RESUMO
BACKGROUND: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. METHODS: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009-2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning. RESULTS: Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm(2) (mean, 154 cm(2)). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%). CONCLUSIONS: Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction.
RESUMO
Breast-conserving surgery (BCS) without adequate margin clearance carries a high risk of local recurrence. We introduced cavity shaving at primary surgery 31 months ago, to assess tumor margin involvement. The aim of this study was to determine how cavity shaving affects the re-excision rate. We compared a group of 394 patients who underwent BCS with cavity shaving of macroscopically clear margins at primary operation, from March 2003 to September 2005 with a group of 392 patients who underwent BCS only from January 2000 to February 2003. Cavity shaves and re-excision specimens were measured and oriented with reference to the primary cancer. Pathological results of all the specimens were analyzed and re-excision rates in both groups were recorded. Compared with BCS alone where 49 of 392 patients (12.5%) required reoperation for margin clearance, only 22 of 394 patients (5.58%) of the group who had concurrent cavity shaves required further surgery (p < 0.01). Analysis of re-excised specimens suggests that reoperation could have been avoided in 44 of 49 patients, if they had standard sized cavity shave at primary operation. We conclude that cavity shavings during primary BCS significantly reduce the re-excision rate to ensure microscopic clearance.
