Baldes Natalie, Grapatsas Konstantinos, Dörr Fabian, Menghesha Hruy, Schuler Martin, Welt Anja, Stuschke Martin, Kimmig Rainer, Hoffmann Oliver, Bölükbas Servet
Department of Thoracic Surgery, University Medical Center Essen-Ruhrlandklinik, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
J Thorac Dis. 2024 Oct 31;16(10):7182-7191. doi: 10.21037/jtd-23-1432. Epub 2024 Oct 10.
Advanced breast cancer (BC) can involve the chest wall through local invasion by the primary tumor, locoregional recurrence, hematogenous metastasis, or sternum infiltration of the internal mammary chain lymph nodes. The purpose of this article is to review indications and the methods of chest wall resection and reconstruction in patients with advanced BC.
An online literature search was conducted on PubMed database using the following keywords: "chest wall reconstruction" or "chest wall resection" and "breast cancer". Articles in languages other than English were excluded.
The treatment options should be discussed by a multidisciplinary team. The surgical principles include complete resection of the tumor including all involved or damaged skin, muscle and part of chest wall including ribs, complete or partial sternum and clavicles, as required, to achieve wide clear margins. The chest wall defect should be reconstructed with a good functional result. The optimal strategy for chest wall reconstruction depends on factors such as the defect`s size, location, and previous radiation or surgical intervention. A part of the reconstruction involves stabilizing the chest wall. Additionally, the defect should be covered with well-vascularized tissue, often necessitating reconstruction with muscle flaps or myocutaneous flaps.
A resection and reconstruction of the chest wall may be the best treatment option to achieve a high quality of life and favorable long-term outcomes, mostly as part of multimodality treatment for highly selected patients.
晚期乳腺癌可通过原发肿瘤局部侵犯、区域复发、血行转移或内乳链淋巴结胸骨浸润累及胸壁。本文旨在综述晚期乳腺癌患者胸壁切除与重建的适应证及方法。
在PubMed数据库中进行在线文献检索，使用以下关键词：“胸壁重建”或“胸壁切除”以及“乳腺癌”。排除非英文文献。
治疗方案应由多学科团队讨论。手术原则包括完整切除肿瘤，包括所有受累或受损的皮肤、肌肉以及部分胸壁，视情况包括肋骨、全部或部分胸骨及锁骨，以达到广泛切缘。胸壁缺损应进行重建，以获得良好的功能效果。胸壁重建的最佳策略取决于缺损的大小、位置以及既往放疗或手术干预等因素。重建的一部分包括稳定胸壁。此外，缺损应由血运良好的组织覆盖，通常需要用肌瓣或肌皮瓣进行重建。
胸壁切除与重建可能是实现高质量生活和良好长期预后的最佳治疗选择，主要作为高度选择患者多模式治疗的一部分。
