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Surgical Management of Chest Wall Tumors: An Overview

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The surgical management of chest wall tumors is a complex process. Read the article to learn about different surgical procedures.

Written by

Dr. Pallavi. C

Medically reviewed by

Dr. Pandian. P

Published At January 19, 2023
Reviewed AtMay 29, 2023

Introduction:

The chest wall is a vital organ that protects the heart, lungs, and liver. It plays a crucial role in keeping vital organs safe. The chest wall is made of sternum and ribs. Chest wall tumors are sometimes primary tumors originating from the chest or secondary tumors spreading (metastasizing) to the chest from other sites.

Primary tumors can be either benign or malignant. However, the secondary is malignant and needs surgical excision to prevent further spread and damage to other organs. Generally, bones, soft tissue, or cartilage tumors are called sarcomas. These sarcomas are malignant, and patients might experience swelling, pain, and difficulty breathing depending on the severity of the tumor.

How Common Are Chest Wall Tumors?

  • Chest walls are generally rare and difficult to treat.

  • Chest walls are usually less than five percent of all malignancies.

Who Is Affected By Chest Wall Tumors ?

  • It is common in all age groups.

  • Few sarcomas are more common in children when compared to adults.

  • Treating chest walls is comparatively easy at a young age compared to adults.

What Are Different Types of Chest Wall Tumors?

Different types of tumors that grow in the chest wall are-

  • Chondrosarcoma- Usually occurs in cartilage and is the most common type of chest wall. It is generally painful and keeps enlarging.

  • Osteosarcoma- Usually occurs in the bone and is typically seen in young children. It is painful and a rapidly enlarging tumor.

  • Rhabdomyosarcoma- Usually affects muscles, especially striated muscles affecting children and young adults. It is a painless growing tumor.

  • Ewing's Sarcoma- Usually affects bone and soft tissue. It is common in children and young adults and is very painful. Often the ribs are involved.

  • Malignant Fibrous Histiocytoma- Usually affects the soft tissues and is common in individuals aged 40 to 60. They are slow growing and generally painless.

  • Plasmacytoma- It is a type of multiple melanomas affecting the plasma cells. It is usually painful and can be treated without surgical intervention. Common in individuals of age 40 and above.

  • Fibrous Dysplasia- It commonly affects the bones, mainly in the ribs. It is an excruciating and most common type of chest wall tumor.

What Are the Common Symptoms of Chest Wall Tumors ?

Symptoms are rarely seen in the initial stages, and individuals experience few common symptoms in advanced stages. These include-

  • Fever and continuous tiredness.

  • Pain and swelling.

  • A feeling of a lump in the chest.

  • Atrophy of muscles.

  • Loss of appetite.

  • Experiencing drastic weight loss.

  • Sluggish body movement.

How to Diagnose the Chest Wall Tumors ?

The doctor will suggest a series of investigations to achieve a proper diagnosis and to know the severity of the tumor. These include:

  • Chest X-ray.

  • Magnetic resonance imaging (MRI) helps to provide information on soft tissues.

  • Computed tomography (CT) helps access calcification, bone destruction, and tumor severity.

  • Positron emission tomography (PET) scan along with CT scan.

  • Biopsy of a tumor (generally, a needle biopsy is done to assess the tumor).

How Are Chest Wall Tumors Managed?

After the preoperative evaluation, the surgeons advocate the following procedures to manage the chest wall.

Radiation And Chemotherapy-

  • Once the diagnosis is established, the surgeon may start chemotherapy, where different drugs are used to kill the cancer cell, and radiotherapy, which utilizes high-intensity rays to kill the cancer cells.

  • The disadvantage of radiation therapy is it kills even the normally growing cells. This procedure is helpful in the initial stages of the tumor.

Resection-

  • Resection is advocated in the advanced stages of the tumor.

  • Complete resection of the tumor is advocated without any compromise.

  • Chest walls are often challenging for thoracic and reconstructive surgeons as they have high chances of pulmonary dysfunction.

  • It is best to have a multidisciplinary approach to prevent postoperative complications.

Reconstruction-

  • After the resection, partial or full-thickness thoracic wall defects will need to be addressed.

  • Full-thickness wall defects involve soft tissues, muscles, and bone and should be reconstructed immediately after the resection.

  • Following are some of the options that facilitate the reconstruction and achieve a quick recovery.

