Definition and Overview

Patients with conditions affecting the chest wall and the organs in the chest cavity are candidates for a chest wall surgery, also known as a thoracic surgical procedure. A consultation with the surgeon is a requirement prior to the operation as it educates the patient about the risks, benefits, expected results and other details that he must take into consideration when deciding whether or not to proceed with surgery.

Who Should Undergo and Expected Results

A chest wall surgery consultation is the first step to receiving treatment for an existing thoracic condition. Examples of this procedure are:

  • Chest wall resection
  • Chest wall reconstruction
  • Lung transplants


Meanwhile, patients who require this type of surgery are those with:

  • Primary and secondary tumors in the chest wall or sternum
  • Lung cancer
  • Trauma to the chest cavity
  • Radionecrosis


At the end of the consultation, the patient should be aware of the following:

  • The different types of chest wall procedures
  • Which procedure is most appropriate for the patient’s condition
  • How the procedure will be performed
  • The benefits expected from the surgery
  • The risks of the procedure

How Does the Procedure Work

Chest wall surgery consultations involve:

  • Review of the patient's medical records
  • Physical examination
  • Further tests, if necessary
  • Treatment recommendations


At the start of the consultation, the surgeon will review the patient’s medical records assess his current state of health, any special considerations (such as allergies and surgical history) and his condition (such as the size of the tumor, its location, and so on).

The surgeon will then conduct a routine physical examination to assess whether the patient is in good condition to withstand the impact that surgery will have on the body.

To assess whether chest wall surgery will be beneficial to a patient, additional tests may be performed. In the case of cancerous tumors, these tests include MRI and CT scans to determine the position and extent of the tumor, key information that will affect the planning of the procedure. These scans are sometimes combined with pulmonary function testing and tissue biopsy. Accuracy is very important in evaluating whether the condition can be successfully treated with surgery and whether risks can be minimized.

If test results are not yet available and the tests cannot be performed on the same day, the consultation ends with the surgeon requesting for the necessary tests or asking the patient to come back when the results are ready.

If the patient decides to proceed with the procedure, the surgeon will schedule it and discuss the plans so the patient can prepare for it.

However, patients are not obliged to proceed with the procedure recommended by the surgeon and are free to seek a second opinion with a different surgeon.

Possible Risks and Complications

A chest wall surgery consultation is a safe, routine visit that does not pose any risks to the patient unless testing is involved. Some tests, such as CT and MRI scans and pulmonary function tests come with a certain level of risk.

  • MRI scans - People who have metallic devices such as pacemakers or prosthetics should inform the hospital staff before the actual procedure as these will affect the test results. In fact, some patients, such as those with artificial heart valves or insulin pumps, are not allowed to have an MRI because the magnet used in the test may cause these devices to move. In addition, the test may also be bothersome for patients who have claustrophobia due to the enclosed design of the MRI scanner.

  • T scans – Computed tomography scans expose patients to radiation, although only in small controlled amounts.

  • Pulmonary function tests – This test is not for patients who have had a recent heart attack, surgeries on the chest, abdominal or eye or those who have a severe respiratory infection and heart disease. Even in healthy patients, the tests may cause dizziness and lightheadedness, whereas asthma attacks may occur in patients with a history of asthma.


Aside from the risks of diagnostic tests that may be recommended during the consultation, chest wall surgery itself is also associated with some risks that the patient should consider during the said meeting. Chest wall resections and other thoracic procedures are unquestionably complex and are linked to:

  • Respiratory failure
  • Chest wall instability
  • Allergic reactions to anesthesia
    References:

  • Mason, R. Murray and Nadel's Textbook of Respiratory Medicine, 5th edition, Saunders, 2010.

  • Johnson DH, Blot WJ, Carbone DP, et al. Cancer of the lung: non-small cell lung cancer and small cell lung cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, et al, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2008:chap 76.

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