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Shah NR, Weadock WJ, Williams KM, Moreci R, Stoll T, Joshi A, Petroze R, Newman EA. Use of modern three-dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors. Pediatr Blood Cancer 2024; 71:e30933. [PMID: 38430473 DOI: 10.1002/pbc.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In complex pediatric surgical oncology, surgical planning is contingent upon data gathered from preoperative imaging. Three-dimensional (3D) modeling and printing has been shown to be beneficial for adult presurgical planning, though pediatric literature is less robust. The study reviews our institutional experience with the use of 3D image segmentation and printed models in approaching resection of extracranial solid tumors in children. METHODS This is a single institutional series from 2021 to 2023. Models were based on computed tomography and magnetic resonance imaging studies, optimized for 3D imaging. The feasibility and creation of the models is reviewed, including specific techniques, software, and printing materials from our institution. Clinical implications for surgical planning are also described, along with detailed preoperative and intraoperative images. RESULTS 3D modeling and printing was performed for four pediatric patients diagnosed with extracranial solid tumors. Diagnoses included Ewing sarcoma, hepatoblastoma, synovial sarcoma, and osteosarcoma. No intraoperative complications or discrepancies with the preoperative 3D-printed model were noted. No evidence of local recurrence was identified in any patient thus far. CONCLUSION Our institutional series demonstrates a wide spectrum of clinical application for 3D modeling and printing technology within pediatric surgical oncology. This technology may aid in surgical planning for both resection and reconstruction, can be applied to a diverse breadth of diagnoses, and may potentially augment patient and/or family education about their condition.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William J Weadock
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Keyonna M Williams
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tammy Stoll
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aparna Joshi
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robin Petroze
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Zhao Y, Xie S, Zheng H, Zhang K, Gao X, Liu W, Dai W, Yu H, Shi Q, Hu B, Li Q, Xie T, Wei X. Extended radical resection and chest wall reconstruction for a pulmonary sarcomatoid carcinoma: a case report. Surg Case Rep 2024; 10:64. [PMID: 38494556 PMCID: PMC10944816 DOI: 10.1186/s40792-024-01866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly malignant type of non-small cell lung cancer (NSCLC), for which the treatment of choice is surgery. For peripheral PSC growing outward and invading the chest wall, a complete resection of the affected lung lobes and the invaded chest wall can improve long-term prognosis. However, when the extent of the resected chest wall is large, reconstruction is often required to reduce the risk of postoperative complications. Here, we present a case of PSC invading the chest wall treated with successful extended radical resection for lung cancer and chest wall reconstruction. CASE PRESENTATION A 58-year-old male patient with a nodule in the right upper lobe that had been identified on physical examination 2 years before presentation presented to our hospital with a recent cough, expectoration, and chest pain. Imaging revealed a mass in the right upper lobe that had invaded the chest wall. Preoperative puncture pathology revealed poorly differentiated NSCLC. We performed extended radical resection for lung cancer under open surgery and reconstructed the chest wall using stainless steel wire and polypropylene meshes. The procedure was uneventful, and the patient was discharged 7 days postoperatively. Furthermore, the final pathology revealed PSC. CONCLUSIONS This case underscores the feasibility of surgical R0 resection in patients with PSC with chest wall invasion and no lymph node metastasis, potentially enhancing long-term outcomes. The novel aspect of this case lies in the individualized chest wall reconstruction for a large defect, using cost-effective materials that offered satisfactory structural support and postoperative recovery, thereby providing a valuable reference for similar future surgical interventions.
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Affiliation(s)
- Yingzhi Zhao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Haoqian Zheng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Kaixin Zhang
- Graduate School, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xin Gao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wenwu Liu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Hongfan Yu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Bin Hu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Rd, Chengdu, 610041, China.
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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lonnee PW, Ovadja ZN, Hulsker CCC, van de Sande MAJ, van de Ven CP, Paes EC. Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review. Eur J Pediatr Surg 2023; 33:431-440. [PMID: 36640758 DOI: 10.1055/a-2013-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.
