Primary lung tumors invading the chest wall

Abstract

Chest wall (CW) involvement occurs in approximately 5% of all primary lung neoplasms.According to the most recent TNM classification, lung tumors invading CW are classified as T3, and they represent approximately 45% of all T3 lung cancers. The most common clinical symptom at presentation is chest pain (>60%), which is highly specific of CW infiltration (>90%). Dyspnoea and hemoptysis are also described, especially in case of large lesions. A realistic chance to cure locally advanced tumors invading CW is a surgical resection, consisting in the excision of the primary lung cancer along with the involved CW (sometimes an "en-bloc" resection) and an appropriate lymph-nodal dissection. However, such patients are at high-risk of facing postoperative complications; prognosis mainly depends on: (I) the completeness of resection; and (II) the lymph-nodal involvement. Hence, due to these reasons (incidence, symptoms, prognosis, post-operative complications), such category of patients are to be carefully assessed preoperatively and if deemed practicable, surgery should be taken into consideration. In this view, the aim of this paper is to critically review the most recent series of lung tumors invading the CW, with a particular focus on patients' preoperative evaluation, surgical techniques, postoperative complications and overall outcome.

Surgical complication and postoperative pulmonary function in patients undergoing tumor surgery with thoracic wall resection

“…Furthermore, regarding primary thoracic wall tumors, Bagheri et al (5) reported that the presence of distal metastasis significantly worsened prognosis, and any significant effect on survival was regardless of whether reconstruction was performed. According to previous studies, the 5-year survival rates are 21–61% in patients with lung cancer who present with thoracic wall invasion (1,9) and 73.9–88.5% in those with tumors arising from the soft tissues of the thoracic wall (10,19), results that are comparable to those of our study. However, in our study, neither the R factor nor the N factor caused statistically significant differences in prognosis.…”

“…Thoracic cage reconstruction maintains anatomical and structural stability, protects vital organs, and helps sustain the respiratory mechanism. The procedure is required in 40–60% of individuals who have undergone thoracotomy (1,9,11). Reconstruction is required for individuals with ≥3 resected ribs and defects that are ≥5 cm in diameter or even for patients with smaller defects and cases of suspected thoracic cage instability (9–11,13,19).…”

“…With regard to the postoperative overall survival rate, the 5-year survival rates were 53.4% in the lung tumor group and 77.0% in the musculoskeletal tumor group. With regard to the postoperative outcomes of individuals with lung cancer who presented with thoracic wall invasion, positive margin (R1,2) and lymph node metastasis (N1,2) have been reported as poor prognostic factors (1,9,10). The number of resected ribs and thoracic wall invasion reportedly did not affect prognosis (1).…”

“…With regard to the postoperative outcomes of individuals with lung cancer who presented with thoracic wall invasion, positive margin (R1,2) and lymph node metastasis (N1,2) have been reported as poor prognostic factors (1,9,10). The number of resected ribs and thoracic wall invasion reportedly did not affect prognosis (1). Furthermore, regarding primary thoracic wall tumors, Bagheri et al (5) reported that the presence of distal metastasis significantly worsened prognosis, and any significant effect on survival was regardless of whether reconstruction was performed.…”

“…Some patients who undergo surgical treatment for soft tissue tumors arising from the thoracic wall and lung tumors invading the thoracic wall require thoracic cage reconstruction. In this procedure, fixation using sutures and mesh, metal implantation, and autologous tissue are used, and a musculocutaneous flap is required if the skin defect is large (1–13). The reconstruction method is preferred with consideration given to the size and site of the defect as well as the patient's health condition and prognosis (14).…”