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Lookup NU author(s): Richard Milner
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© 2020 Elsevier Ltd. Introduction: Chest wall sarcomas are rare. Resection and reconstruction pose significant anatomical and functional challenges. We present our experience of managing these tumours as plastic surgeons working within a specialist sarcoma MDT. Methods: All cases of chest wall sarcoma in which a plastic surgeon took part were analysed (2003–2016). Tumours of the breast, abdomen and groin were excluded. Demographics, surgical details and outcomes were analysed. Results: Forty-seven patients were identified. Median age at presentation was 61 years (range 7–91). Thirty-three were male and 14 were female. Chondrosarcoma (n = 16) was the most frequently occurring tumour, followed by myxofibrosarcoma (n = 6), leiomyosarcoma (n = 5) and unclassified sarcomas (n = 5). The majority of tumours were of high (n = 16) or intermediate grade (n = 17) histologically. Wide local excision was carried out in all cases. Twenty-two cases required a mesh and cement reconstruction of the chest wall. Soft tissue reconstruction involved pedicled LD flap +-skin graft (n = 17), direct closure (n = 13), pedicled VRAM (n = 7), free ALT flap (n = 6), and others (n = 4). Clear resection margins were achieved in 32 patients (68%). Fourteen patients underwent adjuvant radiotherapy and four adjuvant chemotherapy. Nine patients (19%) developed a local recurrence, and the median duration from resection to recurrence was 17 months (range 3–72). Nine patients (19%) developed metastasis. Eleven patients died (23.4%), and the median duration of survival 30 months (range 3–92). Thirty-six patients remain well, with a median duration of follow up 57.5 months (range 6–141). Estimated 5 year disease specific survival is 74.2%. Conclusion: Plastic surgeons have a vital role in the management of chest wall sarcomas. We present a reconstructive algorithm, which has enabled us to achieve good oncological and functional outcomes and a low complication profile.
Author(s): Crowley TP, Atkinson K, Bayliss CD, Barnard S, Milner RH, Ragbir M
Publication type: Article
Publication status: Published
Journal: Journal of Plastic, Reconstructive and Aesthetic Surgery
Year: 2020
Volume: 73
Issue: 8
Pages: 1448-1455
Print publication date: 01/08/2020
Online publication date: 04/03/2020
Acceptance date: 16/02/2020
ISSN (print): 1748-6815
ISSN (electronic): 1878-0539
Publisher: Churchill Livingstone
URL: https://doi.org/10.1016/j.bjps.2020.02.036
DOI: 10.1016/j.bjps.2020.02.036
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