Total spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine

2004 ◽  
Vol 100 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Masashi Komagata ◽  
Makoto Nishiyama ◽  
Atshuhiro Imakiire ◽  
Hirobumi Kato
Keyword(s):  
Lung Cancer ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Spinal Column ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Survival ◽  
Content Type ◽  
Fine Print

✓ Lung cancers invading the chest wall and spinal column are often considered unresectable, and consequently there are few reports describing resection of invasive vertebral lesions. The authors developed a new anterior approach procedure for the en bloc resection of primary lung adenocarcinoma invading the thoracic spine and chest wall, in which the primary tumor does not need to be separated from the vertebrae. The authors describe a total spondylectomy for the en bloc resection of lung cancer invading the spine. A combination of surgical techniques was required, including resection of the osseous elements T-2 and T-3 (the pedicles were excised using a thread saw), anterolateral thoracotomy, apical lobectomy, chest wall resection, vertebrectomy, anterior spinal column reconstruction with a titanium mesh cage containing bioactive glass ceramic, and placement of anterior and posterior spinal instrumentation. At 46 months after surgery, there is no evidence of local recurrence or distant metastasis, and the patient continues to improve. This new procedure allows for the en bloc resection of primary lung tumors and adherent vertebral invasion without separation of the lesion from the vertebra. Thus, surgical management by complete excision of Pancoast tumors can achieve longer-term survival rates without sequelae.

scholarly journals Factors affecting long-term survival after en-bloc resection of lung cancer invading the chest wall✩

2000 ◽  
Vol 18 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Alain Chapelier ◽  
Elie Fadel ◽  
Paolo Macchiarini ◽  
Bernard Lenot ◽  
Francois Le Roy Ladurie ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chest Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Survival ◽  
Long Term Survival ◽  
Factors Affecting

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

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

2018 ◽  
Vol 67 (04) ◽  
pp. 299-305 ◽  
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.

scholarly journals Lung cancer with chest wall invasion: retrospective analysis comparing en-bloc resection and ‘resection in bird cage’

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Heron Teixeira Andrade Santos ◽  
Agnaldo José Lopes ◽  
Cláudio Higa ◽  
Rodolfo Acatauassú Nunes ◽  
Eduardo Haruo Saito
Keyword(s):  
Lung Cancer ◽  
Retrospective Analysis ◽  
Chest Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Chest Wall Invasion ◽  
Wall Invasion

Long-term outcome after en bloc resection and reconstruction of the spinal column and posterior chest wall in the treatment of malignant tumors

2021 ◽  
Author(s):  
Katsumi Harimaya ◽  
Yoshihiro Matsumoto ◽  
Kenichi Kawaguchi ◽  
Hirokazu Saiwai ◽  
Keiichiro Iida ◽  
...  
Keyword(s):  
Chest Wall ◽  
Malignant Tumors ◽  
Spinal Column ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals En bloc resection and reconstruction of a huge chondrosarcoma involving multilevel upper thoracic spine and chest wall: case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaodong Tang ◽  
Zhenyu Cai ◽  
Ruifeng Wang ◽  
Tao Ji ◽  
Wei Guo
Keyword(s):  
Case Report ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Thoracic Cavity ◽  
En Bloc ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Abstract Background En bloc resection of malignant tumors involving upper thoracic spine is technically difficult. We surgically treated a patient with grade 2 chondrosarcoma involving T1–5, left upper thoracic cavity, and chest wall. Case presentation A 37 years old, male patient was referred to our hospital for a huge lump involved left shoulder and chest wall. In order to achieve satisfied surgical margins, anterior approach, posterior approach, and lateral approach were carried out sequentially. After en bloc tumor resection, the upper thoracic spine was reconstructed with a 3D-printed modular vertebral prosthesis, and the huge chest wall defect was repaired by a methyl methacrylate layer between 2 pieces of polypropylene mesh. Postoperatively, the patient suffered from pneumonia and neurological deterioration which fully recovered eventfully. At 24 months after operation, the vertebral prosthesis and internal fixation were intact; there was no tumor local recurrence, and the patient was alive with stable pulmonary metastases. Conclusion This case report describes resection of a huge chondrosarcoma involving not only multilevel upper thoracic spine, but also entire left upper thoracic cavity and chest wall. Although with complications, en bloc tumor resection with combined surgical approach and effective reconstructions could improve oncologic and functional prognosis in carefully selected spinal tumor patients.

scholarly journals Interdisciplinary Radical “En-Bloc” Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents

2021 ◽  
Vol 9 ◽  
Author(s):  
Alireza Basharkhah ◽  
Herwig Lackner ◽  
Anna Karastaneva ◽  
Marko Bergovec ◽  
Stephan Spendel ◽  
...  
Keyword(s):  
Chest Wall ◽  
Ewing Sarcoma ◽  
En Bloc Resection ◽  
Tumor Location ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Survival ◽  
Oncological Treatment ◽  
Costovertebral Joint ◽  
Neo Adjuvant Chemotherapy

