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Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1786196
Original Thoracic

The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

Luiz Felipe Nevola Teixeira 
1   Department of Physiotherapy, European Institute of Oncology, Milano, Italy
,
Fabio Sandrin
1   Department of Physiotherapy, European Institute of Oncology, Milano, Italy
,
Ruy Fernando Kuenzer Caetano da Silva
2   Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
,
Francesco Petrella
2   Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
,
Luca Bertolaccini
2   Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
,
Maria Claudia Simoncini
1   Department of Physiotherapy, European Institute of Oncology, Milano, Italy
,
Lorenzo Spaggiari 
3   Department of Thoracic Surgery, Istituto Europeo di Oncologia, Milano, Italy
4   Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
› Author Affiliations Funding This work was supported by the Ministerio della salute (Ricerca corrente and 5 × 1000 funds, no grant number applicable). The funder had no role in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the article for publication.
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Abstract

Background Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience.

Methods We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up.

Results A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS.

Conclusion The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.

Keywords

lung neoplasms - lung cancer - thoracic surgery - nervous system trauma - rehabilitation - physical therapy specialty

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the European Institute of Oncology Ethics Committee approved this study (R321/15-IEO 345).


Data Availability Statement

The data supporting this study's findings are available from the corresponding author, LFNT, upon reasonable request.


Authors' Contribution

L.F.N.T., F.S., R.F.K.C.S., F.P., L.B. and L.P. contributed to the study conception and design. Data collection was performed by L.F.N.T., F.S., R.F.K.C.S. All the authors made the critical revision of the article and gave the final approval of the version to be published.


Supplementary Material



Publication History

Received: 13 February 2024

Accepted: 28 March 2024

Article published online:
02 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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