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Affiliation(s)
- Pieter W Lonnee
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - Emma C Paes
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
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Polites SF, Rhee DS, Routh JC, Lautz TB, Rodeberg DA, Dasgupta R. Critical elements of pediatric rhabdomyosarcoma surgery. Semin Pediatr Surg 2023; 32:151341. [PMID: 38042091 DOI: 10.1016/j.sempedsurg.2023.151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children, requires multimodal therapy which is determined by risk group stratification. Local control may be achieved by surgical resection, radiation, or both. Resection may occur upfront or following induction chemotherapy as a delayed primary excision. An R1 resection may allow a reduction in radiation exposure; however, debulking is not indicated nor is excision of residual masses at the end of therapy. Regional lymph node assessment is an important component of surgical care, as positive nodal basins require radiation. Depending on the tumor site and biology, sentinel lymph node biopsy vs biopsy of clinically or radiographically concerning nodes is indicated. Therapeutic lymph node dissection is never indicated. Familiarity with site-specific oncologic principles for RMS and participation in a multidisciplinary team including Pediatric Oncology and Radiation Oncology are necessary components of surgical care to ensure optimal outcomes.
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Affiliation(s)
- Stephanie F Polites
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel S Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Routh
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - David A Rodeberg
- Department of Surgery, Department of Pediatric Surgery, University of Kentucky, Lexington, KY, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
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6
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Alshehri A. Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses: A case report and review of literature. World J Clin Cases 2023; 11:4123-4132. [PMID: 37388792 PMCID: PMC10303597 DOI: 10.12998/wjcc.v11.i17.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones. Chest wall lesions may represent a challenge, particularly in pediatric patients. Pain is a common manifestation. However, life-threatening complications can result from direct involvement of adjacent structures. Surgical resection with appropriate reconstruction is often required.
CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion. After appropriate preoperative investigations, he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.
CONCLUSION Resection of chest wall lesions in children represents a challenge. Preoperative planning to determine the appropriate reconstruction strategy is essential.
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Affiliation(s)
- Abdullah Alshehri
- Department of Surgery, College of Medicine, King Saud University, Riyadh 11623, Saudi Arabia
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Mancera J, Echeverri V, Castillo AM, Rodríguez LF, Zarama R, Villamil C, Luengas JP. Clinical experience of thoracoplasty with absorbable rib substitutes. Pediatr Surg Int 2023; 39:146. [PMID: 36869935 PMCID: PMC9985550 DOI: 10.1007/s00383-023-05413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Malignant chest wall tumors are rare in pediatrics. They require multimodal oncological treatment and local surgical control. Resections are extensive; therefore, thoracoplasty should be planned to protect intrathoracic organs, prevent herniation, future deformities, preserve ventilatory dynamics, and enable radiotherapy. METHODS We present a case series of children with malignant chest wall tumors and our surgical experience with thoracoplasty using absorbable rib substitutes (BioBridge®), after local surgical control. BioBridge® is a copolymer made of a polylactide acid blend (70% L-lactic acid y 30% DL-lactide). RESULTS In 2 years, we had three patients with malignant chest wall tumors. Resection margins were negative, without recurrence at follow-up. We achieved good cosmetic and functional results, and no postoperative complications. CONCLUSION Alternative reconstruction techniques such as absorbable rib substitutes provide protection, guarantee a flexible chest wall, and do not interfere with adjuvant radiotherapy. Currently, there are no management protocols in thoracoplasty. This option represents an excellent alternative for patients with chest wall tumors. Knowledge of different approaches and reconstructive principles is essential to offer children the best onco-surgical option.
