En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap

Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.

Download Full-text

Adjuvant Radiation for Soft Tissue Sarcomas

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2015.35.e634 ◽

2015 ◽

pp. e634-e642 ◽

Cited By ~ 5

Author(s):

Colleen I. Dickie ◽

Rick Haas ◽

Brian O'Sullivan

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Soft Tissue Sarcomas ◽

Intensity Modulated Radiotherapy ◽

En Bloc Resection ◽

Bloc Resection ◽

Surgical Approaches ◽

Adjuvant Radiation ◽

En Bloc

Over recent decades, limb-preservation surgery in combination with radiotherapy achieves local control rates exceeding 90% for extremity soft tissue sarcoma (STS). Local control is not as successful for retroperitoneal sarcoma (approximately 60%) despite aggressive surgical approaches including en bloc resection of uninvolved adjacent organs combined with intensity modulated radiotherapy (IMRT). This review will discuss the indications for adjuvant radiation therapy (RT) for primary presentation of soft tissue sarcoma: “What,” referring to the type and manner of planning and delivery of RT; “When,” referring to the timing and scheduling of RT; and “Why,” referring to the rationale for the use of RT will be addressed. From a practical stand point, this Educational Chapter on “adjuvant RT” will focus on pre- and postoperative RT in the context of gross total resection for extremity and retroperitoneal soft tissue sarcoma, the two most frequent paradigms for the use of adjuvant RT.

Download Full-text

Chest wall invasion in non–small cell lung carcinoma: A rationale for en bloc resection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2001.112826 ◽

2001 ◽

Vol 121 (4) ◽

pp. 649-656 ◽

Cited By ~ 63

Author(s):

Francesco Facciolo ◽

Giuseppe Cardillo ◽

Michele Lopergolo ◽

Guido Pallone ◽

Francesco Sera ◽

...

Keyword(s):

Chest Wall ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

En Bloc Resection ◽

Bloc Resection ◽

Small Cell ◽

Small Cell Lung ◽

En Bloc ◽

Cell Lung Carcinoma ◽

Wall Invasion

Download Full-text

Use of a Fascia Lata Autograft to Reconstruct a Large Triceps Tendon Defect After En-Bloc Resection of a Soft-Tissue Sarcoma

JBJS Case Connector ◽

10.2106/jbjs.cc.19.00390 ◽

2020 ◽

Vol 10 (1) ◽

pp. e0390-e0390

Author(s):

Rachel Clancy ◽

Zachary Lim ◽

Robert A. Ravinsky ◽

Anne O'Neill ◽

Peter Ferguson ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

En Bloc Resection ◽

Bloc Resection ◽

Fascia Lata ◽

En Bloc ◽

Tendon Defect ◽

Triceps Tendon

Download Full-text

Non-Small Cell Lung Cancer with Chest Wall Involvement: Integrated Treatment or Surgery Alone?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1632363 ◽

2018 ◽

Vol 67 (04) ◽

pp. 299-305 ◽

Cited By ~ 2

Author(s):

Marco Chiappetta ◽

Dania Nachira ◽

Maria Teresa Congedo ◽

Elisa Meacci ◽

Venanzio Porziella ◽

...

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Small Cell Lung Cancer ◽

Chest Wall ◽

Adjuvant Radiotherapy ◽

En Bloc Resection ◽

Bloc Resection ◽

Small Cell ◽

Small Cell Lung ◽

En Bloc

Background The aim of this study was to identify prognostic factors in patients affected by non-small cell lung cancer (NSCLC) with chest wall (CW) involvement, analyzing different strategies of treatment and surgical approaches. Methods Records of 59 patients affected by NSCLC with CW involvement underwent surgery were retrospectively reviewed, from January 2000 to March 2013. Results Induction therapy was administered to 18 (30.5%) patients while adjuvant treatment to 36 (61.0%). In 36 (61%) patients, lung resection was associated only with a parietal pleural resection while in 23 (39%) with CW en-bloc resection. Overall 5-year survival was 34%. Prognostic factors were evaluated in the 51 (86.4%) completely resected (R0) patients.Five-year survival was 60% in patients undergoing induction therapy followed by surgery and 24% in those who underwent surgery as first treatment (p = 0.11). Five-year survival was better in the neoadjuvant group than that in the surgery group in IIB (T3N0) p-stage (100 vs 28%, p = 0.03), while in the IIIA (T3N1–2,T4N0) p-stage it was of 25 vs 0%, respectively (p = 0.53).No 5-year survival difference was found in case of parietal pleural resection versus CW en-bloc resection (p = 0.27) and in case of only parietal pleural involvement versus soft tissue (p = 0.78).In case of incomplete resection (R1), patients undergoing adjuvant radiotherapy had better 2-year survival than patients untreated: 60% vs 0% (p = 0.025). Conclusions Type of surgical resection and the deep of infiltration of disease do not influence survival in this subset of patients. Integrated treatments seem to be suitable: neoadjuvant therapies ensure a better survival rate than surgery alone in IIB and IIIA patients, instead adjuvant radiotherapy proves a fundamental option in incomplete resections.

