STS E Book - Chest Wall and Sternum Resection and Reconstruction

Question 1

What must be ruled out in the differential if suspicious of a primary chest wall neoplasm?

I.E. What are more common diagnoses with a similar presentation?

Answer 1

Healing rib fracture and metastatic lesion - far more prevalent than all primary chest wall neoplasms combined.

Ask about trauma and other oncology history.

Question 2

In doing an incisional biopsy of a possible soft tissue chest wall neoplasm, how much skin needs to be accounted for in a resection if complete surgical excision becomes necessary?

Answer 2

5 cm of clear skin

Question 3

What margin is needed for a chondrosarcoma of the chest?

Answer 3

4 cm of healthy tissue around the tumor is the best way to eliminate local recurrence

Question 4

What is the most common primary chest wall malignancy?

Answer 4

chondrosarcoma

Question 5

What is the efficacy of neo/adj chemo and/or radiation on chondrosarcoma?

Answer 5

resistant to both; the treatment is radical resection with 5cm margins

Question 6

What is survival most related to in a chest wall malignancy?

Answer 6

Histological grade and size, and to the adequacy of resection.
Grade 1 - 70% 10-year survival.
<6 cm lesion size (greatest dimension) - 87% 10-year survival.

Question 7

When resecting recurrent chest wall neoplasm visible on the skin after radiation, what is the principle of the resection margin?

Answer 7

Margin of the skin showing any radiation change should be resected - even if the defect is large; healing is better if flaps are approximated to healthy tissues.

Question 8

How are primary fibrosarcomas of the chest wall usually treated?

Answer 8

aggressive surgical resection, most chemo agents have relatively little effect, some effect with radiotherapy for lower grade fibrosarcomas (desmoids)