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Affiliation(s)
- Juliana Mancera
- Pediatric Surgical Oncology Department, Hospital Militar Central, Transversal 3° No. 49 - 00, Piso 8, 110231, Bogotá, Colombia.
| | - Viviana Echeverri
- Pediatric Surgical Oncology Department, Hospital Militar Central, Transversal 3° No. 49 - 00, Piso 8, 110231, Bogotá, Colombia
- Pediatric Surgery Department, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Ana M Castillo
- Pediatric Surgery Department, Clínica Pediátrica Colsanitas, Calle 127 No. 20-56, Bogotá, Colombia
| | - Luis F Rodríguez
- Pediatric Surgery Department, Hospital Infantil Los Ángeles, Carrera 32 No. 21ª-30, Pasto, Colombia
| | - Ricardo Zarama
- Pediatric Surgery Department, Hospital Infantil Los Ángeles, Carrera 32 No. 21ª-30, Pasto, Colombia
| | - Carlos Villamil
- Pediatric Surgery Department, Hospital Infantil Los Ángeles, Carrera 32 No. 21ª-30, Pasto, Colombia
| | - Juan P Luengas
- Pediatric Surgical Oncology Department, Hospital Militar Central, Transversal 3° No. 49 - 00, Piso 8, 110231, Bogotá, Colombia
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Developments in the Surgical Approach to Staging and Resection of Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020449. [PMID: 36672397 PMCID: PMC9857078 DOI: 10.3390/cancers15020449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Although survival after rhabdosarcoma treatment has improved over the years, one third of patients still develop locoregional relapse. This review aims to highlight developments pertaining to staging and local treatment of specific RMS tumor sites, including head and neck, chest/trunk, bladder-prostate, female genito-urinary, perianal, and extremity sites.
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Zhang H, Hou B, Xia T, Ji L, Li J, Chen T, Shang G. Primary sternal tumour resection and reconstruction with LARS mesh-bone cement sandwich by 3D-printing: Case reports. Front Bioeng Biotechnol 2023; 11:1024480. [PMID: 37091347 PMCID: PMC10119393 DOI: 10.3389/fbioe.2023.1024480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background: There are many reconstruction methods after sternal tumor resection, but the method that LARS mesh combines with bone-cement has not been reported. Case report: A 54-year-old female patient and a 55-year-old male patient admitted to our department all presented with sternum masses, but neither presented with respiratory disorders. In women with limited manubrium sternum lesions, we resected the manubrium sternum completely. In men with sternal lesions, we removed part of the sternum and part of the sternocostal joint. The patients recovered well after surgery, and there were no respiratory complications and no tumor recurrence during the 1-year follow-up respectively. Conclusion: We report two cases of sternal defect repair using LARS mesh combined with bone cement. This method is safe and stable, and can achieve satisfactory results.
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Affiliation(s)
- He Zhang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Bo Hou
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Tienan Xia
- Department of Orthopedics, Fifth People’s Hospital of Shenyang, ShenYang, Liaoning, China
| | - Lu Ji
- Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Jiatong Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
| | - Ting Chen
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
| | - Guanning Shang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, Liaoning, China
- *Correspondence: Ting Chen, ; Guanning Shang,
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Harris CJ, Helenowski I, Murphy AJ, Mansfield SA, LaQuaglia MP, Heaton TE, Cavalli M, Murphy JT, Newman E, Overmen RE, Kartal TT, Cooke-Barber J, Donaher A, Malek MM, Kalsi R, Kim ES, Zobel MJ, Goodhue CJ, Naik-Mathuria BJ, Jefferson IN, Roach JP, Mata C, Piché N, Joharifard S, Sultan S, Short SS, Meyers RL, Bleicher J, Le HD, Janek K, Bütter A, Davidson J, Aldrink JH, Richards HW, Tracy ET, Commander SJ, Fialkowski EA, Troutt M, Dasgupta R, Lautz TB. Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study. Ann Surg 2022; 276:e969-e975. [PMID: 33156070 PMCID: PMC8093319 DOI: 10.1097/sla.0000000000004579] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development, and (3) patient-reported quality of life in children with sarcoma of the chest wall. SUMMARY OF BACKGROUND DATA Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery, and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence. METHODS A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008 and 2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys. RESULTS The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (interquartile range = 1-3), and number of ribs resected did not correlate with margin status ( P = 0.36). Local recurrence occurred in 23% and margin status was the only predictive factor(HR 2.24, P = 0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posteriorrib resection (HR 8.43; P= 0.003) and increased number of ribs resected (HR 1.78; P = 0.02). Overall, patient-reported quality of life is not impaired after chest wall tumor resection. CONCLUSIONS Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.
