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Huang L, Li F, Neudecker J, Elsner A, Strauchmann J, Dziodzio T, Zhou H, Rueckert J. Chest wall resections for non-small cell lung cancer: a literature review. J Thorac Dis 2024; 16:4794-4806. [PMID: 39144312 PMCID: PMC11320248 DOI: 10.21037/jtd-23-774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/21/2024] [Indexed: 08/16/2024]
Abstract
Background and Objective The development of early screening for lung cancer has led to improved overall survival in patients with non-small cell lung cancer (NSCLC). However, the management of NSCLC patients with resectable and potentially resectable chest wall invasion (CWI) requires attention. The purpose of this review is to summarize the role of surgery (chest wall resections) in NSCLC patients with CWI. Methods A literature search and review from three databases (PubMed, Embase, and ScienceDirect) comprised the last 39 years. This review was focused on the treatment of NSCLC patients with CWI, mainly including the preoperative evaluation, principles of treatment and strategic decision-making, surgical complications, and prognostic factors. Key Content and Findings Through the collection of relevant literature on NSCLC that invades the chest wall, this narrative review describes the actual role in clinical practice and future developments of chest wall resections. Preoperative treatment requires the multidisciplinary team (MDT) team to conduct accurate clinical staging of the patient and pay attention to the patient's lymph node status and rib invasion status. The successful implementation of chest wall resection and possible chest wall reconstruction requires refined individualized treatment based on the patient's clinical characteristics, supplemented by possible postoperative systemic treatment. Conclusions Surgery plays an important role in treating NSCLC patients with CWI, and a collaborative, experienced MDT is an essential component of the successful treatment of CWI with lung cancer. In the future, more high-quality clinical research is needed to focus on CWI patients so that patients can receive more effective treatment options and better clinical prognosis.
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Affiliation(s)
- Luyu Huang
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Feng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jens Neudecker
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aron Elsner
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Strauchmann
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Dziodzio
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jens Rueckert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Chen T, Chan EG, Huang B, Bertolaccini L, Fernando HC, Tasoudis PT, Motas N, Pennathur A, Fang W, Zhang J. Outcomes following minimally invasive approaches vs. open extended lobectomy for non-small cell lung cancer: a propensity-matched analysis of the National Cancer Database. Transl Lung Cancer Res 2024; 13:334-344. [PMID: 38496690 PMCID: PMC10938095 DOI: 10.21037/tlcr-24-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
Background Traditional thoracotomy, an invasive surgical procedure, has been the standard approach for extended lobectomy in treating non-small cell lung cancer (NSCLC). However, minimally invasive surgery (MIS) has gained traction with advancements in surgical techniques. Despite this, the outcomes of extended lobectomy via a minimally invasive approach remain largely uncharted. Using the comprehensive National Cancer Database (NCDB), our research aimed to clarify the safety, feasibility, and efficacy of minimally invasive extended lobectomy in patients diagnosed with NSCLC. Methods Our study encompassed a selection of patients with NSCLC who underwent extended lobectomy (defined as lobectomy or bilobectomy with chest wall, diaphragm or pericardial resection) between 2010 and 2014. Through propensity score matching (PSM), we ensured a balanced comparison between patients who underwent MIS and those who opted for the traditional open extended lobectomy. Both univariate and multivariate analyses were employed to discern whether the surgical approach had any significant impact on the prognosis of patients undergoing this specific procedure. Results Before PSM, our dataset included 3,934 patients. After 1:2 PSM, the MIS group included 683 cases, while the open group included 1,317 cases. One notable finding was the reduced average postoperative hospital stay for the MIS group at 7.15 days compared to the open group at 8.40 days (P<0.001). Furthermore, the 5-year survival rate was similar, with the MIS group at 53.1% and the open group at 51.3% (P=0.683). Conclusions The results of our study suggest that MIS for extended lobectomy not only is safe and feasible but also is oncologically effective. However, it is imperative to note that these encouraging findings necessitate further validation through prospective studies to ascertain the full scope of benefits and potential risks associated with MIS.
