121 * MANAGEMENT OF MALIGNANT CHEST WALL TUMOURS: A MULTIDISCIPLINARY APPROACH IMPROVES OUTCOMES

Abstract

Objectives: Wide excision of malignant chest wall tumours is essential in order to prevent local recurrence, and to benefit long-term survival. This results in chest wall defects requiring reconstruction for functional and structural integrity. We reviewed our experience involving a multidisciplinary team in the management of these tumours and outcome. Method(s): The records of patients who underwent chest wall resection for malignant tumours since April 2008 were reviewed. Patients with lung cancer were excluded. Result(s): Forty-seven patients (18 male) underwent surgery. Ages ranged from 18-77 (mean 52.10) years. The majority of patients (13) had chondrosarcomas. Surgical resection included ribs (2-7), sternum, clavicle, diaphragm, lung and liver. The defect was reconstructed using a combination of prosthetic material and/or soft tissue. Prosthetic material was used in 42 patients (Marlex, methylmethacrylate Marlex composite graft, titanium bars). Forty patients had soft tissue flaps (latissimus dorsi, pedicled and free rectus abdominus, pectoralis major and skin grafts). There was no major postoperative morbidity and average length of stay in the hospital was 8.5 days (range 5-14). The resection margins in all patients operated on with curative intent were microscopically clear of tumour. During follow-up, there were eight deaths. The surviving patients have satisfactory postoperative respiratory function. Conclusion(s): The management of chest wall tumours requires a multidisciplinary approach to achieve radical resection, reconstruction to maintain chest wall stability and provision of a versatile coverage with eventual good longterm outcome.