Download Full-text

Myofibroma of the cervical spine presenting as brachialgia

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine131194 ◽

2014 ◽

Vol 21 (6) ◽

pp. 916-918 ◽

Cited By ~ 2

Author(s):

Benjamin M. Davies ◽

Daniel du Plessis ◽

Kanna K. Gnanalingham

Keyword(s):

Soft Tissue ◽

Facet Joint ◽

Surgical Excision ◽

En Bloc Resection ◽

Bloc Resection ◽

Benign Tumors ◽

Histopathological Analysis ◽

En Bloc ◽

Left Posterior ◽

Midline Approach

Myofibromas are rare, benign tumors of myofibroblasts. Their occurrence in adults, involving bone outside of the head and neck, is especially uncommon. The authors report the case of a 34-year-old woman who presented with left-sided brachialgia. Magnetic resonance imaging identified an expansile soft-tissue lesion of the C6–7 facet joint. En bloc resection via a left posterior midline approach was undertaken. Histopathological analysis confirmed the lesion to be a myofibroma. Brachialgia resolved following surgery and there is no evidence of recurrence at 20 months follow-up. Myofibroma is a rare cause of primary soft-tissue tumor of the spine. Surgical excision remains the mainstay of treatment.

Download Full-text

A Case of “en bloc” Excision of a Chest Wall Leiomyosarcoma and Closure of the Defect with Non-Cross-Linked Collagen Matrix (Egis®)

Case Reports in Oncology ◽

10.1159/000452147 ◽

2016 ◽

Vol 9 (3) ◽

pp. 655-660 ◽

Cited By ~ 1

Author(s):

Marco Rastrelli ◽

Saveria Tropea ◽

Romina Spina ◽

Alessandra Costa ◽

Roberto Stramare ◽

...

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Tissue Regeneration ◽

Soft Tissue Sarcomas ◽

Surgical Excision ◽

Smooth Muscle Tumor ◽

Chest Wall Resection ◽

En Bloc ◽

Dermal Matrix ◽

Treatment Protocols

Sarcomas arising from the chest wall account for less than 20% of all soft tissue sarcomas, and at this site, primitive tumors are the most frequent to occur. Leiomyosarcoma is a malignant smooth muscle tumor and the best outcomes are achieved with wide surgical excision. Although advancements have been made in treatment protocols, leiomyosarcoma remains one of the more difficult soft tissue sarcoma to treat. Currently, general local control is obtained with surgical treatment with wide negative margins. We describe the case of a 50-year-old man who underwent a chest wall resection involving a wide portion of the pectoralis major and minor muscle, the serratus and part of the second, third and fourth ribs of the left side. The full-thickness chest wall defect of 10 × 8 cm was closed using a non-cross-linked acellular dermal matrix (Egis®) placed in two layers, beneath the rib plane and over it. A successful repair was achieved with no incisional herniation and with complete tissue regeneration, allowing natural respiratory movements. No complications were observed in the postoperative course. Biological non-cross-linked matrix, derived from porcine dermis, behaves like a scaffold supporting tissue regeneration; it can be successfully used as an alternative to synthetic mesh for chest wall reconstruction.

Download Full-text

Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699411 ◽

2010 ◽

Vol 43 (01) ◽

pp. 088-091

Author(s):

Pearlie W. W. Tan ◽

Chin-Ho Wong ◽

Heng-Nung Koong ◽

Bien-Keem Tan

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Rectus Femoris ◽

Musculocutaneous Flap ◽

Anterolateral Thigh Flap ◽

Soft Tissue Reconstruction ◽

Wall Defect ◽

Prolene Mesh ◽

Anterolateral Thigh ◽

Tissue Reconstruction

ABSTRACTWe present a massive 25 cm x 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh–methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral–anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.

Download Full-text