Download PDF
Thorac Cardiovasc Surg 2006; 54(3): 182-187
DOI: 10.1055/s-2005-872973
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of Primary Soft Tissue Sarcomas Involving the Chest: Experiences in 25 Patients

J. Pfannschmidt1 , P. Geisbüsch1 , T. Muley1 , H. Dienemann1 , H. Hoffmann1
  • 1Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany
Further Information

Publication History

Received August 1, 2005

Publication Date:
26 April 2006 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Primary soft tissue sarcomas of the chest wall are uncommon and data concerning treatment and results are sparse. We reviewed our experience with chest wall resections of these lesions. Methods: Retrospective review of our database identified 25 patients (12 men, 13 women) who underwent chest wall resection for primary soft tissue sarcoma during the 18-year study period (January 1984 through to January 2002). The mean follow-up period was 46.5 months. Results: The 30-day mortality was zero. The cumulative 5-year survival rate of all 25 patients was 56.9 %, and the median survival 99.5 months. This compared with 42.2 % and a median survival of 36.0 months after chest wall resection for high grade tumor histology. Histological type grading clearly influenced long-term survival (p = 0.036). Local recurrence occurred in 9 patients, 6 of 8 who were resected with positive margins and 3 of 17 who were resected with negative margins. Chest wall resections extended with lung resections did not significantly impair postoperative pulmonary function compared to patients without concomitant lung resections. Conclusions: Chest wall resections in primary soft tissue sarcomas can be accomplished safely with a low mortality rate. Long-term survival can be achieved for primary soft tissue sarcomas but histological grading is of prognostic significance.

Key words

Malignant chest wall tumor - soft tissue sarcoma - surgery

References

  • 1 Perham D W. Thoracic resections for tumors growing from bony chest wall.  Trans South Surg Assoc. 1899;  2 233
    PubMedGoogle Scholar
  • 2 Walsh G L, Davis B M, Swisher S G. et al . A single-institutional, multidisciplinary approach to primary sarcomas involving the chest wall requiring full-thickness resections.  J Thorac Cardiovasc Surg. 2001;  121 48-60
    CrossrefPubMedGoogle Scholar
  • 3 Gordon M S, Hajdu S I, Bains M S, Burt M E. Soft tissue sarcomas of the chest wall. Results of surgical resection.  J Thorac Cardiovasc Surg. 1991;  101 843-854
    PubMedGoogle Scholar
  • 4 Incarbone M, Pastorino U. Surgical treatment of chest wall tumors.  World J Surg. 2001;  25 218-230
    CrossrefPubMedGoogle Scholar
  • 5 King R M, Pairolero P C, Trastek V F, Piehler J M, Payne W S, Bernatz P E. Primary chest wall tumors: factors affecting survival.  Ann Thorac Surg. 1986;  41 597-601
    CrossrefPubMedGoogle Scholar
  • 6 Kaplan E LMP. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  457-481
    PubMedGoogle Scholar
  • 7 Peto R PJ. Asymptomatically efficient rank invariant test procedures.  J R Stat Soc A. 1972;  135 185-206
    PubMedGoogle Scholar
  • 8 Greager J A, Patel M K, Briele H A, Walker M J, Wood D K, Gupta T K. Soft tissue sarcomas of the adult thoracic wall.  Cancer. 1987;  59 370-373
    PubMedGoogle Scholar
  • 9 Anderson B O, Burt M E. Chest wall neoplasms and their management.  Ann Thorac Surg. 1994;  58 1774-1781
    CrossrefPubMedGoogle Scholar
  • 10 Sabanathan S, Shah R, Mearns A J. Surgical treatment of primary malignant chest wall tumours.  Eur J Cardiothorac Surg. 1997;  11 1011-1016
    CrossrefPubMedGoogle Scholar
  • 11 Barth Jr R J, Merino M J, Solomon D, Yang J C, Baker A R. A prospective study of the value of core needle biopsy and fine needle aspiration in the diagnosis of soft tissue masses.  Surgery. 1992;  112 536-543
    PubMedGoogle Scholar
  • 12 Epstein H D. Fine-needle aspiration of soft tissue lesions.  Pathology (Phila). 1996;  4 463-492
    PubMedGoogle Scholar
  • 13 Graeber G MJD, Pairolero P C. Primary neoplasms. Pearson GFDJ, Hiebert CA, Ginsberg RJ, McKneally MF, Urschel H Thoracic Surgery. Philadelphia; Churchill Livingstone 1995: 1237-1251
    Google Scholar
  • 14 Lardinois D, Muller M, Furrer M. et al . Functional assessment of chest wall integrity after methylmethacrylate reconstruction.  Ann Thorac Surg. 2000;  69 919-923
    CrossrefPubMedGoogle Scholar
  • 15 Kroll S S, Walsh G, Ryan B, King R C. Risks and benefits of using Marlex mesh in chest wall reconstruction.  Ann Plast Surg. 1993;  31 303-306
    CrossrefPubMedGoogle Scholar
  • 16 McCormack P, Bains M S, Beattie Jr E J, Martini N. New trends in skeletal reconstruction after resection of chest wall tumors.  Ann Thorac Surg. 1981;  31 45-52
    CrossrefPubMedGoogle Scholar
  • 17 Graeber G M, Snyder R J, Fleming A W. et al . Initial and long-term results in the management of primary chest wall neoplasms.  Ann Thorac Surg. 1982;  34 664-673
    PubMedGoogle Scholar
  • 18 Arnold P G, Pairolero P C. Chest-wall reconstruction: an account of 500 consecutive patients.  Plast Reconstr Surg. 1996;  98 804-810
    CrossrefPubMedGoogle Scholar
  • 19 Yang J C, Chang A E, Baker A R. et al . Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity.  J Clin Oncol. 1998;  16 197-203
    CrossrefPubMedGoogle Scholar
  • 20 Coindre J M, Terrier P, Bui N B. et al . Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group.  J Clin Oncol. 1996;  14 869-877
    Google Scholar

MD J. Pfannschmidt

Department of Surgery
Thoraxklinik Heidelberg

Amalienstraße 5

69126 Heidelberg

Germany

Phone: + 496221396217

Fax: + 49 62 21 39 65 43

Email: joachim.pfannschmidt@thoraxklinik-heidelberg.de