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Affiliation(s)
- Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ernest G. Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Binhao Huang
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Hiran C. Fernando
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Panagiotis T. Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalia Motas
- Department of Thoracic Surgery, Institute of Oncology Bucharest, Bucharest, Romania
- Clinic of Thoracic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Vacuum-assisted closure for chest wall reconstruction infection caused by Streptococcus mitis after surgery of lung cancer: a case report. Surg Case Rep 2024; 10:29. [PMID: 38294618 PMCID: PMC10830934 DOI: 10.1186/s40792-024-01828-7] [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: 12/17/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Among a cohort of patients who underwent chest wall resection and reconstruction by rigid prosthesis, 6% required removal of the prosthesis, and in 80% of these cases the indication for prosthesis removal was infection. Although artificial prosthesis removal is the primary approach in such cases of infection, the usefulness of vacuum-assisted closure (VAC) has also been reported. CASE PRESENTATION A 64-year-old man with diabetes mellitus underwent right middle and lower lobectomy with chest wall (3rd to 5th rib) resection and lymph node dissection because of lung squamous cell carcinoma. The chest wall defect was reconstructed by an expanded polytetrafluoroethylene (PTFE) sheet. Three months after surgery, the patient developed an abscess in the chest wall around the PTFE sheet. We performed debridement and switched to VAC therapy 2 weeks after starting continuous drainage of the abscess in the chest wall. The space around the PTFE sheet gradually decreased, and formation of wound granulation progressed. We performed wound closure 6 weeks after starting VAC therapy, and the patient was discharged 67 days after hospitalization. CONCLUSIONS We experienced a case of chest wall reconstruction infection after surgery for non-small cell lung cancer that was successfully treated by VAC therapy without removal of the prosthesis. Although removal of an infectious artificial prosthesis can be avoided by application of VAC therapy, perioperative management to prevent surgical site infection is considered essential.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Takaki Mizoguchi
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Lo Iacono G, Mazzella A, Mohamed S, Petrella F, Sedda G, Casiraghi M, Girelli L, Bertolaccini L, Spaggiari L. The Role of Surgery in Primary Chest Wall Tumors: Over 20 Years’ Experience in Resection and Reconstruction. Cancers (Basel) 2023; 15:cancers15072153. [PMID: 37046813 PMCID: PMC10093177 DOI: 10.3390/cancers15072153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Primary chest wall tumors comprise a heterogeneous group of neoplasms arising from soft tissues and bones. While surgical excision is the standard of care for benign tumors, the management of malignant tumors requires multimodal treatment. We conducted a predictive analysis of outcome, recurrence-free and overall survival. Methods: We retrospectively reviewed the clinical and pathological records of all patients treated in our center between 1998 and 2020. Results: 53 patients (15–85 years) were treated in our department. The average tumor diameter was 65 ± 35 mm (10–160 mm). Negative margins were obtained in 48 patients (90.6%), whereas in the remaining 5, R1 resection was accomplished. Median overall survival was 63,03 months (1–282 months). Overall survival was 90% at 1 year, 78% at 2 years, and 61% at 5 years. Our analysis identified tumor diameter, postoperative complications, and high grade of malignancy as factors that can influence prognosis. Conclusions: The treatment of primary chest wall tumors remains a very challenging process. Different histological types preclude definition of an unequivocal approach. Complete resection with healthy margins remains a definitive cornerstone in the treatment of these cancers as part of a more comprehensive approach.
