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

Abstract

Objectives: Our study aimed to evaluate factors influencing perioperative and long-term outcomes of patients undergoing curative-intent chest wall resection and reconstruction.

Methods: A retrospective single-center analysis was conducted on all patients undergoing curative-intent chest wall resection and reconstruction from 2010 to 2023. Perioperative outcome was analyzed for the entire cohort. Overall survival (OS) and disease-free survival (DFS) were analyzed 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: 143 consecutive patients (median age 62 years, 44.1% females) were included 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 = 75), diaphragm (n = 6), pericardium (n = 2), subclavian vein (n = 2), pulmonary artery (n = 1), and multiple structures (n = 22). Reconstruction was performed using synthetic protheses (n = 89), metallic (n = 6), or combinations of materials (n = 32). Median tumor diameter was 10 cm, 88% were malignant. Local recurrence rate was 9.5%. Median DFS (86 events) was 36 months, and median OS (62 events) 80 months. The 5-year-DFS and OS were 54.1% and 74.1%. In patients with lung cancer OS was significantly affected by age (p = 0.028), histology (p < 0.001), resection size >10 cm (p = 0.018), postoperative performance status (PS) (p < 0.001) and postoperative complications (p < 0.001) in multivariable analysis, DFS by postoperative PS (p < 0.001).

Conclusions: Postoperative performance status is correlated with overall survival after chest wall resection.