18%) patients. Progressive disease was noted in 4 (23,5%) cases after 3 to 12 months. Median follow-up of patients was 14,7 months. Died from disease progression 4 (23,5%) patients died from disease progression in the period from 10 to 34 months after the surgery. Conclusion. Our results indicate the need for selecting an active surgical approach in this category of patients. The vast majority of the operations in view of the tentative large deficiency of chest wall is not possible to manage without a reconstructive plastic surgery, which allows to restore the function of skeletal completely, and to prevent the development of cardio-respiratory disturbances and thus to achieve good functional and orthopedic outcome.

upper chest wall, tumors, surgical treatment, reconstruction

1. Давыдов М.И., Алиев М.Д., Соболевский В.А. и соавт. Статья: Хирургическое лечение злокачественных опухолей грудной стенки. Вестник РОНЦ им. Н.Н. Блохина РАМН. 2008, т. 19, №1, с. 35-40.

2. Захарычев В.Д., Ганул А.В. и соавт. Выбор лечебных подходов при злокачественных опухолях грудной стенки. Онкология. 2009, т. 11, № 4, с. 279-282.

3. Зацепин С.Т Костная патология взрослых. М., «Медицина». 2001, с. 501-519.

4. Кованов В.В. Оперативная хирургия и топографическая анатомия. М., «Медицина». 2001, с.129-130.

5. Тепляков В.В., Карпенко В.Ю., Илюшин А.Л. и соавт. Хирургическое лечение злокачественных опухолей грудной стенки. М., Хирургия. 2010, № 9, с. 36-41.

6. Чаклин В.Д. Опухоли костей и суставов. М., 1974, 288 с.

7. Чиссов В.И., Трахтенберг А.Х., Мамонтова А.С. Торакальная онкохирургия. МНИОИ им. П.А. Герцена. М., 1994, 156 с.

8. Athanassiadi K., Theakos N., Benakis G. et al. Omental transposition: the final solution for major sternal wound infection. Asian Cardiovasc Thorac Ann. 2007, Jun., v. 15 (3), p. 200-203.

9. Belmahi A., Ouezzani S., El Aziz S. Efficiency of the combination of Mersilene-musculocutaneous flap in the reconstruction of full-thickness chest wall defects. A retrospective study of 14 cases. Ann. Chir. Plast. Esthet. 2007, Apr., v. 52 (2), p. 96-102.

10. Biscard J.D., Swenson S.A. Tumors of sternum. Arch. Surg. 1948, v. 56, p. 570-577.

11. Calvo V., Morcillo A., Paris F. et al. Sternectomy and reconstruction for malignant disease. International Congress of Thorax surgery. Athens, Greece, 1-8 july. 1997, p. 541-546.

12. Carbognani P., Vagliasindi A., Costa P. et al. Surgical treatment of primary and metastatic sternal tumours. Cardiovasc Surg. 2001, Jun., v. 42 (3), p. 411.

13. Fouad F.A. Chest wall resection and reconstruction: analysis of 11 cases after methylmethacrylate reconstruction. J. Egypt. Natl. Cane. Inst. 2006, Sep., v. 18 (3), p. 175-182.

14. Garrett L. Walsh, Bryan M. Davis et al. A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections. J. Thorac. Cardiovasc Surg. 2001, v. 121, p. 48-60.

15. Graham J. Marlex mesh as a prosthesis in the repair ofthoracic wall defects. Ann. Surg. 1950, v. 151, p. 469-479.

16. Imai K., Minamiya Y, Saito H. et al. Giant cell tumor of the sternum. Jpn. J. Thorac Cardiovasc Surg. 2006, v. 54 (9), p. 405-408.

17. Incarbone M., Nava M., Lequaglie C. et al. Sternal resection for primary or secondary tumors. J. Thorac. Cardiovasc. Surg. 1997, Jul., v. 114 (1), p. 93.

18. Kilic D., Gungor A., Kavukcu S. et al. Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction. J. Invest. Surg. 2006, Nov.-Dec., v. 19 (6), p. 353-360.

19. Kuntz C.A. Thoracic surgical oncology. Clin. Tech. Small Anim. Pract. 1998, Feb., v. 13 (1), p. 47-52.

20. Liptay M.G., Fry WA. Malignant bone tumors ofthe chest wall. Semin. Thorac. Cardiovasc Surg. 1999, v. 11, p. 278-284.

21. Parham F.W. Thoracic resection for tumor growing from the bony wall of chest. Trans. Surg. Gynecol. Assoc. 1898, v. 11, p. 223-363.

22. Pass H. Primary and metastatic chest wall tumors. In Thoracic Oncology. WB Saunders Company. 1989, p. 546-565.

23. Sakaguchi К., Horio H., Kuwabara К. et al. Large chest wall reconstruction using a pedicled osteomuscle composite flap: report of a case. Surg. Today. 2006, v. 36 (2), p. 180-183.

24. Shikada Y., Yoshino I., Fukuyama S. et al. Completely wide resection of malig-nant fibrous histiocytoma of the chest wall; expect for long survival. Ann. Thorac Cardiovasc Surg. 2006, Apr., v. 12 (2), p. 141-144.

25. Skoracki R., Chang D. Reconstruction of the chestwall and thorax. J. Surg. Oncol. 2006, Nov., v. 94 (6), p. 455-465.

26. Somers J., Faber L.P. Chondroma and chondrosarcoma. Semin. Thorac Cardiovasc Surg. 1999, v. 11, p. 270-277.

27. Strauch B., Lianq L. Atlas of microvascular surgery: anatomy and operative approaches. New York. 2006, p. 453-495.

28. Voss B., Bauernschmitt R., Brockmann G. et al. Osteosynthetic thoracic stabilization after complete resection of the sternum.Eur. J. Cardiothorac Surg. 2007, Aug., v. 32 (2), p. 391-393. Epub. 2007, May 23.

29. Weyant M., Bains M., Venkatraman E. et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann. Thorac. Surg. 2006 Jan., v. 81 (l), p. 279-285.