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Affiliation(s)
- Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Kader S, Watkins A, Servais EL. The oncologic efficacy of extended thoracic resections. J Surg Oncol 2023; 127:288-295. [PMID: 36630102 DOI: 10.1002/jso.27151] [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: 10/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
Locally invasive lung cancers pose unique challenges for management. Surgical resection of these tumors can pose high morbidity due to the invasion into surrounding structures, including the spine, chest wall, and great vessels. With advances in immunotherapy and chemoradiation, the role for radical resection of these malignancies and associated oncologic outcomes is evolving. This article reviews the current literature of extended thoracic resections with a focus on technical approach, functional outcomes, and oncologic efficacy.
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Affiliation(s)
- Sarah Kader
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Ammara Watkins
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
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Wiendieck K, Dörfler A, Sommer B. Extended salvage surgery after high-dose chemoradiation therapy for tumors in the cervico-thoracic junction with invasion of the chest wall and the spine: a case series. J Surg Case Rep 2022; 2022:rjac581. [PMID: 36601096 PMCID: PMC9800033 DOI: 10.1093/jscr/rjac581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 12/31/2022] Open
Abstract
The treatment of malignant tumors localized in the upper thoracic cavity and involving the spine at the cervico-thoracic junction (CTJ) is challenging. We report on three patients with malignant tumors invading the thoracic inlet and the spine at the CTJ. All three patients underwent radical tumor resection and 360° spine fusion following the posterior pedicle screw instrumentation and anterior vertebrectomy combined with implantation of an expandable titanium cage. Postoperatively, a mild paresis with hypesthesia of the ipsilateral arm occurred in one patient because of brachial plexus involvement. Two patients were still alive at last follow-up after 83 and 143 months, the third patient succumbed to tumor progression 13 months after extended salvage surgery. We display the possibilities of extended 'salvage' therapy in well-selected patients that were deemed hopeless regarding neurological function, biomechanical stability and tumor control after multiple courses of combined radio-chemotherapy.
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Affiliation(s)
- Kurt Wiendieck
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany,Department of Spine Surgery, Kliniken Dr. Erler gGmbH, Nürnberg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Björn Sommer
- Correspondence address. Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany. Tel: +49 821 400165684; Fax: +49 821 400 3314; E-mail:
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7
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Yutaka Y, Terada K, Tanaka S, Yamada Y, Ohsumi A, Nakajima D, Hamaji M, Menju T, Yoshizawa A, Date H. Prognostic impact of pathologically confirmed rib invasion in patients with lung cancer requiring chest wall resection. J Thorac Dis 2022; 14:4660-4668. [PMID: 36647488 PMCID: PMC9840023 DOI: 10.21037/jtd-22-976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary lung cancer that invades the chest wall is classified as T3 regardless of the depth of invasion. This study assessed the prognostic impact of pathologically confirmed rib invasion in patients with pT3N0-1 lung cancer requiring chest wall resection. METHODS We retrospectively analyzed the records of patients with non-small cell lung cancer (NSCLC) who underwent combined lung and chest wall resection with rib involvement from 2006 to 2019. The median follow-up period was 64.0 months. RESULTS In total, 42 patients (41 men, 1 woman) were enrolled. The median patient age was 64 years (range, 42-79 years). The median tumor size before treatment was 56.5 mm (range, 21-80 mm), and an osteolytic sign was identified on computed tomography (CT) in 42.9% (18/42). Among 27 patients who received induction chemoradiotherapy, 5 (18.5%) achieved a complete pathological response. The operations comprised 36 lobectomies, 5 segmentectomies, and 1 wedge resection with resection of 2.5 ribs on average. Pathological examination revealed rib invasion in 18 (42.9%) patients. The 5-year disease-free and overall survival rates with pathological rib invasion were 44.4% and 77.4% (P=0.0114), respectively and those without pathological rib invasion were 44.7% and 81.3% (P=0.0222), respectively. Pathologically confirmed rib invasion was the only factor identified to have a prognostic impact in the univariate and multivariate analyses [hazard ratio (HR), 5.98; 95% confidence interval (CI): 1.37-26.1]. Locoregional recurrence and distant metastases were more common in patients with than without pathologically confirmed rib invasion [4 (22.2%) and 6 (33.3%), respectively, among 18 patients with pathological rib invasion; 2 (8.3%) and 3 (12.5%), respectively, among 24 patients without pathological rib invasion] (P=0.0073). CONCLUSIONS Pathologically confirmed rib invasion was found to have a significant unfavorable prognostic impact in patients with pT3N0-1 lung cancer requiring chest wall resection. Multimodal therapy may be preferable in these patients to prevent local and distant relapse.