Reconstruction With Mesh-

  • Different synthetic nets are available to increase the rigidity of the chest wall and protect the internal organs. These are durable, pliable, and radiolucent and help to achieve quick coverage.

Reconstruction With Implants-

  • Composite implants are generally used for reconstruction. These implants help to achieve the original contours of the chest and are usually indicated for anterior and lateral chest wall defects. They are found to produce good results with minimal chances of infection.

Osteosynthesis-

  • This procedure is recommended when a direct approximation of sternal edges is possible. In this procedure, the bony edges are stabilized using mechanical devices that help a proper union and adequate fixation.
    • Once the rebuilding is complete, the wound is covered with a skin flap-like pectoralis major flap taken from the lower breast fold along with muscle. Thoracoepigastric flap from the abdominal region and latissimus doris muscular flap from the lateral side of the upper body helps in extensive coverage of the chest wall.
    • Sore throat caused due to the tube placed in the windpipe for breathing during surgery.

    • Nausea and vomiting from general anesthesia.

    • Pain, swelling, and soreness around the reconstruction site.

    • Increased thirst.

    • Sleeplessness and restlessness.

    • Tingling and numbness at the surgical site.

    • Lethargy.

    • Patients should continue the medications and should not miss follow-up appointments.

    • Restrict physical activities.

    • Continue the physiotherapy exercises to improve the flexibility of the chest.

    • Adapting healthy lifestyle habits and quitting smoking and tobacco products if the practice is present.

    • Screening tests should be performed yearly as suggested by the surgeon or health care provider.

Reconstruction With Flaps-

Once the rebuilding is complete, the wound is covered with a skin flap-like pectoralis major flap taken from the lower breast fold along with muscle. Thoracoepigastric flap from the abdominal region and Latissimus Doris muscular flap from the lateral side of the upper body helps in extensive coverage of the chest wall.


What Happens After Surgery?

After the surgery, the patient may experience the following symptoms

  • Sore throat caused due to the tube placed in the windpipe for breathing during surgery.

  • Nausea and vomiting from general anesthesia.

  • Pain, swelling, and soreness around the reconstruction site.

  • Increased thirst.

  • Sleeplessness and restlessness.

  • Tingling and numbness at the surgical site.

  • Lethargy.

These symptoms usually reduce once the healing starts, and the patient can resume normal activities recommended by the surgeon.

What Are the Post-Operative Instructions Given to a Patient?

  • Patients should continue the medications and should not miss follow-up appointments.

  • Restrict physical activities.

  • Continue the physiotherapy exercises to improve the flexibility of the chest.

  • Adapting healthy lifestyle habits and quitting smoking and tobacco products if the practice is present.

  • Screening tests should be performed yearly as suggested by the surgeon or health care provider.


Conclusion:

Surgical management of the chest wall varies from patient to patient, depending on the severity of the tumor. Early detection always helps to achieve more significant results with minimal resection. The earlier the detection greater the chances of success

Frequently Asked Questions

1.

How to Excise a Tumor From the Chest Wall?

The steps to remove the tumor from the chest wall are as follows:


- General anesthesia is given to the patient to provide a pain-free procedure.


- A cut is made on the chest wall.


- The surgeon will remove the tumor without preserving the surrounding tissue.


- For chest wall reconstruction, grafts or flaps are required.


- The sutures are used to close the incision.


- The patient will be closely monitored to check recovery.

2.

What Is the Imaging of the Mass of the Chest Wall?

The imaging of the mass of the chest wall is as follows:


- X-ray shows the presence of mass, its location, and surrounding structures.


- Computed tomography provides a cross-sectional image of the chest wall. It assesses the nature of the tumor's mass, size, and shape.


- Magnetic resonance imaging evaluates the soft tissue.


- Ultrasound assesses the shape and size of chest wall mass.

3.

How to Manage a Mass on the Chest Wall?

The treatment of the mass on the chest wall is described below:


- Surgical removal of the mass.


- Radiation therapy after surgery or when surgery cannot be feasible.


- Chemotherapy to kill cancer cells. It can be given before or after surgery.


- Immunotherapies.


- Palliative care to provide emotional support.


- Follow-up care.

4.

What Is the Surgical Management of Excision of a Tumor?

The overview of the surgical process of the tumor is described below:


- Administration of general anesthesia.


- The cut is made on the skin over the tumor.


- The tumor is removed, but care should be taken to preserve blood vessels, nerves, and surrounding structures.