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Affiliation(s)
- Courtney J Harris
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Irene Helenowski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew J Murphy
- Division of General Pediatric Surgery, Surgery Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara A Mansfield
- Division of General Pediatric Surgery, Surgery Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michael P LaQuaglia
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Todd E Heaton
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michele Cavalli
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph T Murphy
- Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erika Newman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor MI
| | - Richard E Overmen
- Section of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor MI
| | - Tanvi T Kartal
- Section of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor MI
| | - Jo Cooke-Barber
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Addison Donaher
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ranjeet Kalsi
- Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eugene S Kim
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Michael J Zobel
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Catherine J Goodhue
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Bindi J Naik-Mathuria
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Texas
| | - Imory N Jefferson
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Texas
| | - Jonathan P Roach
- Children’s Hospital of Colorado, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Claudia Mata
- Children’s Hospital of Colorado, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec, Canada
| | - Shahrzad Joharifard
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Serge Sultan
- Department of Psychology and Pediatrics, University of Montreal, Centre Hospitalier Universitaire Ste-Justine Research Center, Montreal, Quebec, Canada
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josh Bleicher
- Division of Pediatric Surgery, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Hau D Le
- Division of Pediatric Surgery, American Family Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin Janek
- Division of Pediatric Surgery, American Family Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andreana Bütter
- Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Holden W Richards
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sarah J Commander
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth A Fialkowski
- Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, Oregon
| | - Misty Troutt
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Theodorou CM, Lawrence YS, Brown EG. Chest wall reconstruction in pediatric patients with chest wall tumors: A systematic review. J Pediatr Surg 2022:S0022-3468(22)00736-9. [PMID: 36585305 DOI: 10.1016/j.jpedsurg.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes. METHODS A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction. RESULTS There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing's sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin's tumor (n = 16, 8.5%; a subset of Ewing's sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months. CONCLUSIONS In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christina M Theodorou
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States.
| | - Yemi S Lawrence
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
| | - Erin G Brown
- University of California Davis Medical Center, Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, 2335 Stockton Blvd, Sacramento, 95817, CA, United States
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12
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Gupta K, Puri G, Kataria K, Jayaram J. Complex chest wall reconstruction after excision of malignant phyllodes tumour. BMJ Case Rep 2022; 15:e247067. [PMID: 36162967 PMCID: PMC9516169 DOI: 10.1136/bcr-2021-247067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Phyllodes tumour is a rare breast tumour which is locally invasive, and full thickness chest wall involvement by phyllodes is rarely reported. A woman presented with recurrent phyllodes tumour and multilobulated exophytic mass of size 18.5×5.3 cm in anterior chest wall which was abutting the right 2nd-7th rib, left 3rd-5th rib and costal cartilages. She underwent wide excision of the left chest wall tumour with excision of left 3rd-5th rib, with polypropylene mesh and pedicled lattismus dorsi myocutaneous flap reconstruction. After recovery, 3 weeks later, she underwent wide excision of the phyllodes tumour on the right chest wall with excision of 2nd-7th rib, lateral border of sternum, right crus of the diaphragm and the lower lobe of the right lung. Anterior chest wall was reconstructed using scaffold made from Steinmann pins and polypropylene mesh with greater omentum pedicled flap and split thickness skin graft.
