Surgical treatment of primary chest wall sarcomas: experiences in 19 cases

Abstract

Introduction: Chest wall sarcomas are rare and agressive with late discovery. It rises many challenges for the confirmation of the primitive character and for the therapeutic strategy. The prognosis depends on surgical resection and histological type.Our aim was to clarify the outcomes of patients managed surgically.

Methods: We retrospectively reviewed the clinical data from patients who were operated for chest wall sarcomas within 16 years at the thoracic surgery department of AbderrahmenMami Hospital Ariana–Tunisia.

Results: Nineteen patients underwent resection of chest wall sarcomas. The median size of the tumor was 77.4 mm (17 to 150 mm). Eight patients received neoadjuvant chemotherapy. Elective approach was used in 14 cases. The involved rib was resected in 17 cases (1 to 4 ribs). Rib resection was extended to the diaphragm in 5 cases, the involved lung in 6 cases and the sternum in 2 cases. The chest wall defect was covered by muscular flap in 7 cases. Definitive pathological study confirmed the primitive character of sarcomas and revealed: Ewing sarcoma (6 cases), leiomyosarcoma (5 cases), synovial sarcoma (3 cases), pleomorphic sarcoma (1 case), phyllode sarcoma (1 case), chondrosarcoma (1 case),rhabdomyosarcoma(1 case) and liposarcoma(1 case).The postoperative course was complicated in 2 cases. Negative margin resection was achieved in 17 cases.Four patients received adjuvant chemotherapy.With a median follow-up of 12 months (1 – 36 months),tumor progression was observed in 4 patients

Conclusion: Treatment decision for primary chest wall sarcomas should be taken in a multidisciplinary meeting. Surgical resection is associated with a good long-term outcomes. Adjuvant treatment remains a controversial issue