Pikin O V, Ryabov A B, Alexandrov O A, Kolbanov K I, Rudenko M S, Topilin O G, Hayrapetyan M I, Chernusov V A
Moscow Research Oncology Institute named after. P.A. Herzen - branch of the National Medical Research Center for Radiology, Moscow, Russia.
Sverdlovsk Regional Oncology Dispensary, Yekaterinburg, Russia.
Khirurgiia (Mosk). 2024(8):41-51. doi: 10.17116/hirurgia202408141.
Chest wall resection is performed for a variety of diseases, for primary rib and soft tissue tumors, metastatic lesions, or locally invasive growth of lung and mediastinal tumors being the most common indications. Following the resection phase, it is essential to determine the method of chest wall reconstruction that will restore the structural function, preserve pulmonary biomechanics, reduce the likelihood of residual pleural space, pulmonary hernia, and protect intrathoracic organs. The main objective of this study is to investigate the outcomes of chest wall resection with reconstruction using Codubix material.
This retrospective multicenter study included 22 patients who underwent chest wall tumor resection with subsequent Codubix rib endoprosthesis reconstruction from 2019 to 2023. Four medical institutions participated in the study: P.A. Herzen Moscow Cancer Research Institute, Sverdlovsk Regional Oncology Hospital, Morozov Children's City Clinical Hospital and Kaluga Regional Oncology Hospital. Inclusion criteria were the presence of chest wall tumors, both primary and secondary, removal of more than 2 ribs, resection of the rib arch and the sternum.
The median age was 60 years (48-66), 11 (50%) patients were females and 11 (50%) males. Operations for chest wall sarcoma, metastatic lesions, and lung cancer were performed in 9 (40.9%), 4 (18.2%), and 3 (13.6%) patients, respectively. The median number of removed ribs was 3 (2-4), with a maximum of 7. Sternotomy was performed in 9 (40.9%) patients, and subtotal resection of the body or handle of the sternum was carried out in 77.7%. Combined resections were performed in 14 (63.6%) patients. Radical tumor removal (R0) was achieved in 21 (95.5%) patients. Complications were observed in 9 (40.9%) patients, with intermuscular seroma being the most common in three (33.3%), followed by hydrothorax in 2 (22.2%), bilateral pneumonia, acute respiratory failure, and postoperative delirium in 1 (11.1%) patient each. One patient had the Codubix plate removed due to postoperative wound infection. The median overall and recurrence-free survival was not reached, and the 1-year recurrence-free survival was 63.9%, with an overall survival of 86.8%.
Reconstruction with Codubix material allows for satisfactory functional and cosmetic results, characterized by a low complication rate and good adaptive properties.
胸壁切除术用于多种疾病，最常见的适应证是原发性肋骨和软组织肿瘤、转移性病变，或肺部及纵隔肿瘤的局部侵袭性生长。在切除阶段之后，确定胸壁重建方法至关重要，该方法应恢复结构功能、保留肺生物力学、降低残留胸膜腔、肺疝的可能性，并保护胸内器官。本研究的主要目的是调查使用Codubix材料进行胸壁切除并重建的结果。
这项回顾性多中心研究纳入了2019年至2023年期间接受胸壁肿瘤切除并随后使用Codubix肋骨内置假体进行重建的22例患者。四家医疗机构参与了该研究：莫斯科赫尔岑国立肿瘤研究所、斯维尔德洛夫斯克州肿瘤医院、莫罗佐夫市儿童临床医院和卡卢加州肿瘤医院。纳入标准为存在原发性和继发性胸壁肿瘤、切除超过2根肋骨、切除肋弓和胸骨。
中位年龄为60岁（48 - 66岁），11例（50%）为女性，11例（50%）为男性。分别有9例（40.9%）、4例（18.2%）和3例（13.6%）患者接受了胸壁肉瘤、转移性病变和肺癌手术。切除肋骨的中位数量为3根（2 - 4根），最多为7根。9例（40.9%）患者进行了胸骨切开术，77.7%的患者进行了胸骨体或柄的次全切除。14例（63.6%）患者进行了联合切除。21例（95.5%）患者实现了肿瘤根治性切除（R0）。9例（40.9%）患者出现并发症，其中肌间血清肿最为常见，有3例（33.3%），其次是胸腔积液2例（22.2%），双侧肺炎、急性呼吸衰竭和术后谵妄各1例（11.1%）。1例患者因术后伤口感染取出了Codubix钢板。中位总生存期和无复发生存期未达到，1年无复发生存率为63.9%，总生存率为86.8%。
使用Codubix材料进行重建可获得令人满意的功能和美容效果，其特点是并发症发生率低且适应性良好。
