Exploring the Role of Bioprosthesis for Chest Wall Reconstruction in Pediatric Oncology.

Aim of the study: Investigating the possible role of bioprosthesis in the treatment of primary chest wall Ewing sarcoma (pCWES) after major chest wall resection in the pediatric oncologic population and its role in addressing the significant controversies related to the ongoing growth process in this population. This study presents the insights from a pediatric referral center, aiming at evaluating the oncological and functional outcomes of children treated with bioprosthesis.

Methods: Data were collected retrospectively for all cases of pCWES managed at our facility over 5 years. All of the patients underwent the same surgical procedure for chest wall reconstruction, with positioning of a porcine biologic prosthesis covered by a latissimus dorsi muscle pedicled flap. A multidisciplinary evaluation was offered in all cases. Evaluated outcomes included morbidity, mortality, and subsequent functional and aesthetic results.

Results: Three patients were included: two males and one female. Median age at diagnosis was 13 years (range: 18 months to 19 years). One patient presented with lung metastases at diagnosis. All patients underwent a neoadjuvant chemotherapy regimen. Postoperative chemotherapy was restarted after a median of 47 postoperative days (range: 40-59). All of the patients are alive at the latest follow-up (mean follow-up time = 29 months), and the rate of local recurrence was 0.

Conclusion: Our series includes the youngest patient documented in the literature to be treated with a biologic prosthesis without the use of rigid materials. This approach appears to be both safe and effective for pediatric patients with pCWES. A multidisciplinary approach remains essential.