The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis
Background:. The effectiveness and safety of chest wall surgery for various breast conditions remain unclear. Previous studies have reported a high risk of morbidity. We hypothesized that the limited chest wall resection can be performed under safe and good technique and aim to identify the extent o...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-02-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005568 |
| _version_ | 1797292776798289920 |
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| author | Prakasit Chirappapha, MD Lakkana Adireklarpwong, MD Panuwat Lertsithichai, MD Thongchai Sukarayothin, MD Ronnarat Suvikapakornkul, MD Monchai Leesombatpaiboon, MD Yodying Wasuthit, MD Kidakorn Kiranantawat, MD Piya Cherntanomwong, MD |
| author_facet | Prakasit Chirappapha, MD Lakkana Adireklarpwong, MD Panuwat Lertsithichai, MD Thongchai Sukarayothin, MD Ronnarat Suvikapakornkul, MD Monchai Leesombatpaiboon, MD Yodying Wasuthit, MD Kidakorn Kiranantawat, MD Piya Cherntanomwong, MD |
| author_sort | Prakasit Chirappapha, MD |
| collection | DOAJ |
| description | Background:. The effectiveness and safety of chest wall surgery for various breast conditions remain unclear. Previous studies have reported a high risk of morbidity. We hypothesized that the limited chest wall resection can be performed under safe and good technique and aim to identify the extent of safe surgery.
Methods:. A retrospective study analyzed patients who underwent chest wall resection for chest wall recurrence breast cancer, locally advanced breast cancer, phyllodes, fibromatosis breast tumor, and osteoradionecrosis from January 1, 2008, to April 10, 2023. The primary objectives were the extent of safe chest wall surgery and performance status postoperatively.
Results:. Thirteen chest wall resections with an average of two to three ribs removed were performed. Patients who had two or more rib resections underwent mesh stabilization; nevertheless, paradoxical chest without deteriorating oxygenation remained. Anterolateral thigh-free flap, pedicled-TRAM or latissimus dorsi flap, pectoralis major myocutaneous flap, and local fasciocutaneous bilateral advancement flap were performed on five, four, three, and one patient, respectively. Patients with a maximum of three ribs removed had an ECOG score of 0–1 postoperatively. Hematoma and wound dehiscence affected two patients. In a small series of chest wall recurrence cases (N = 7), R0 resection had better disease-free survival of 13 months.
Conclusions:. The procedure of chest wall resection and reconstruction can be performed safely with a maximum of three ribs removed, using mesh and myocutaneous flaps in two or more rib resections. Further studies with larger sample sizes will provide better understanding. |
| first_indexed | 2024-03-07T20:02:28Z |
| format | Article |
| id | doaj.art-bd78905dffdb4efd8942973b09840387 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-03-07T20:02:28Z |
| publishDate | 2024-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-bd78905dffdb4efd8942973b098403872024-02-28T06:48:00ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-02-01122e556810.1097/GOX.0000000000005568202402000-00049The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and OsteoradionecrosisPrakasit Chirappapha, MD0Lakkana Adireklarpwong, MD1Panuwat Lertsithichai, MD2Thongchai Sukarayothin, MD3Ronnarat Suvikapakornkul, MD4Monchai Leesombatpaiboon, MD5Yodying Wasuthit, MD6Kidakorn Kiranantawat, MD7Piya Cherntanomwong, MD8From the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandFrom the * Department of Surgery, Breast and Endocrine Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand† Department of Surgery, Plastic Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand‡ Department of Surgery, Cardiovascular Thoracic Surgery Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Background:. The effectiveness and safety of chest wall surgery for various breast conditions remain unclear. Previous studies have reported a high risk of morbidity. We hypothesized that the limited chest wall resection can be performed under safe and good technique and aim to identify the extent of safe surgery. Methods:. A retrospective study analyzed patients who underwent chest wall resection for chest wall recurrence breast cancer, locally advanced breast cancer, phyllodes, fibromatosis breast tumor, and osteoradionecrosis from January 1, 2008, to April 10, 2023. The primary objectives were the extent of safe chest wall surgery and performance status postoperatively. Results:. Thirteen chest wall resections with an average of two to three ribs removed were performed. Patients who had two or more rib resections underwent mesh stabilization; nevertheless, paradoxical chest without deteriorating oxygenation remained. Anterolateral thigh-free flap, pedicled-TRAM or latissimus dorsi flap, pectoralis major myocutaneous flap, and local fasciocutaneous bilateral advancement flap were performed on five, four, three, and one patient, respectively. Patients with a maximum of three ribs removed had an ECOG score of 0–1 postoperatively. Hematoma and wound dehiscence affected two patients. In a small series of chest wall recurrence cases (N = 7), R0 resection had better disease-free survival of 13 months. Conclusions:. The procedure of chest wall resection and reconstruction can be performed safely with a maximum of three ribs removed, using mesh and myocutaneous flaps in two or more rib resections. Further studies with larger sample sizes will provide better understanding.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005568 |
| spellingShingle | Prakasit Chirappapha, MD Lakkana Adireklarpwong, MD Panuwat Lertsithichai, MD Thongchai Sukarayothin, MD Ronnarat Suvikapakornkul, MD Monchai Leesombatpaiboon, MD Yodying Wasuthit, MD Kidakorn Kiranantawat, MD Piya Cherntanomwong, MD The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis Plastic and Reconstructive Surgery, Global Open |
| title | The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis |
| title_full | The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis |
| title_fullStr | The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis |
| title_full_unstemmed | The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis |
| title_short | The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis |
| title_sort | feasibility of chest wall resection and reconstruction during an operation in breast cancer phyllodes tumor and osteoradionecrosis |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005568 |
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