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Affiliation(s)
- Komal Gupta
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Gopal Puri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Jnaneshwari Jayaram
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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13
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Bai B, Hao J, Hou M, Wang T, Wu X, Liu Y, Wang Y, Dai C, Hua Y, Ji G, Zhou G. Repair of Large-Scale Rib Defects Based on Steel-Reinforced Concrete-Designed Biomimetic 3D-Printed Scaffolds with Bone-Mineralized Microenvironments. ACS APPLIED MATERIALS & INTERFACES 2022; 14:42388-42401. [PMID: 36094886 DOI: 10.1021/acsami.2c08422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tissue engineering technology provides a promising approach for large-scale bone reconstruction in cases of extensive chest wall defects. However, previous studies did not consider meticulous scaffold design specific to large-scale rib regeneration in terms of three-dimensional (3D) shape, proper porous structures, enough mechanical strength, and osteogenic microenvironments. Thus, there is an urgent need to develop an appropriate bone biomimetic scaffold (BBS) to address this problem. In this study, a BBS with controllable 3D morphology, appropriate mechanical properties, good biocompatibility and biodegradability, porous structure suitable for cell loading, and a biomimetic osteogenic inorganic salt (OIS) microenvironment was successfully prepared by integrating computer-aided design, 3D-printing, cast-molding, and freeze-drying technologies. The addition of the OIS in the scaffold substantially promoted ectopic bone regeneration in vivo, which might be attributed to the activation of osteogenic and angiogenic signaling pathways as well as upregulated expression of osteogenic genes. More importantly, dual long rib defects could be successfully repaired and medullary cavity recanalized by the rib-shaped mature cortical bone, which might be mediated by the activation of osteoclast signaling pathways. Thus, this paper presents a reliable BBS and proposes a new strategy for the repair of large-scale bone defects.
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Affiliation(s)
- Baoshuai Bai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Junxiang Hao
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Mengjie Hou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Tao Wang
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Xiaodi Wu
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Yanhan Liu
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
| | - Yiyang Wang
- National Tissue Engineering Center of China, Shanghai 200001, China
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Chengxiang Dai
- Cellular Biomedicine Group, Incorporated, No. 85 Faladi Road, Building 3, Pudong New Area, Shanghai 201210, China
| | - Yujie Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
| | - Guangyu Ji
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Tissue Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong 261000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
- Shanghai JiaoTong University School of Medicine, Shanghai 200240, China
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14
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Palpable pediatric chest wall masses. Pediatr Radiol 2022; 52:1963-1973. [PMID: 35316339 DOI: 10.1007/s00247-022-05323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
Pediatric chest wall lesions are varied in etiology ranging from normal and benign to aggressive and malignant. When palpable, these lesions can alarm parents and clinicians alike. However, most palpable pediatric chest lesions are benign. Familiarity with the various entities, their incidences, and how to evaluate them with imaging is important for clinicians and radiologists. Here we review the most relevant palpable pediatric chest entities, their expected appearance and the specific clinical issues to aid in diagnosis and appropriate treatment.
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15
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Chest Wall Reconstruction: A Comprehensive Analysis. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Iqbal S, Ali S, Fatimi SH. Novel reconstruction of neo-sternum with steel wires for recurrent chondrosarcoma. Ann Thorac Surg 2021; 113:e371-e374. [PMID: 34329602 DOI: 10.1016/j.athoracsur.2021.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 11/01/2022]
Abstract
Chondrosarcoma (CS) is a primary chest wall tumor causing huge masses arising from rib, sternum or costochondral junction. Successful treatment warrants complete surgical resection with wide, free margins followed by reconstruction of the bony chest wall and soft tissue coverage of the defect. We report the case of excision of giant recurrent sternal CS followed by reconstruction of Neo-sternum using steel wires. This novel technique portrays steel wire-based reconstructions as a safe, reproducible and readily available prosthetic material for complex chest wall surgeries.
