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Primary Neoplasm of the Chest Wall: Surgical Management

Department of Cardiothoracic Surgery 1 Department of Plastic Surgery Jawaharlal Institute of Postgraduate Medical Education & Research Pondicherry, India

For reprint information contact: Subbarao Kastari Satya Venkata Kumara, MCh Tel: 91 413 37 2210 Fax: 91 413 37 2375 email: jipmer{at}jipmer.ren.nic.in Department of Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry 605006, India.

From January 1986 to December 1997, 17 patients (12 males and 5 females) aged 13 to 70 years were treated for primary neoplasms of the chest wall. There were 4 cases of fibrous dysplasia, 3 each of chondrosarcoma and Askin's tumor, 2 of plasmacytoma, and 1 each of fibrosarcoma, Ewing's sarcoma, synovial sarcoma, osteosarcoma, and enchondroma. All patients, except the case of Ewing's sarcoma, underwent wide excision or debulking for unresectable tumor, and reconstruction of the chest wall. Preoperative neoadjuvant chemotherapy was given to 1 patient with osteosarcoma, radiotherapy and chemotherapy were given to 2 others. In 8 patients, the skeletal defect was reconstructed with prosthetic material. Soft tissue reconstructive procedures with various myocutaneous flaps were performed in 6 patients. None of the patients required mechanical ventilation postoperatively. There were 2 early deaths. During follow-up of 3 months to 10 years, all patients with benign tumors were free of recurrence, 2 with Askin's tumors and 1 with osteosarcoma died. Prefabricated acrylic ribs are recommended for skeletal support during chest wall reconstruction.