The surgical management of sarcomas of the chest wall: A 13-year single institution experience.
J Plast Reconstr Aesthet Surg
; 73(8): 1448-1455, 2020 Aug.
Article
em En
| MEDLINE
| ID: mdl-32291186
ABSTRACT
INTRODUCTION:
Chest wall sarcomas are rare. Resection and reconstruction pose significant anatomical and functional challenges. We present our experience of managing these tumours as plastic surgeons working within a specialist sarcoma MDT.METHODS:
All cases of chest wall sarcoma in which a plastic surgeon took part were analysed (2003-2016). Tumours of the breast, abdomen and groin were excluded. Demographics, surgical details and outcomes were analysed.RESULTS:
Forty-seven patients were identified. Median age at presentation was 61 years (range 7-91). Thirty-three were male and 14 were female. Chondrosarcoma (nâ¯=â¯16) was the most frequently occurring tumour, followed by myxofibrosarcoma (nâ¯=â¯6), leiomyosarcoma (nâ¯=â¯5) and unclassified sarcomas (nâ¯=â¯5). The majority of tumours were of high (nâ¯=â¯16) or intermediate grade (nâ¯=â¯17) histologically. Wide local excision was carried out in all cases. Twenty-two cases required a mesh and cement reconstruction of the chest wall. Soft tissue reconstruction involved pedicled LD flap +-skin graft (nâ¯=â¯17), direct closure (nâ¯=â¯13), pedicled VRAM (nâ¯=â¯7), free ALT flap (nâ¯=â¯6), and others (nâ¯=â¯4). Clear resection margins were achieved in 32 patients (68%). Fourteen patients underwent adjuvant radiotherapy and four adjuvant chemotherapy. Nine patients (19%) developed a local recurrence, and the median duration from resection to recurrence was 17 months (range 3-72). Nine patients (19%) developed metastasis. Eleven patients died (23.4%), and the median duration of survival 30 months (range 3-92). Thirty-six patients remain well, with a median duration of follow up 57.5 months (range 6-141). Estimated 5 year disease specific survival is 74.2%.CONCLUSION:
Plastic surgeons have a vital role in the management of chest wall sarcomas. We present a reconstructive algorithm, which has enabled us to achieve good oncological and functional outcomes and a low complication profile .Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sarcoma
/
Neoplasias Torácicas
/
Parede Torácica
Tipo de estudo:
Observational_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Plast Reconstr Aesthet Surg
Ano de publicação:
2020
Tipo de documento:
Article