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Affiliation(s)
- Sara Iqbal
- Section of Cardiothoracic Surgery, Aga Khan University Hospital (AKUH), Karachi, Pakistan.
| | - Sajjad Ali
- Ziauddin Medical University, Karachi, Pakistan
| | - Saulat H Fatimi
- Section of Cardiothoracic Surgery, Aga Khan University Hospital (AKUH), Karachi, Pakistan
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17
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Hameury F, Marec-Berard P, Eymery M, Wijnen MHW, van der Kaaij N, Mure PY, Tronc F, Chotel F, Libbrecht C, van Boven WJP, Haveman LM. Pleuropneumonectomy as Salvage Therapy in Children Suffering from Primary or Metastatic Sarcomas with Pleural Localizations. Cancers (Basel) 2021; 13:cancers13153655. [PMID: 34359557 PMCID: PMC8345037 DOI: 10.3390/cancers13153655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to achieve local control. Local therapy with radiotherapy, whether in combination with chemotherapy, appears to be insufficient to eliminate the tumor cells. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined. Outcome is variable, four patients died within 14 months after PP, one patient suffered from local recurrence, and four patients are in long-lasting remission. This extended operation is quite well tolerated. Lung function seems preserved, and quality of life is generally good. Because it gives improvement of survival in patients with pleural lesions, PP can be considered as effective salvage therapy in selected patients. Abstract Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to obtain local control. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent salvage PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined with EORTC-QLQ-C30 questionnaire. At the time of PP age was between 9–17 years. Underlying disease included metastatic osteosarcoma (n = 5), Ewing sarcoma (two metastatic, one primary), and one primary undifferentiated sarcoma. Early complications occurred in three patients. Mean postoperative hospitalization stay was 14.5 days. Pulmonary function test showed 19–66% reduction of total lung capacity which led to mild exercise intolerance but did not affect daily life. Four patients died of multi-metastatic relapse <14 months after PP, one patient had a local recurrence, and four patients are in complete remission between 1.5 and 12 years after PP. In conclusion, in this small patient group treated with a pleuropneumonectomy for primary or metastatic lesions, outcome is variable; however, this extended surgical technique was generally quite well tolerated. Postoperative lung function seems well preserved, and it seems to lead to at least an extension of life with good quality and therefor can be considered as salvage therapy.
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Affiliation(s)
- Frédéric Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Perrine Marec-Berard
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Mathilde Eymery
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Marc H. W. Wijnen
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Niels van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Pierre-Yves Mure
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - François Tronc
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Franck Chotel
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Clara Libbrecht
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Wim Jan P. van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Center, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Lianne M. Haveman
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-972-7272; Fax: +31-88-972-5009
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18
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Alam NZ. Surgical Management of Chest Wall Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Girotti PNC, Königsrainer I, Pastorino U, Girotti AL, Rosa F. Optimal chest wall prosthesis: comparative study of mechanical and functional behaviour. Eur J Cardiothorac Surg 2020; 59:ezaa355. [PMID: 33188690 DOI: 10.1093/ejcts/ezaa355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Chest wall resections are most commonly performed for tumours, infection, radiation necrosis and trauma. Defects in the anterior chest greater than 5 cm, posterior defects more than 10 cm or resection including more than 3 ribs, independently of the location, require skeletal prosthetic reconstruction. The aim of this paper was to evaluate the strength of prostheses that reproduced the normal human anatomy using different materials subjected to the most dangerous loading conditions. METHODS The biomechanical behaviours of different prosthetic materials under critical rib fracture conditions were analysed using the finite element method and then validated through mechanical testing of 3-dimensional polymethylmethacrylate ribs as a prosthesis reproducing the native anatomy of the human ribcage. RESULTS The prosthetic materials and the polymethylmethacrylate prosthesis were tested under 3 load conditions: sternal load (an anterior-posterior load applied at the third rib); lateral load (strength applied at the lateral arch of the fifth rib) and vertical load (vertical load applied at the first sternocostal junction) and showed the same results in terms of failures compared to the results from the finite element method model simulation (same location and number of fractures were detected). Although the displacement error between the finite element method and experimental test was up to 5% overall, no other microcracking was observed. CONCLUSIONS This experimental study demonstrated that all prosthetic materials currently available for human use show optimal mechanical behaviour in term of resistance and organ protection. Specifically, polymethylmethacrylate was a good candidate as a prosthetic material in term of lightness, resistance and prosthetic weight.
