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Michael J. Weyant
Manjit S. Bains
Robert J. Downey
Bernard J. Park
Raja M. Flores
Nabil Rizk
Valerie W. Rusch
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Ann Thorac Surg 2006;81:279-285
© 2006 The Society of Thoracic Surgeons

Original article: General thoracic

Results of Chest Wall Resection and Reconstruction With and Without Rigid Prosthesis

Michael J. Weyant, MD a , Manjit S. Bains, MD a , Ennapadam Venkatraman, PhD b , Robert J. Downey, MD a , Bernard J. Park, MD a , Raja M. Flores, MD a , Nabil Rizk, MD a , Valerie W. Rusch, MD a , *

a Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York
b Department of Epidemiology and Biostatistics, Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, New York

Accepted for publication June 5, 2005.

* Address correspondence to Dr Rusch, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Email: ruschv{at}mskcc.org).

BACKGROUND: Chest wall resections are associated with significant morbidity, with respiratory failure in as many as 27% of patients. We hypothesized that our selective use of a rigid prosthesis for reconstruction reduces respiratory complications.

METHODS: The records of all patients undergoing chest wall resection and reconstruction were reviewed. Patient demographics, use of preoperative therapy, the location and size of the chest wall defect, performance of lung resection if any, the type of prosthesis, and postoperative complications were recorded. Predictor of complications were identified by {chi}2 and logistic regression analyses.

RESULTS: From January 1, 1995, to July 1, 2003, 262 patients (median age, 60 years) underwent chest wall resection for tumor in 251 (96%), radiation necrosis in 7 (2.7%); and infection in 4 patients (1.3%). The median defect size was 80 cm2 (range, 2.7 to 1,200 cm2) and the median number of ribs resected was 3 (range, 1 to 8). Major lung resection was performed in 85 patients (34%). Prosthetic reconstruction was rigid (polypropylene mesh/methylmethacrylate composite) in 112 (42.7%), nonrigid (polytetrafluoroethylene or polypropylene mesh) in 97 (37%), and none in 53 patients. Postoperatively, 10 patients died (3.8%), 4 of whom had pneumonectomy plus chest wall resection. Respiratory failure occurred in 8 patients (3.1%). By multivariate analysis, the size of the chest wall defect was the most significant predictor of complications.

CONCLUSIONS: Our incidence of respiratory failure is lower than previously reported and may relate to our use of rigid repair for defects likely to cause a flail segment. Pneumonectomy plus chest wall resection should be performed only in highly selected patients.




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