- The bleeding from the blood vessels should be controlled.


- After the complete excision of the tumor, the cut is closed with sutures.


- Reconstruction of the surgical site is done.


- Patient monitoring in the recovery room.


- Follow-up care.

5.

What Devices Are Used to Remove a Tumor?

The devices that are used to remove a tumor are as follows:


- A scalpel is a knife-like instrument used to make cuts.


- Electrocautery is used to cut tissue by using an electric current.


- Surgical scissors.


- Hemostatic forceps to tie blood vessels.


- Suction device to remove fluids.


- Needle and sutures.


- Surgical drains.


- Surgical clips.


- Retractors.

6.

How to Manage Lipoma in the Chest Wall?

The overview of the management approaches for lipoma in the chest wall is described below:


- Administration of local anesthesia.


- Surgical lipoma removal is done by cutting the skin.


- The lipoma is surgically removed.


- An incision is closed with the help of sutures.


- The recovery is quick.

7.

Is There Any Need for Surgery to Remove a Tumor?

The need for surgery to remove a tumor is based on several factors, such as whether the tumor is cancerous or non-cancerous. Other factors, such as large-size tumors, hinder normal function and need removal. Some benign tumors are removed due to cosmetic concerns. If there are complications associated with the tumor, such as bleeding, it needs to be removed.

8.

Is There Any Need for Surgery to Remove a Tumor?

The need for surgery to remove a tumor is based on several factors, such as whether the tumor is cancerous or non-cancerous. Other factors, such as large-size tumors, hinder normal function and need removal. Some benign tumors are removed due to cosmetic concerns. If there are complications associated with the tumor, such as bleeding, it needs to be removed.

9.

What Procedures Are Advised for Large Tumors Without Invasion of the Chest Wall?

The procedures that can be performed for large tumors without invasion of the chest wall are as follows:


- Wide local incision.


- Minimal invasive techniques.


-Tumor debulking (surgical excision of the small portion of the tumor to reduce the large size to a smaller one).


- Chemotherapy.


- Radiation therapy.


- Complete surgical excision.

10.

Can a Chest Wall Tumor Be Non-Cancerous?

Yes, a chest wall tumor can be non-cancerous. These types of tumors do not spread to other areas of the body. These tumors consist of fat, muscle, bone, and connective tissue. These types of tumors are not harmful and do not cause any symptoms. In some cases, it may cause discomfort and need surgical removal.

11.

Is the Chest Wall Excised During Mastectomy?

During mastectomy (breast tissue removal), the chest wall is not completely removed. There are several types of mastectomy. The portion of chest removal is based on the type of mastectomy performed. In a total mastectomy, the chest wall is not removed. The surgery is focused on the excision of breast tissue.

12.

How to Diagnose Chest Wall Tumors?

The steps to detect chest wall tumors are described below:


- The healthcare provider will take a detailed medical history by asking about the symptoms and physically examining the chest wall.


- Medical imaging, such as computed tomography, magnetic resonance imaging, and ultrasound, is used to visualize the tumors and the structures within the chest wall.


- Biopsy to know the pathology of the tumor, whether the tumor is benign or cancerous.

13.

What Is the Duration of Recovery for Chest Wall Surgery?

The recovery duration for chest wall surgery is based on the person's health, extent of surgery, and complications, if present. The recovery time of different types of chest wall surgery is described below:


- The recovery time for mastectomy is from four to six weeks.


- In the case of tumor resection, the recovery time is shorter for smaller tumors and longer for larger tumors.


- The recovery is longer in the case of rib resection.


- In the case of open chest surgery, the recovery time is several weeks.


- The recovery time for minimally invasive surgery can range from a few weeks to months.

14.

What Is the Chance of Survival for a Chest Wall Tumor?

The survival rate for an individual with a chest wall tumor is based on the type of tumor, such as benign or cancerous, and the effectiveness of treatment. The prognosis of benign tumors is excellent, and the recurrence is uncommon. In the case of malignant tumors, the survival rate varies.

15.

What Are the Names of Chest Wall Muscles?

The muscles in the chest wall include,


- Pectoralis major.


- Intercoastal muscles.


- Serratus anterior.


- Subclavius.


- Rectus abdominis.


- Transversus thoracis.


- Levatores costarum.

Source Article IclonSourcesSource Article Arrow
Dr. Pandian. P
Dr. Pandian. P

General Surgery

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surgerychest wall cancer
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