Sarcoma (1998) 2, 143± 147
Chest wall sarcoma: outcome in 22 patients after resection requiring
thoracic cage reconstruction
PER JOÈ NSSON,1 ERIK GYLLSTEDT,1 GOÈ RAN HAMBRAEUS,1 RAMON LILLOGIL1 &
ANDERS RYDHOLM 2
1Departments of Thoracic Surgery and 2Orthopaedics, Lund University Hospital, S-22185 Lund, Sweden
Purpose. To evaluate the outcome after resection of malignant chest wall sarcoma, requiring reconstruction of the chest
Subjects. Twenty-two patients, 15 with primary tumours, were operated on in our institution between 1983 and 1996.
Four patients underwent surgery after a previous intralesional or marginal excision and three patients because of a local
Methods. The tumour was resected `en bloc’ , including skin, muscle and thoracic skeleton. When necessary, adjacent
organs invaded by the tumour, such as lung, pericardium and diaphragm, were also removed to obtain a wide margin.
Reconstruction of the chest wall was performed with Marlex mesh (n
5 9), methylmethacrylate cement (n
5 2) or a Marlex
methylmethacrylate `sandwich’ (n
Results. The median tumour size was 9.5 (2± 20) cm. The most common type of tumour was chondrosarcoma (12 cases).
No patient died in hospital. Five patients required reoperation because of complications, two patients because of loosening
of the acrylate prosthesis, two because of necrosis of soft tissue coverage and one was reoperated because of bleeding. Four
patients died of generalized tumour disease between 5 and 77 months after surgery and one patient died of a local
recurrence 32 months after the primary operation. Seventeen patients are alive, with a median follow-up of 36 (4± 162)
months. Microscopic radicality (negative margin) was achieved in 17 patients but 5 of these had local recurrences. Two
of ® ve patients with positive margins had a local recurrence of the tumour. Of the seven patients with local recurrences,
two also developed metastases.
Large chest wall sarcomas can be successfully resected and the ch