Definition & Overview
The excision of chest wall tumours is the surgical removal of abnormal growths on the walls of the chest cavity or thorax. The procedure typically involves the reconstruction of the thoracic wall, including the ribs and possibly other parts like the sternum, spine, and superior sulcus.
There are several treatment options available for patients with chest wall tumours. These include radiation therapy or chemotherapy. However, the surgical option is considered in cases where other treatment methods are not effective. This is also a treatment option for those with localised tumours. Localised tumours are those found in only one area of the chest cavity and have not spread. After surgery, most patients undergo a reconstructive procedure to restore the structure of the chest. This also helps restore the normal functioning of the chest cavity.
Chest wall tumours are classified into two types: primary and secondary. Primary tumours originate from the chest wall itself, developing from its muscles or bones. Secondary tumours, on the other hand, originate from different parts of the body and spread to the chest wall.
Who Should Undergo and Expected Results
The surgical excision of a chest wall tumour is performed on patients diagnosed with:
- Chondrosarcoma - A type of bone cancer in the chest wall. It commonly affects the ribs. But some cases originate from the scapula, sternum, or clavicle.
- Osteosarcoma - A type of malignant chest wall tumour that also develops in the ribs, scapula, or clavicle. It mainly affects adults. This condition is quite painful and often metastasises to nearby organs like the lungs and liver.
- Ewing sarcoma - Children and young individuals diagnosed with Ewing sarcoma should also undergo the procedure. This type of tumour is quite aggressive. It also often recurs and spreads to other parts of the body.
- Fibrosarcoma - This type of tumour is malignant and develops from fibrous connective tissue. It typically affects adult male individuals though there are cases of infants diagnosed with this condition. It affects the bones of the chest cavity and is quite painful. It can also affect and spread to the overlying muscle tissue.
- Malignant fibrous histiocytoma - This rare type of cancer often develops from soft tissues and affects the bones, muscles, and cartilage. During its early stage, this tumour is quite painless, making it difficult to detect and diagnose. It occurs in adult male patients who are 50 years of age or older.
- Benign tumours in the chest wall - Though most benign tumours do not need any medical attention or treatment, a large-sized growth within the thoracic cavity can have several adverse effects. These include difficulty in breathing and pain as the mass of tissue presses on the lungs and nerves. In some cases, benign tumours can cause the muscle in the chest wall to atrophy or shrink and lose their function. Examples of common benign chest wall tumours include osteochondroma, chondroma, and fibrous dysplasia.
By undergoing the procedure, patients have better chances of survival, especially if the condition is detected during its early stages. Technological advancements in surgical and reconstruction procedures further improve long-term outcomes and lower the risk of recurrences.
Since it is a major surgical procedure, patients are expected to rest and recuperate for several weeks, even months. They must undergo physical rehabilitation to hasten healing and restore function to the affected parts.
How is the Procedure Performed?
Before surgery, the location and features of the tumour are identified and studied with the use of different imaging technologies.
After giving the patient anaesthesia, the chest is prepared and draped. The surgeon makes an incision in the chest area near the location of the tumour to dissect the underlying tissues, including the pectoral muscles. The surgeon continues to expose the chest cavity and assesses the location of the tumour. The costal and intercostal cartilages are then divided to allow adequate access to the chest wall. Using surgical saw and scissors, the surgeon would then proceed to divide the sternum. The tumour is then excised and removed. If the tumour affects the bony parts of the chest wall, such as the ribs or sternum, the surgeon would also need to remove them.
Since a part of the chest wall cavity has been removed, there might be a need for the reconstruction of the chest wall. The surgeon can use prostheses to address this defect. In some cases, a composite prosthesis is moulded, placed between two layers of mesh, and sewn into nearby muscles and bones. If there is a need, rib grafts can also be used to provide stability to the chest wall.
Though small size incision can be closed with direct sutures, most large sized incisions require the use of skin grafts or flaps for closure. Examples of soft tissue coverage include the breast flap, pedicled myocutaneous flaps, and free flaps. The covering tissue may be taken from nearby tissues such as the abdomen or the breast. In some cases, tissue is harvested from another part of the body, such as the thigh, and grafted into the surface of the chest.
Possible Risks and Complications
As a major surgical procedure requiring anaesthetics and at least one incision, the excision of chest wall tumours can cause some complications, such as:
- Pleural effusion, in which fluid builds up in the tissue layer that separates the lungs and the thoracic wall
- Damage to nearby organs like the heart, lungs, or liver
- Bleeding and infection at the surgical site
Necrosis or cell death, if the body rejects the skin and bone grafts
American Cancer Society