Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates

Abstract

ObjectivesEn-bloc complete resection remains the treatment of choice for localized chest wall (CW) tumors. Titanium bars reconstruction demonstrated encouraging results with satisfactory early outcomes. However, long-term outcomes remain under-reported. The purpose of this study is to evaluate long-term outcomes after CW resection and repair with titanium devices.MethodsFrom June 2012 to December 2018, we retrospectively reviewed all patients with CW tumors who underwent surgical resection and repair using titanium. Long-term outcomes were assessed.ResultsWe identified 87 patients who underwent CW tumor resections and titanium reconstruction. Sixty-eight patients were included in the study (excluding benign tumors, Pancoast tumors, palliative surgeries, or clavicle reconstruction). There were 29 sarcomas, 20 isolated CW metastases, eight lung cancers, four breast cancers, three thymic malignancies, two sarcomatoid mesothelioma, and one desmoid tumor. Complete resection was achieved in 64 patients (94%), while R1 resection in four patients (6%). Resection involved one rib in two patients, two ribs in thirteen, three ribs in eighteen, four ribs in nine, five ribs in two, seven ribs in one, partial sternum in fifteen, and full sternum in sixteen patients. No patient experienced flail chest. The 1-year, 3-year, and 5-year overall survival rates and disease-free survivals were 82.3%, 61.4%,57.3%, and 67.6%,57.3%,52.6%, respectively. Surgical site infection occurred in 18% (n = 12) of cases. Eleven of twelve patients had an early infection (<1 year), which required material removal in six patients. Asymptomatic connector unsealing occurred in 6% (n = 4), with only one re-intervention. Titanium allergy has never been reported. Chronic chest pain (lasting more than 3 months after surgery, with daily use of pain killer) was reported in 24% of patients. ConclusionCW resections with titanium reconstruction are associated with long-term survivors. Titanium devices were safe, reliable, and achieved satisfactory oncological results with low morbidity and implant-related complication rates.

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

“…Overall, the use of titanium bars and sternal plates correlated with a good long-term outcome; however, complications such as a post-surgery infection rate of 18% (mostly, soon after the operation, within the first 12 months, a ratio that seems rather low compared to prior studies) and persistent chest pain (defined as chronic pain for more than 3 months requiring daily medication) affected 24% of the cohort. When compared with the overall survival rate between the subjects with primitive chest wall cancers and secondary malignancies, a long rank p -value was not statistically significant ( p = 0.574) [ 64 ].…”

Double-Barrel Vascularized Free Fibula Flap for Reconstruction of Sternal Nonunion with Bone Defect

“…1 Preoperative imaging of sternal nonunion for presurgical planning. deformation rate of 40.7% 8,10,11 . Berthet et al explored implant failure rates after titanium chest wall osteosynthesis, reporting a 44.4% rate 10 .…”

“…A n unstable chest wall can cause paradoxical motion that impairs respiratory function and discomfort with movement 8,9 . A stable, long-lasting reconstruction is important, but the sternum's multidirectional movement under tension and compression forces that act in all planes make reconstruction challenging 2,4,5 .…”

“…A stable, long-lasting reconstruction is important, but the sternum's multidirectional movement under tension and compression forces that act in all planes make reconstruction challenging 2,4,5 . Current approaches to managing sternal nonunion involve rigid sternal fixation, which provides chest wall stability and minimizes risk of lung volume depletion and paradoxical chest wall movement 8 . Studies describing titanium rib bridge system STRATOS (Strasbourg Thoracic Osteosynthesis System, MedXpert GmbH) report an infection rate as high as 5.6% and implant deformation rate of 40.7% 8,10,11 .…”

“…Current approaches to managing sternal nonunion involve rigid sternal fixation, which provides chest wall stability and minimizes risk of lung volume depletion and paradoxical chest wall movement 8 . Studies describing titanium rib bridge system STRATOS (Strasbourg Thoracic Osteosynthesis System, MedXpert GmbH) report an infection rate as high as 5.6% and implant deformation rate of 40.7% 8,10,11 . Berthet et al explored implant failure rates after titanium chest wall osteosynthesis, reporting a 44.4% rate 10 .…”