Outcome after Surgical Resections of (recurrent) Chest Wall Sarcomas

Outcome after Surgical Resections

of(recurrent) Chest Wall Sarcomas

Is it worthwhile?

Michael WoutersBert van Geel

Lotte NieuwenhuisHarm van Tinteren

Cees VerhoefHouke Klomp

Frits van Coevorden

Resections for Chest Wall SarcomaBackground

Sarcomas

1 % of all malignancies in adults 10-15% arise in the chest wall best controlled by wide (full-thickness)

chest wall resections neo-(adjuvant) radio- or chemotherapy

Resections for Chest Wall SarcomaBackground / Literature

Author(pub.year)

Study period(years)

Chest wall malignancie

s

Chest wall sarcomas

Recurrent sarcomas

Pfannschmidt (’06)

18 25 25 0

Gross (’05) 32 55 55 17

Chang (’04) 10 113 27 unknown

Walsh (’01) 10 51 51 11

Sabanathan (’97)

38 49 49 0

Incarbone (’97) 13 52 19 0

Chapelier (’94) 11 32 32 9

Burt (’92) 40 126 126 0

Gordon (’91) 40 149 149 0

Perry (’90) 11 28 28 4

King (’86) 20 71 71 unknown

Pairolero (’85) 8 90 36 12

Graeber (’82) 37 59 48 unknown

Resections for Chest Wall sarcomaObjective

To evaluate:

- morbidity, mortality and (disease-free) survival

- outcome for primary and recurrent sarcomas of the chest wall

Resections for Chest Wall sarcomaMethods

retrospective study 2 tertiary referral centers in the

Netherlands 1980 – 2006 any sarcoma involving:

• Ribs• Sternum• Costo-vertebral junction• Vertebral body

full-thickness Chest Wall resection

Resections for Chest Wall sarcomaFull-thickness Chest Wall resection

Resection of Chest Wall sarcomaPatients

P rim a rych e s t w a ll sa rco m a

83 (62% )

R e cu rre n tch e s t w a ll sa rco m a

44 (33% )

M e ta sta s is o f sa rco m ao n ch es t w a ll

6 (5% )

C h e s t W a ll re se c tio nsfo r sa rco m a133 (1 0 0% )

median follow-up time: 74 months

Resections of Chest Wall sarcomaResults / Patient & Tumor characteristics

characteristics PRIMARY RECURRENT

Age 48 (13-81) 52 (23-75)

Gender ( m – f ) 49 – 51% 45 –55 %

Histology-chondro/osteo-liposarcoma-fibrosarcoma-pleiomorf-leiomyosarcoma-angiosarcoma-other / NOS

36 (43%)3 (4%)

11 (13%)7 (8%)4 (5%)3 (4%)

19 (23%)

13 (30%)4 (9%)8 (18%)6 (14%)2 (4%)4 (9%)7 (16%)

Tumor-grade-low-intermediate-high-unknown

16 (19%)20 (24%)31 (38%)16 (19%)

5 (11%)5 (11%)

18 (41%)16 (36%)

Resections of Chest Wall sarcomaResults / Treatment characteristics

characteristics PRIMARY RECURRENT

Intention surgery-curative-palliative

81 (98%)2 (2%)

43 (98%)1 (2%)

Neo-adj. Treatment-none-chemotherapy-Radiotherapy

64 (77%)17 (20%)2 (3%)

41 (93%)2 (5%)1 (2%)

Skeletal resection-ribs (mean number)-sternum-other

2.4 (0-10)27 (32%)16 (19%)

2.4 (0-7)9 (20%)10 (23%)

Reconstruction-none-mesh +/- omentum / myocutaneus flap

15 (18%)68 (82%)

9 (20%)35 (80%)

Resections of Chest Wall sarcomaResults / Outcome / Morbidity

PRIMARY RECURRENT

Complications-none-bleeding-infectious-reconstr. failure-pulm. / cardiac

66 (80%)3 (4%)6 (8%)2 (2%)9 (11%)

34 (77%)0 (0%)5 (11%)5 (11%)0 (0%)

Re-operations-number of patients

3 (4%) 2 (5%)

Hospital staymedian (days) 9 12

In-hosp mortality

0 (0%) 0 (0%)

Resections of Chest Wall sarcomaResults / Outcome

PRIMARY RECURRENT

Margins-R0-R1-R2

66 (80%)13 (16%)3 (3%)

28 (64%)10 (23%)5 (11%)

Recurrence-no recurrence-local recurrence-distant recurrence

42 (51%)20 (24%)21 (25%)

11 (25%)21 (48%)12 (27%)

Disease-free survivalmedian (months)

36 18

Survivalmedian (months) 125 55

Resection of Chest Wall sarcomaResults / Outcome / DFS vs OS

DFS OS

Resection of Chest Wall sarcomaResults / Outcome / Recurrences

127chest wall sarcomas

83 primary

sarcomas

44 recurrent sarcomas

SURGERY SURGERY

41 (49%)recurrence

42 (51%)disease free

17 local recurrence

3 local & distant

recurrence

21 distant

recurrence

5 SURGERY


33 (75%)2nd recurrence

12 distant

recurrence

1 local & distant

recurrence

20 local

recurrence

12SURGERY



83primary

sarcomas

44recurrent sarcomas

SURGERY SURGERY

41recurrence


17local recurrence

3local & distant

recurrence

21 (25%)distant

recurrence

SURGERY


332nd recurrence

12 (27%) distant

recurrence

1local & distant

recurrence

20local

recurrence

12SURGERY



83primary

sarcomas

44recurrent sarcomas

SURGERY SURGERY

41 (49%)recurrence

42disease free

17 (20%)local recurrence

3 local & distant

recurrence

21distant

recurrence

5 SURGERY

11disease free

33 (75%)2nd recurrence

12 distant

recurrence

1local & distant

recurrence

20 (46%)local

recurrence

12 SURGERY

Resections for Chest Wall SarcomaDiscussion

Primary and Recurrent Chest Wall sarcomas have different recurrence patterns.

This selection of locally recurrent Chest Wall sarcomas has less tendency to metastasize.

Resections for Chest Wall SarcomaConclusions

Safe and effective procedure, even in locally recurrent sarcomas

5-year survival after resection of recurrent chest wall sarcomas

is ‘worthwhile’!

Recurrent chest wall sarcomas should be resected if technically possible.

Outcome after Surgical Resections of (recurrent) Chest Wall Sarcomas

Documents

Transcript of Outcome after Surgical Resections of (recurrent) Chest Wall Sarcomas