Primary chest wall neoplasms - an experience of 39 patients

Abstract

Objective: To evaluate treatment approaches, role of surgical resection and reconstruction and outcome of patients with primary chest wall tumor. Study Design A prospective observational study. Place and Duration. The study was conducted at the Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from March 1996 to April 2000. Patient and Methods A total of 39 patients underwent resection for primary chest wall tumors. Male were 27 and female were 12. Age range was 15 years - 55 years with a mean age of 23±2 years. 75% of patients presented with a painless mass while 25% complained of pain. Twenty three were on right side, twelve were on the left side while 4 extended onto the sternum. Sizes were <3cm (7 patients), 3-5cm (24 patients), 5-10cm (6 patients) and > 10cm (2 patients). Chest radiograph in all and CT thorax was done in 20 cases. Out of 39 cases, 25 had previous biopsies attempted by other surgeons leading to ulceration and fungation in 18 cases. Chest wall resection and primary closure was done in 33 cases. In 4 cases marlex mesh alone was used while in 2 cases it was reinforced with Methyl Methacrylate. Results Mean operative time was 68 (+/-40) minutes. Postoperatively, 19 patients required ventilation. Out of these, 14 patients were extubated the same day, 3 the next day while 02 patients died despite prolonged ventilation. Post-operative flail was observed in 3 cases without respiratory compromise. Histopathology reporting were chondrosarcoma in 24, fibrosarcoma in 6 cases while the rest were not reported. Twenty one patients were followed-up for up to one year with no evidence of disease while the remaining were lost to follow up. Conclusion To conclude primary chest wall tumors can be safely managed by resection and primary closure or chest wall reconstruction and are associated with long term survival.