Chest wall resection and reconstruction for malignant conditions in childhood

Jay L. Grosfeld, Frederick J. Rescorla, Karen W. West, Dennis W. Vane, G. Paul DeRosa, Arthur J. Provisor, Robert Weetman

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

This report evaluates the efficacy of extensive chest wall resection and prosthetic reconstruction in 15 children with chest wall malignancies. There were nine boys and six girls, with a mean age of 9.6 years. Eleven patients had primary chest wall tumors including Ewing's sarcoma (ES), six; rhabdomyosarcoma (RH), two; chondrosarcoma (CS), one; Askin's malignant neuroectodermal tumor, one; and mesenchymal sarcoma, one. Four children had metastases to chest wall and lung from Wilms' tumor (WT), two; osteogenic sarcoma (OS), one; and neuroblastoma (NB), one. Chest wall resection of two to six ribs and reconstruction with Marlex mesh (seven), lattisimus flap (two), prolene mesh (one), and more recently, a Gortex patch (five), was performed. Eight of the patients required concomitant en-bloc pulmonary resection (wedge, five; lobectomy, two; pneumonectomy, one) and two required resection of diaphragm. Fourteen received adjunctive therapy (chemotherapy, 14; irradiation, eight [preoperative, five; postoperative, three]. Six patients had second-look resections after chemotherapy. There was no operative mortality. Early pulmonary function was normal; however, pulmonary restrictive disease and scoliosis occurred with growth. One ES patient developed a radiation-induced second malignant tumor at age 10 and one ES child died at age 6 (no evidence of disease) of meningitis. Average survival length for ES patients was 77 months (range, 18 to 132 months). Currently, eight patients are alive and five are free of disease. Extensive chest wall resection and reconstruction is useful in the treatment of primary chest wall tumors, but is palliative in metastatic cases. The Gortex patch is the current prosthetic of choice.

Original languageEnglish (US)
Pages (from-to)667-673
Number of pages7
JournalJournal of Pediatric Surgery
Volume23
Issue number7
DOIs
StatePublished - Jul 1988
Externally publishedYes

Keywords

  • chest wall reconstruction
  • Chest wall tumor
  • Ewing's sarcoma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'Chest wall resection and reconstruction for malignant conditions in childhood'. Together they form a unique fingerprint.

  • Cite this

    Grosfeld, J. L., Rescorla, F. J., West, K. W., Vane, D. W., DeRosa, G. P., Provisor, A. J., & Weetman, R. (1988). Chest wall resection and reconstruction for malignant conditions in childhood. Journal of Pediatric Surgery, 23(7), 667-673. https://doi.org/10.1016/S0022-3468(88)80642-0