Surgical Approach to Primary Tumors of the Chest Wall in Children and Adolescents: 30 Years of Mono-Institutional Experience

Abstract

Long-term survival is achievable for chest wall tumors in a high-volume referral center where a multimodal treatment should be set to reach the best result. As advances in medical treatment have increased survival, surgical techniques must ensure a lasting functional result. When refining the reconstruction techniques, such as the rib-like approach, it is necessary to expand the options of curative surgery for young patients.

Ewing Sarcoma of the Chest Wall: Prognostic Factors of Multimodal Therapy Including En Bloc Resection

“…One of the strengths of our study is its homogenous cohort of 30 patients, all treated by surgical resection, with a 93% R0 margin of resection. This high level of diseasefree resection was obtained as a result of extended en bloc resection, highlighted by the significant amount (27%; n ¼ 8: 5 patients with hemivertebrectomy and 3 patients with transversectomy) of associated spinal resection when compared with the most recent series (Table 3) [7,12,13,16,22]. At 5 years, median OS was 60.7% and DFS was 40.6%, rates comparable to those reported by Shamberger and associates [12] and Indelicato and colleagues [16].…”

A huge Ewing's sarcoma of the rib presenting with superior vena cava syndrome and dysphagia

“…The literature suggests that surgery is the best option for Ewing's sarcoma in the chest wall to achieve definitive local control and should be practiced by specialists experienced in complex thoracic oncology. 11 In this case, we were prepared to resect the superior vena cava and the inferior vena cava and reconstruct the artificial vessels before the operation, but the tumor capsule was intact and the tumor did not invade the above vessels or the heart, and eventually we only removed the rib and tumor. In terms of the range of ribs that should to be resected, it is recommended to remove the involved rib and partially excise the adjacent ribs to achieve a tumor-free margin.…”

“…Our patient was also treated with neoadjuvant chemotherapy, but the tumor did not shrink. The literature suggests that surgery is the best option for Ewing's sarcoma in the chest wall to achieve definitive local control and should be practiced by specialists experienced in complex thoracic oncology 11 . In this case, we were prepared to resect the superior vena cava and the inferior vena cava and reconstruct the artificial vessels before the operation, but the tumor capsule was intact and the tumor did not invade the above vessels or the heart, and eventually we only removed the rib and tumor.…”

Survival and Scoliosis Following Resection of Chest Wall Tumors in Children and Adolescents

“…3,5,[11][12][13] Due to the infrequency of these neoplasms, there is, however, a scarcity of analyses regarding predictors of survival and other long-term outcomes including scoliosis. [5][6][7][8]11 Furthermore, existing studies are limited by small sample size, incomplete cohorts, and limited follow-up. 1 Consequently, the major challenges in treating pediatric CWTs include determining ideal surgical management and providing patients and parents with appropriate counseling on expected oncological and functional outcomes.…”