Long-term outcome and prognostic factors after chest wall resection and reconstruction

Abstract

Objectives: Our study aimed to evaluate factors influencing perioperative and long-term outcomes of patients undergoing curative-intent chest wall resection and reconstruction.

Methods: A retrospective single-centre analysis was conducted on all patients undergoing curative-intent chest wall resection and reconstruction from 2010 to 2023. Perioperative outcome was analysed for the entire cohort. Overall survival and disease-free survival were analysed using the Kaplan-Meier method and log-rank test and multivariable Cox proportional hazards regression models with a particular focus on patients with lung cancer and chest wall involvement.

Results: A total of 143 consecutive patients (median age 62 years, 44.1% females) were included, and 75% of patients received perioperative systemic therapy or radiation. Rib resection alone was performed in 69.9%, additional sternal resection in 16.1%, spine resection in 11.9% and clavicle resection in 2.1%. Additional resections included the lung (n = 75), diaphragm (n = 6), pericardium (n = 2), subclavian vein (n = 2), pulmonary artery (n = 1) and multiple structures (n = 22). Reconstruction was performed using synthetic protheses (n = 89), metallic (n = 6) or combinations of materials (n = 32). Median tumour diameter was 10 cm; 88% were malignant. Local recurrence rate was 9.5%. Median disease-free survival (86 events) was 36 months, and median overall survival (62 events) was 80 months. The 5-year disease-free survival and overall survival were 54.1% and 74.1%, respectively. In patients with lung cancer, overall survival was significantly affected by age (P = 0.028), histology (P < 0.001), resection size >10 cm (P = 0.018), postoperative performance status (P < 0.001) and postoperative complications (P < 0.001) in multivariable analysis and disease-free survival by postoperative performance status (P < 0.001).

Conclusions: Postoperative performance status is correlated with overall survival after chest wall resection.

Keywords: chest wall reconstruction; chest wall resection; chest wall tumour; prognostic factors.

Graphical abstract

Figure 1:

Surgical approach and its association with resected sections and operation time

Figure 2:

Multivariable analysis of factors associated with perioperative complications

Figure 3:

Multivariable analysis of factors associated with hospital stay

Figure 4:

Multivariable analysis of factors associated with neuropathic pain

Figure 5:

Multivariable analyses of prognostic factors for overall survival