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Abstract：
BACKGROUND: Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy.
METHODS: Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated.
RESULTS: Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05-111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693-0.957; p = 0.0126).
CONCLUSIONS: Surgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.
METHODS: Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated.
RESULTS: Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05-111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693-0.957; p = 0.0126).
CONCLUSIONS: Surgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.
摘要：
背景：恶性胸壁肿瘤需要进行广泛切除，以确保无肿瘤边缘，根据肿瘤的深度和大小选择重建方法。需要血管化组织来覆盖浅表软组织缺损或骨组织缺损。本研究根据重建策略评估并发症的差异。
方法：回顾性分析45例胸壁恶性肿瘤患者的52例手术。患者被归类为浅表肿瘤，包括A组简单闭合小软组织缺损，B组皮瓣覆盖宽软组织缺损，或者深部肿瘤，包括C组进行全厚度切除，有或没有网状重建，D组进行全厚度切除，皮瓣覆盖有或没有聚甲基丙烯酸甲酯。根据重建策略评估52例手术的并发症，然后阐明手术和呼吸系统并发症的危险因素。
结果：45例首次手术患者的总局部无复发生存率为5年83.9%，10年70.6%。手术并发症发生率为11.5%(6/52),仅发生在深部肿瘤的病例中，主要来自D组。需要胸壁重建(p=0.0016)和皮瓣转移(p=0.0112)的手术与并发症的发生率显著相关。涉及并发症的手术显示肿瘤明显更大，骨性胸壁切除面积更大，出血量更大（p<0.005）。皮瓣转移是从多变量分析中确定的唯一有意义的预测因子(OR:10.8,95CI:1.05-111;p=0.0456)。呼吸系统并发症发生率为13.5%(7/52),发生于浅表和深部肿瘤，尤其是B组和D组,皮瓣转移与呼吸系统并发症的发生率显著相关(p<0.0005).呼吸道并发症组患者年龄较大,更经常有吸烟史，与无呼吸系统并发症组的病例相比，FEV1.0%更低，皮肤切除面积更宽(p<0.05)。术前FEV1.0%是多变量分析确定的唯一显著预测因子(OR:0.814,95CI:0.693-0.957;p=0.0126)。
结论：手术并发症在D组及涉及皮瓣转移的手术后更为常见。即使在浅表肿瘤伴皮瓣转移的情况下，严重的术前FEV1.0％也与呼吸系统并发症有关。
方法：回顾性分析45例胸壁恶性肿瘤患者的52例手术。患者被归类为浅表肿瘤，包括A组简单闭合小软组织缺损，B组皮瓣覆盖宽软组织缺损，或者深部肿瘤，包括C组进行全厚度切除，有或没有网状重建，D组进行全厚度切除，皮瓣覆盖有或没有聚甲基丙烯酸甲酯。根据重建策略评估52例手术的并发症，然后阐明手术和呼吸系统并发症的危险因素。
结果：45例首次手术患者的总局部无复发生存率为5年83.9%，10年70.6%。手术并发症发生率为11.5%(6/52),仅发生在深部肿瘤的病例中，主要来自D组。需要胸壁重建(p=0.0016)和皮瓣转移(p=0.0112)的手术与并发症的发生率显著相关。涉及并发症的手术显示肿瘤明显更大，骨性胸壁切除面积更大，出血量更大（p<0.005）。皮瓣转移是从多变量分析中确定的唯一有意义的预测因子(OR:10.8,95CI:1.05-111;p=0.0456)。呼吸系统并发症发生率为13.5%(7/52),发生于浅表和深部肿瘤，尤其是B组和D组,皮瓣转移与呼吸系统并发症的发生率显著相关(p<0.0005).呼吸道并发症组患者年龄较大,更经常有吸烟史，与无呼吸系统并发症组的病例相比，FEV1.0%更低，皮肤切除面积更宽(p<0.05)。术前FEV1.0%是多变量分析确定的唯一显著预测因子(OR:0.814,95CI:0.693-0.957;p=0.0126)。
结论：手术并发症在D组及涉及皮瓣转移的手术后更为常见。即使在浅表肿瘤伴皮瓣转移的情况下，严重的术前FEV1.0％也与呼吸系统并发症有关。