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Affiliation(s)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Ugo Pastorino
- Department of Thoracic Surgery, National Institute of Cancer, Milan, Italy
| | | | - Francesco Rosa
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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20
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Huang S, Qiu P, Zhang Y, Li J, Chen W, Chen B, Liang Z, Liang Z, Luo K, Huang B. Reconstruction of the chest wall in locally advanced breast cancer with multi-disciplinary cooperation: a case report of mesh repair plus TRAM combined with DIEP chest wall reconstruction. Gland Surg 2020; 9:1048-1055. [PMID: 32953614 PMCID: PMC7475378 DOI: 10.21037/gs-20-436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/11/2020] [Indexed: 02/05/2023]
Abstract
Locally advanced breast cancer, which is defined as a malignant breast tumor that invades or adheres to the surrounding tissue, is characterized by the invasion of the chest wall and the skin surface by the tumor. Multiple lymph nodes are invaded and fuse into a mass, causing extensive axillary lymph node metastasis. However, locally advanced breast cancer does not exhibit distant metastasis. At present, in most hospitals in China and the rest of the world, this type of breast cancer is primarily managed through systematic and local treatments. However, a consensus concerning the optimal surgical method for chest wall reconstruction, which for many surgeons is a difficult and confusing procedure, has not been reached. In the past, many breast centers had used skin flap combined with hard mesh titanium alloy plate to repair the large chest wall defects. Although titanium alloy plate can maintain the stability of the chest wall, it may have a negative effect on the follow-up radiotherapy of breast cancer patients, which is a controversial method. In addition, titanium alloy mesh also has the risk of deformation and fracture. These factors will cause some hidden dangers to patient safety. According to the research, the soft mesh not only has the characteristics of satisfactory compatibility and robustness for maintaining the stability of chest wall, but also does not affect the postoperative radiotherapy of patients. Combined with the advantages of soft mesh, Our department treated a case of locally advanced breast cancer with chest wall invasion. Through cooperation between the breast surgery and thoracic surgery departments, a mesh repair plus transverse rectus abdominis myocutaneous (TRAM) combined with deep inferior epigastric perforator (DIEP) procedure was performed to remove the breast tumor and repair the large area of skin defect after surgery, and a relatively satisfactory therapeutic effect was achieved. In this case, we took two novel approaches: first, a 4-layer high-density polyethylene mesh was used to repair the defect; secondly, the inferior epigastric artery perforation was anastomosed with the thoracoacromial artery (end-to-end anastomosis) and the inferior epigastric vein perforation was anastomosed with the axillary vein (end-to-side anastomosis).
