Department of Thoracic Surgery, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa city, Chiba, 277-8661, Japan.
Department of Pathology, Kameda Medical Center, Chiba, Japan.
Surg Today. 2020 Oct;50(10):1262-1271. doi: 10.1007/s00595-020-02015-5. Epub 2020 May 5.
Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the "ribcage" procedure for tumors involving the chest wall after induction chemoradiotherapy.
This was a single center retrospective study conducted from 2012 to 2018. The "ribcage" procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure.
Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients.
Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence.
涉及胸壁的非小细胞肺癌（NSCLC）通常采用整块肋骨切除术或壁层胸膜切除术进行治疗；然而，前者会导致胸廓畸形，后者则与局部复发相关。为了防止这两种后遗症，我们在诱导放化疗后对涉及胸壁的肿瘤实施了“胸廓”手术。
这是一项 2012 年至 2018 年进行的单中心回顾性研究。“胸廓”手术旨在保留涉及胸壁的肺癌患者的肋骨，其操作包括从肋骨上剥离肋间肌和骨膜，从而形成鸟笼样外观。17 例明确涉及胸壁但未破坏肋骨的 NSCLC 患者接受了诱导放化疗，然后接受了胸廓手术。其中 16 例患者通过术中冷冻切片证实了肋骨的阴性切缘，随后接受了胸廓手术。
16 例患者均实现了完全切除，无 1 例发生重大术后并发症。中位随访 37 个月后，所有患者均未出现局部复发的迹象。
我们的研究结果表明，胸廓手术是一种较好的手术选择，因为它可以防止胸廓畸形和局部复发。
