La chirurgia resettiva e ricostruttiva nelle neoplasie primitive o secondarie della parete toracica: la nostra esperienza

ajor chest wall resections often represent a difficult challenge for surgeons because of surgical and aesthetic reconstruction. In case of large defects a synthetic mesh with armoured ribs or titanium bar skeletron covered or uncovered with pedicled muscle transposition or omental flaps could be used. We report our experience on 57 patients, 43 males and 14 females mean age 66.2y (range 34-86). 35 (61.4%) cases were lung cancers with thoracic wall involvement, 16 were sternal, scapular or chest wall sarcomas, 6 were sternal and rib metastastatic involvement from extrathoracic neoplasms. We performed 51 thoracectomies and 6 sternetomies, 5 subtotal and one total. We resected an average of 3 ribs (range 1-6) and performed in 35 cases a reconstruction with synthetic mesh, in 7 associated with cyanomethacrilate armoured ribs, in 2 with thytanium bars. In total sternectomy we reconstruct the anterior ribs with 2 silicon tubes, in one of subtotals with 2 titanium bars. 25 cases needed pedicled muscle transposition, in 20 cases with latissimus dorsi in 5 with pectoralis major. We had no mortality or major complications. 13 patients presented minor complications as atrial fibrillation in 4, respiratory failure in 6, 2 wall hematoma and one syeroma. Mean hospital stay was 9.8 days (range 7-20). Major chest wall resections are possible for the multiple reconstructive choices actually proposed. An adequate preoperative study of the patient, a correct surgical strategy and the use of all reconstructive techniques are the keys for a successful outcome.