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The surgical management of sarcomas of the chest wall: A 13-year single institution experience

Lookup NU author(s): Richard Milner

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Abstract

© 2020 Elsevier Ltd. 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 (n = 16) was the most frequently occurring tumour, followed by myxofibrosarcoma (n = 6), leiomyosarcoma (n = 5) and unclassified sarcomas (n = 5). The majority of tumours were of high (n = 16) or intermediate grade (n = 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 (n = 17), direct closure (n = 13), pedicled VRAM (n = 7), free ALT flap (n = 6), and others (n = 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.

Publication metadata

Author(s): Crowley TP, Atkinson K, Bayliss CD, Barnard S, Milner RH, Ragbir M

Publication type: Article

Publication status: Published

Journal: Journal of Plastic, Reconstructive and Aesthetic Surgery

Year: 2020

Volume: 73

Issue: 8

Pages: 1448-1455

Print publication date: 01/08/2020

Online publication date: 04/03/2020

Acceptance date: 16/02/2020

ISSN (print): 1748-6815

ISSN (electronic): 1878-0539

Publisher: Churchill Livingstone

URL: https://doi.org/10.1016/j.bjps.2020.02.036

DOI: 10.1016/j.bjps.2020.02.036

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