Long-term outcome and prognostic factors after chest wall resection and reconstruction

Fernandez Gonzalez, Alba M and Matilla, Jose R and Pipek, Orsolya Anna and Sanchez, Laura Gonzalez and Begic, Merjem and Megyesfalvi, Zsolt and Döme, Balázs and Aigner, Clemens (2025) Long-term outcome and prognostic factors after chest wall resection and reconstruction. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY, 40 (6). No. ivaf126. ISSN 2753-670X

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Abstract

OBJECTIVES: Our study aimed to evaluate factors influencing perioperative and long-term outcomes of patients undergoing curativeintent chest wall resection and reconstruction. METHODS: A retrospective single-centre analysis was conducted on all patients undergoing curative-intent chest wall resection and reconstruction from 2010 to 2023. Perioperative outcome was analysed for the entire cohort. Overall survival and disease-free survival were analysed using the Kaplan–Meier method and log-rank test and multivariable Cox proportional hazards regression models with a particular focus on patients with lung cancer and chest wall involvement. RESULTS: A total of 143 consecutive patients (median age 62 years, 44.1% females) were included, and 75% of patients received perioperative systemic therapy or radiation. Rib resection alone was performed in 69.9%, additional sternal resection in 16.1%, spine resection in 11.9% and clavicle resection in 2.1%. Additional resections included the lung (n ¼ 75), diaphragm (n ¼ 6), pericardium (n ¼ 2), subclavian vein (n ¼ 2), pulmonary artery (n ¼ 1) and multiple structures (n ¼ 22). Reconstruction was performed using synthetic protheses (n ¼ 89), metallic (n ¼ 6) or combinations of materials (n ¼ 32). Median tumour diameter was 10 cm; 88% were malignant. Local recurrence rate was 9.5%. Median disease-free survival (86 events) was 36 months, and median overall survival (62 events) was 80 months. The 5-year disease-free survival and overall survival were 54.1% and 74.1%, respectively. In patients with lung cancer, overall survival was significantly affected by age (P ¼ 0.028), histology (P < 0.001), resection size >10 cm (P ¼ 0.018), postoperative performance status (P < 0.001) and postoperative complications (P < 0.001) in multivariable analysis and disease-free survival by postoperative performance status (P < 0.001). CONCLUSIONS: Postoperative performance status is correlated with overall survival after chest wall resection.

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