Introduction: Ewing sarcomas of the chest wall, historically known as “Askin tumors” represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only between 40 and 60% in most studies. Multimodal oncological treatment according to specific Ewing sarcoma protocols and radical “en-bloc” resection with simultaneous chest wall repair are key factors for long-term survival. However, the surgical complexity depends on tumor location and volume and potential infiltrations into lung, pericardium, diaphragm, esophagus, spine and major vessels. Thus, the question arises, which surgical specialties should join their comprehensive skills when approaching a child with Ewing sarcoma of the chest wall.Patients and Methods: All pediatric patients with Ewing sarcomas of the chest wall treated between 1990 and 2020 were analyzed focusing on complete resection, chest wall reconstruction, surgical complications according to Clavien-Dindo (CD) and survival. Patients received neo-adjuvant chemotherapy according to the respective Ewing sarcoma protocols. Depending on tumor location and organ infiltration, a multi-disciplinary surgical team was orchestrated to perform radical en-bloc resection and simultaneous chest wall repair.Results: Thirteen consecutive patients (seven boys and six girls) were included. Median age at presentation was 10.9 years (range 2.2–21 years). Neo-adjuvant chemotherapy (n = 13) and irradiation (n = 3) achieved significant reduction of the median tumor volume (305.6 vs. 44 ml, p < 0.05). En-bloc resection and simultaneous chest wall reconstruction was achieved without major complications despite multi-organ involvement. Postoperatively, one patient with infiltration of the costovertebral joint and laminectomy required surgical re-intervention (CD IIIb). 11/13 patients were treated with clear resections margins (R1 resection in one patient with infiltration of the costovertebral joint and marginal resection <1 mm in one child with multiple pulmonary metastases). All patients underwent postoperative chemotherapy; irradiation was performed in four children. Two deaths occurred 18 months and 7.5 years after diagnosis, respectively. Median follow-up for the remaining patients was 8.8 years (range: 0.9–30.7 years). The 5-year survival rate was 89% and the overall survival 85%.Conclusion: EWING specific oncological treatment and multi-disciplinary surgery performing radical en-bloc resections and simultaneous chest wall repair contribute to an improved survival of children with Ewing sarcoma of the chest wall.

Lung Cancer Invading the Chest Wall: A Plea for En-Bloc Resection but the Need for New Treatment Strategies

2005 ◽  
Vol 80 (6) ◽  
pp. 2032-2040 ◽  
Author(s):  
Christophe Doddoli ◽  
Benoit D’Journo ◽  
Françoise Le Pimpec-Barthes ◽  
Antoine Dujon ◽  
Christophe Foucault ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chest Wall ◽  
Treatment Strategies ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
New Treatment

Modified approach for the selective treatment of temporal lobe epilepsy: transsylvian—transcisternal mesial en bloc resection

1998 ◽  
Vol 88 (5) ◽  
pp. 855-862 ◽  
Author(s):  
Peter Vajkoczy ◽  
Karsten Krakow ◽  
Stefan Stodieck ◽  
Bernd Pohlmann-Eden ◽  
Peter Schmiedek
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Parahippocampal Gyrus ◽  
Oculomotor Nerve Palsy ◽  
En Bloc ◽  
Content Type ◽  
Mesial Temporal Lobe ◽  
Fine Print

Object. The authors propose a novel surgical approach for amygdalohippocampectomy (AH) in patients with temporal lobe epilepsy. Via a transsylvian—transcisternal route, the parahippocampal gyrus is directly exposed from its medial aspect, thus allowing a standardized en bloc resection of the temporomesial epileptogenic structures—the amygdala, anterior hippocampus, parahippocampal gyrus, and subiculum. Additional anatomical studies have been performed for standardization of this approach. Methods. From 1990 to 1996, 32 patients presenting with medically intractable mesial temporal lobe epilepsy underwent AH via the transsylvian—transcisternal approach. Preoperative computerized tomography and magnetic resonance imaging revealed temporomesial lesions in 16 patients. Histopathological examination revealed cavernous malformations in seven patients, low-grade astrocytomas in four, hamartomas in three, and gangliogliomas in two patients. Specimens obtained in patients with no lesions were diagnosed as hippocampal sclerosis in all cases. No patient experienced permanent morbidity. Nine percent of the patients developed a temporary partial oculomotor nerve palsy. Only one patient developed a postoperative visual field deficit with a contralateral quadrantanopsia. With respect to seizure outcome, all patients benefited from surgery. At follow-up evaluation (mean 26.4 months), 80% of the patients were free from seizures (Engel Class I). Eight patients in this group were no longer receiving medication. Seventeen percent had experienced only one to several seizures since surgery (Engel Class II) and 3% reported a worthwhile improvement (Engel Class III). Conclusions. In contrast to previously described standard techniques for AH, the transsylvian—transcisternal approach presented in this study offers improved anatomical orientation and intraoperative control over the mesial temporal lobe and preserves the lateral as well as the laterobasal temporal lobe.

Sign in / Sign up

Export Citation Format

Share Document