Speakers - 2027

Title: Surgical management of primary malignant chest wall tumors: Case series

Abstract

Background: Primary malignant tumors of the chest wall are rare, accounting for approximately 5% of all thoracic tumors. Their prognosis depends mainly on histological subtype and completeness of surgical resection, and management often requires complex reconstruction to preserve chest wall stability and respiratory function. We report our surgical experience with these tumors over a 22-year period.
Methods: This study included 34 patients who underwent surgical treatment for primary malignant chest wall tumors between January 1996 and January 2018 at the Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse.
Results: There was a male predominance (62%), with a mean age of 46.3 years (range: 13–76) and a mean consultation delay of 16 months. Chest wall swelling (79%) and chest pain (62%) were the most common presenting features. Chest CT was performed in 88.2% of patients and preoperative biopsy confirmed the diagnosis in 47%; histopathology on the surgical specimen was diagnostic in all cases. Chondrosarcoma was the most frequent histological subtype (38.2%), followed by osteosarcoma (20.5%) and Ewing's sarcoma (14.7%). All patients underwent R0 resection, most commonly via posterolateral thoracotomy (50%). Chest wall reconstruction consisted of direct closure (47%), bony reconstruction with titanium bars or Mersilene® mesh (17.6%), or musculocutaneous flap coverage (35.2%). Two postoperative complications occurred (5.8%), with no perioperative mortality.
Conclusion: Complete oncologic resection remains the cornerstone of treatment for primary malignant chest wall tumors. A thorough preoperative workup and multimodal management combining surgery, reconstruction, and adjuvant therapy allow acceptable morbidity and low mortality, though long-term prognosis remains driven by local recurrence and distant metastasis risk.
Keywords: chest wall tumor, chondrosarcoma, surgical resection, chest wall reconstruction