Definition and Overview

A follow-up is a critical part of post-operative care for patients who underwent a chest wall surgery, which is used to treat a variety of conditions, the most common of which is cancer or malignant tumors on the muscles, bones and other structures of the chest wall.

The chest wall serves as the protective wall of the body’s most vital organs. Any problems affecting it can lead to serious consequences such as life threatening respiratory and circulatory systems conditions. It is composed of 12 ribs connected to a flexible skeletal structure making up the shoulder region, internal and external muscles, blood vessels, cartilage, nerves, fatty tissue and other soft connective tissues. These structures can sometimes fall prey to various conditions or health risks either due to illness or trauma. Chest wall surgery serves as one of the most effective forms of treatment for any of these conditions, although it does carry some degree of risk.

Who Should Undergo and Expected Results

A chest wall surgery follow-up may refer to the first checkup scheduled by the surgeon shortly after the patient has been discharged from the hospital or regular scheduled visits performed afterward, usually for an extended period of time, i.e. up to 24 months after the procedure. These regular visits may be scheduled at intervals of six months. This type of follow-up is for patients who received surgical treatment for the following conditions:

  • Chest wall tumor
  • Lung cancer
  • Mesothelioma
  • Esophageal cancer
  • Malignant pleural effusion
  • Sarcoma
  • Lymphoma
  • Thymoma
  • Metastatic cancer that has spread to the lungs or chest wall
  • Chest wall deformities, both congenital and acquired
  • Chest wall injury
  • Airway disorders
  • Pectus excavatum
  • Hyperhydrosis
    The follow-up visits are crucial regardless of the type of surgery performed which can be any of the following:

  • Chest wall resection – This removes the part of the chest wall where the tumor has grown, including a margin of healthy tissue around it. In most cases, the surgery removes the tumor completely, but patients usually still have to undergo chemotherapy or radiation therapy to make sure all cancer cells are destroyed.

  • Chest wall reconstruction – This is performed when the chest wall suffers from a deformity, either congenital or acquired. Congenital deformities are caused by developmental abnormalities that appear at birth while acquired deformities may be due to trauma/injury or to the ravaging effects of cancer or as a side effect of a resection. The goal of this procedure is to reconstruct the chest wall to restore its original form and function.

  • Lung transplantation – Used only in severe lung disease and end-stage lung cancer, lung transplants involve replacing the patient’s lung/s with donor lung/s, which are usually taken from brain-dead patients that are kept on life support. However, the process of undergoing a lung transplant, which requires an open chest wall procedure, is long and complicated. Before the surgery, the patient will undergo several tests and may have to wait until a donor lung with compatible tissue is found. After the surgery, the patient will need continuous immunosuppression therapy to keep the body from rejecting the new lung and will thus also require continuous follow-up care.
    The goals of an immediate follow-up appointment include the following:

  • To evaluate the results of a recent surgery

  • To monitor the patient’s condition after the procedure
  • To check for post-operative side effects
  • To manage the side effects of treatment medications

Long-term follow-up care, on the other hand, is expected to achieve the following:

  • To check for recurrences, especially in the case of cancer
  • To manage late side effects
  • To ensure safe use of maintenance medications
  • To help the patient maintain good health post-surgery

How Does the Procedure Work

A chest wall surgery follow-up usually involves the steps listed below:

  • Review of the patient’s medical history
  • Assessment of past and present symptoms
  • Detection of new symptoms
  • Evaluation of medications and their effects if any maintenance drugs are prescribed
  • Physical examination
    Aside from these, doctors sometimes recommend special tests, such as:

  • Lung function testing

  • Electrocardiogram
  • Mammography
  • Thyroid examination
  • Imaging scans, such as x-rays and CT scans
  • Blood tests
  • Biopsy
    These tests may be performed to check for signs of recurrence or to confirm a suspected recurrence.

Although most follow-ups tend to follow a specific pattern, the timing and scheduling of visits depend on the patient’s follow-up care plan, which is customized based on his needs and condition. The care plan will also take into consideration the patient’s own preferences. Thus, some patients may be asked to return to the doctor’s office once a year, while some may be scheduled for a follow-up more often, e.g. every two months or so, or less frequently, e.g. every two years.

Possible Risks and Complications

A chest wall surgery follow-up is a safe, routine visit that poses very minimal risks to the patient when special testing is requested by the doctor.

However, patients face a more serious risk if they choose to forego their follow-up appointments due to post-operative risks as well as of recurrences. Since this type of procedure is a complex open-chest surgery, post-operative side effects, which are listed below, are highly likely to take place.

  • Infection
  • Bleeding
  • Blood loss
  • Blood clot
  • Pain
    The risk of recurrence is present in all cancer cases, although some patients may be more susceptible than others. Showing up to all scheduled chest wall surgery follow-up visits will increase a person’s chances of early detection leading to early treatment and full recovery.


    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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