Results of chest wall resection and reconstruction with and without rigid prosthesis Journal Article

Authors: Weyant, M. J.; Bains, M. S.; Venkatraman, E.; Downey, R. J.; Park, B. J.; Flores, R. M.; Rizk, N.; Rusch, V. W.
Article Title: Results of chest wall resection and reconstruction with and without rigid prosthesis
Abstract: Background. Chest wall resections are associated with significant morbidity, with respiratory failure in as many as 27% of patients. We hypothesized that our selective use of a rigid prosthesis for reconstruction reduces respiratory complications. Methods. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Patient demographics, use of preoperative therapy, the location and size of the chest wall defect, performance of lung resection if any, the type of prosthesis, and postoperative complications were recorded. Predictor of complications were identified by χ2 and logistic regression analyses. Results. From January 1, 1995, to July 1, 2003, 262 patients (median age, 60 years) underwent chest wall resection for tumor in 251 (96%), radiation necrosis in 7 (2.7%); and infection in 4 patients (1.3%). The median defect size was 80 cm2 (range, 2.7 to 1,200 cm2) and the median number of ribs resected was 3 (range, 1 to 8). Major lung resection was performed in 85 patients (34%). Prosthetic reconstruction was rigid (polypropylene mesh/methylmethacrylate composite) in 112 (42.7%), nonrigid (polytetrafluoroethylene or polypropylene mesh) in 97 (37%), and none in 53 patients. Postoperatively, 10 patients died (3.8%), 4 of whom had pneumonectomy plus chest wall resection. Respiratory failure occurred in 8 patients (3.1%). By multivariate analysis, the size of the chest wall defect was the most significant predictor of complications. Conclusions. Our incidence of respiratory failure is lower than previously reported and may relate to our use of rigid repair for defects likely to cause a flail segment. Pneumonectomy plus chest wall resection should be performed only in highly selected patients. © 2006 by The Society of Thoracic Surgeons.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; reconstructive surgical procedures; retrospective studies; major clinical study; review; plastic surgery; postoperative period; preoperative care; demography; infection; lung resection; pneumonectomy; incidence; device removal; prediction; pneumonia; postoperative complication; postoperative complications; thoracic neoplasms; medical record; atelectasis; multivariate analysis; equipment design; logistic regression analysis; time series analysis; prosthesis; politef; thorax surgery; surgical mesh; thoracic wall; radiation necrosis; performance; respiratory failure; prostheses and implants; prosthesis implantation; radiodermatitis; polytetrafluoroethylene; respiratory distress syndrome, adult; methacrylic acid methyl ester; polypropylene; flail chest; methylmethacrylate; polypropylenes
Journal Title: Annals of Thoracic Surgery
Volume: 81
Issue: 1
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2006-01-01
Start Page: 279
End Page: 285
Language: English
DOI: 10.1016/j.athoracsur.2005.07.001
PUBMED: 16368380
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 54" - "Export Date: 4 June 2012" - "CODEN: ATHSA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Venkatraman Ennapadam Seshan
    285 Seshan
  2. Valerie W Rusch
    655 Rusch
  3. Nabil Rizk
    134 Rizk
  4. Raja Flores
    107 Flores
  5. Bernard J Park
    155 Park
  6. Robert J Downey
    203 Downey
  7. Manjit S Bains
    229 Bains
  8. Michael J Weyant
    3 Weyant