背景:胸壁肿瘤是一组异质性肿瘤,由不同专业的外科医生进行治疗。由于它们的稀有性,他们的诊断和治疗没有达成共识.
方法:本回顾性研究,描述性分析包括接受胸壁切除术的恶性胸壁肿瘤患者。肿瘤被归类为原发性肿瘤,次要,和转移性肿瘤。分析包括临床病理特征,切除-重建剖面,和复发模式。
结果:在1999年至2020年期间,共有181例患者接受了胸壁切除术。在原发性肿瘤(69%),大部分为软组织肿瘤(59%).在继发性肿瘤中,大多数来自乳房(45%)和肺(42%)。25%的患者接受了新辅助化疗,98%的患者行R0切除。软组织,骨骼+软组织,45%的患者进行了延长切除,70%,28%的患者,分别。大多数患者(60%)接受了肋骨切除术,中位切除3.5根肋骨。平均缺陷尺寸为24cm2。40%的患者进行了软组织重建,大多带有背阔肌皮瓣。57%的患者进行了刚性重建,18%接受了网状骨水泥夹心技术重建。29%和39%的患者接受了辅助放疗和化疗,分别。
结论:这是关于恶性胸壁肿瘤的最大的单机构经验之一。结果突出了不同的肿瘤光谱和多模态方法,以实现最佳的功能和生存结果。在有限的资源设置中,手术,包括重建专业知识,是非常关键的。
BACKGROUND: Chest wall tumors are a heterogeneous group of tumors that are managed by surgeons from diverse specialties. Due to their rarity, there is no consensus on their diagnosis and management.
METHODS: This retrospective, descriptive analysis includes patients with malignant chest wall tumors undergoing chest wall resection. Tumors were classified as primary, secondary, and metastatic tumors. The analysis includes clinicopathological characteristics, resection-reconstruction profile, and relapse patterns.
RESULTS: A total of 181 patients underwent chest wall resection between 1999 and 2020. In primary tumors (69%), the majority were soft tissue tumors (59%). In secondary tumors, the majority were from the breast (45%) and lung (42%). Twenty-five percent of patients received neoadjuvant chemotherapy, and 98% of patients underwent R0 resection. Soft tissue, skeletal + soft tissue, and extended resections were performed in 45%, 70%, and 28% of patients, respectively. The majority of patients (60%) underwent rib resections, and a median of 3.5
ribs were resected. The mean defect size was 24 cm2. Soft tissue reconstruction was performed in 40% of patients, mostly with latissimus dorsi flaps. Rigid reconstruction was performed in 57% of patients, and 18% underwent mesh-bone cement sandwich technique reconstruction. Adjuvant radiotherapy and chemotherapy were given to 29% and 39% of patients, respectively.
CONCLUSIONS: This is one of the largest single-institutional experiences on malignant chest wall tumors. The results highlight varied tumor spectra and multimodality approaches for optimal functional and survival outcomes. In limited resource setting, surgery, including reconstructive expertise, is very crucial.