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Affiliation(s)
- Shengchao Huang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Pu Qiu
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuanqi Zhang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jianwen Li
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Weizhang Chen
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoying Chen
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhu Liang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhongzeng Liang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kangwei Luo
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoyi Huang
- Department of Breast Surgery, Oncology, Chest Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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21
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Buschmann J, Yamada Y, Schulz-Schönhagen K, Hess SC, Stark WJ, Opelz C, Bürgisser GM, Weder W, Jungraithmayr W. Hybrid nanocomposite as a chest wall graft with improved integration by adipose-derived stem cells. Sci Rep 2019; 9:10910. [PMID: 31358841 PMCID: PMC6662805 DOI: 10.1038/s41598-019-47441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
Surgery of the chest wall is potentially required to cover large defects after removal of malignant tumours. Usually, inert and non-degradable Gore-Tex serves to replace the missing tissue. However, novel biodegradable materials combined with stem cells are available that stimulate the healing. Based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/aCaP) and pure PLGA, a dual layer biodegradable hybrid nanocomposite was generated. Mouse adipose-derived stem cells were cultered on electrospun disks (ASCs of C57BL/6), and biomechanical tests were performed. The cell-seeded scaffolds were engrafted in C57BL/LY5.1 mice to serve as a chest wall substitute. Cell invasion into the bi-layered material, extent of CD45+ cells, inflammatory response, neo-vascularization and ECM composition were determined at 1 and 2 months post-surgery, respectively. The bi-layered hybrid nanocomposite was stable after a 2-week in vitro culture, in contrast to PLGA/aCaP without a PLGA layer. There was a complete biointegration and good vascularization in vivo. The presence of ASCs attracted more CD45+ cells (hematopoietic origin) compared to cell-free scaffolds. Inflammatory reaction was similar for both groups (±ASCs) at 8 weeks. A bi-layered hybrid nanocomposite fabricated of electrospun PLGA/aCaP and a reinforcing layer of pristine PLGA is an ideal scaffold for chest wall reconstruction. It is stable and allows a proper host tissue integration. If ASCs are seeded, they attract more CD45+ cells, supporting the regeneration process.
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Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Yoshito Yamada
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Schulz-Schönhagen
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Samuel C Hess
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Wendelin J Stark
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Christine Opelz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, University Hospital Rostock, Rostock, Germany
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22
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Elbawab H, Alreshaid F, Hashem T, Alnasser A, Husain R, Aljehani Y. Intercostal hemangioma: Case report of a rare chest wall tumor in childhood. Int J Surg Case Rep 2019; 60:319-322. [PMID: 31280064 PMCID: PMC6612705 DOI: 10.1016/j.ijscr.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 01/30/2023] Open
Abstract
Intercostal hemangioma is an extremely rare disease, accounting for approximately 0.01% of all benign hemangiomas. Hemangiomas are prone to bleed spontaneously or after minor traumatic injury. Complete excision of the tumor is mandatory even after embolization to prevent recruitment of a collatera1 blood supply.
Introduction Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence. Case presentation A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5 × 4 × 5.6 cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma. Discussion Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas. Conclusion Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence.
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Affiliation(s)
- Hatem Elbawab
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Farouk Alreshaid
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tariq Hashem
- Department of Pathology, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asayil Alnasser
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raja Husain
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser Aljehani
- Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Feng K, Yin D, Zheng W, Yu X. Treatment of open chest rib fractures with the matrix rib internal fixation system: A case report. Medicine (Baltimore) 2019; 98:e15683. [PMID: 31096506 PMCID: PMC6531140 DOI: 10.1097/md.0000000000015683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Rib fractures are common among patients with blunt chest wall trauma and often represent life-altering injuries. PATIENT CONCERNS A 31-year-old woman presented with right chest trauma, with pain and bleeding as a result of a traffic accident 1 hour previously. DIAGNOSES Chest computed tomography showed open chest trauma, multiple rib fractures, flail chest, hemopneumothorax, and lung contusion on the right side. INTERVENTIONS We decided to perform debridement via emergency, thoracoscopic exploration to remove blood and contaminants from the chest cavity. Thereafter, the third to seventh fractured ribs were fixed and reconstructed using the matrix rib internal fixation system, followed by suturing of the incision according to the original anatomical level. OUTCOMES The patient was discharged 15 days after surgery, and recovered well with satisfactory results. LESSONS We believe that initial chest reconstruction with internal fixation in the first stage following thorough debridement may be suitable for treating flail chest, and could save the patient's life in the early stages. However, the decision to perform the first-stage operation for the open contaminated wound should be carefully considered.
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Affiliation(s)
- Kan Feng
- Department of Thoracic Surgery, First Hospital, Fuyang District
| | | | - Wujun Zheng
- Department of Thoracic Surgery, First Hospital, Fuyang District
| | - Xiaojun Yu
- Department of Thoracic Surgery, First Hospital, Fuyang District
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