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Affiliation(s)
- Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazuhiko Terada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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8
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Kuckelman J, Debarros M, Bueno R. Extended Resections for Lung Cancer. Surg Clin North Am 2022; 102:345-363. [DOI: 10.1016/j.suc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Topolnitskiy EB, Shefer NA, Marchenko ES, Chekalkin TL, Khakimov KI. [Reconstruction of post-resection chest wall defects in surgical treatment of invasive non-small cell lung cancer]. Khirurgiia (Mosk) 2022:31-40. [PMID: 36469466 DOI: 10.17116/hirurgia202212131] [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: 06/17/2023]
Abstract
OBJECTIVE To present the results of reconstruction of post-resection chest wall defects with nickel-titanium (TiNi) implants in patients with invasive NSCLC and to analyze the features of perioperative management. MATERIAL AND METHODS We enrolled 9 patients with NSCLC involving the ribs after lobectomy or pneumonectomy with chest wall reconstruction. Defects were closed used TiNi mesh and rib prostheses. We selected the shape and dimensions of artificial ribs individually before surgery according to CT data and 3D models of reinforcing elements. RESULTS There were male smokers aged 64.6±4.6 years among patients (range 58-73). T3N0M0 was diagnosed in 6 patients, T3N1M0 - 2, T3N2M0 - 1. Squamous cell carcinoma was verified in 4 (44.4%) patients, adenocarcinoma - in 5 (55.6%) patients. All patients had comorbidities. Mean Charlson's comorbidity index was 6.56±4.6. Dimension of chest wall defect varied from 78 to 100 cm2. Postoperative period was uneventful without signs of respiratory failure. There were no lethal outcomes. Complications occurred in 33.3% of patients (prolonged air discharge through the drains, pleuritis and atrial fibrillation). CONCLUSION Surgical treatment of NSCLC spreading to the chest wall is a complex task requiring further improvement. Bioadaptive TiNi implants are a promising reinforcing material that allows successful reconstruction of post-resection chest wall defects with good anatomical, functional and cosmetic results. «Sandwich» technology is advisable for extensive defects. This approach includes 2 layers of knitted mesh and rib prostheses between these layers.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia
- Regional Clinical Hospital, Tomsk, Russia
- Tomsk State University, Tomsk, Russia
| | - N A Shefer
- Siberian State Medical University, Tomsk, Russia
- Regional Clinical Hospital, Tomsk, Russia
| | | | | | - Kh I Khakimov
- Research Institute of Oncology of the Tomsk National Research Medical Center, Tomsk, Russia
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10
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Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y, Kang SB, Kang JH, Obrosov A. Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors. J Funct Biomater 2021; 12:jfb12040060. [PMID: 34842727 PMCID: PMC8628886 DOI: 10.3390/jfb12040060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T3N0M0, two were T3N1M0, and one was T3N2M0. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.
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Affiliation(s)
- Evgeniy Topolnitskiy
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Surgery, Siberian State Medical University, 634050 Tomsk, Russia
| | - Timofey Chekalkin
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- R&D Center, TiNiKo Co., Ochang 28119, Korea;
- Correspondence:
| | - Ekaterina Marchenko
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Yuri Yasenchuk
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Seung-Baik Kang
- Boramae Medical Center, Seoul National University Hospital, Seoul 07061, Korea;
| | | | - Aleksei Obrosov
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03-046 Cottbus, Germany
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