Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12498

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    P3.07-003 - Functional Outcomes in Reconstruction of Massive Chest Wall Defects: A 17-Year Experience (ID 117)

    09:30 - 09:30  |  Author(s): M. Clemens
    • Abstract

    Background
    Large chest wall resections with significant loss of the skeletal framework can result in flail chest, prolonged ventilator dependence, and major respiratory impairment. Limited case reports address the extreme situation of massive chest wall defects, defined as oncologic resection of 5 or more ribs. We review our institutional experience and compare patient demographics, surgical techniques, and clinical outcomes to evaluate which factors are predictive or protective of complications.

    Methods
    Patients information was prospectively entered into a departmental database and then retrospectively reviewed. All consecutive patients who underwent immediate reconstruction of massive thoracic neoplastic or oncologic-related defects (≥5 ribs resected) between 1994 – 2011 were included. Tumor defect and reconstructive factors were evaluated for possible relationships with complications. Logistic regression analysis evaluated predictive factors for surgical outcomes.

    Results
    A total of 59 patients (median age 53) were available for review. Rib resections ranged from 5 to 10 ribs (defect area 80-690cm[2]). Indications included lung malignancy (52.5%), sarcoma (33.9%), and squamous cell carcinoma (5.9%). Types of rigid and semi-rigid reconstruction included use of prosthetic implants (83%), methylmethacrylate (25.4%), bioprosthetic mesh (5.1%). Soft tissue reconstruction required free tissue transfer (6.8%) and local muscle flaps (45.7%). Diaphragm reconstruction was required in 18.6% patients. The overall complication rate was 62%; which was subdivided into pulmonary complications (48%), cardiac complications (12%), and wound complications (17%). On average, patients were ventilator dependent for 3.9 days, required ICU monitoring for 4.9 days, and were discharged after 15.6 days. Mean follow-up time was 36 months. The 90-day overall survival rate of patients after initial procedure was 89.4%; all deaths occurred within superior resections (p=.03). Average postoperative decreases in FEV1 and FVC were 6.8% and 5.3%, respectively. Patients with superior resections and those older than 60 years were more likely to have post-operative complications.

    Conclusion
    In patients with massive oncologic thoracic defects, complex reconstructions are associated with a high rate of complications. However, creation of a stable construct is possible to prevent debilitating respiratory impairment and minimize pleural complications. Frequently, massive defects may be reconstructed with local muscle flaps obviating the need for free flaps. Prospective multicenter trials are warranted to differentiate and establish superiority of specific techniques and implant devices within these rare but challenging cases.