Chest wall resection for neoplasms with reconstruction using titanium-nickelide implants

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OBJECTIVE

To assess the results of surgical treatment for chest wall neoplasms with reinforcing titanium-nickelide (TiNi) implants.

MATERIAL AND METHODS

The paper presents the result of surgical treatment for chest wall neoplasms involving the osteochondral structures and that of postresection defect replacement in 15 patients. Their mean age was 60 years. Reconstruction of a patient’s tomographic images was used to create a 3D anatomy model of the intervention area, according to which the resection and reconstruction stages were planned and the shape of a TiNi reinforcing element was chosen. Chest wall tumors were represented by non-small cell lung cancer (NSCLC) invading the chest wall in 53.3% of the patients, of whom 5, 2, and 1 patients had T3N0M0, T3N1M0, and T3N2M0, respectively. Squamous cell carcinoma and adenocarcinoma were detected in 3 (37.5%) and 5 (62.5%) patients, respectively. Chest wall resection and plasty were performed in 2 cases for metastases from renal cancer after radical nephrectomy. In one case, the malignant chest wall tumor was a rib metastasis from lung adenocarcinoma following right lower lobectomy. Two patients with fibrous dysplasia and one case with a plasmacytoma of the rib underwent one-stage postresection defect elimination. One case with breast cancer had mastectomy and chemoradiation that was complicated by osteomyelitis of the sternum and ribs; sanitizing operations formed a chest wall defect with a ventral hernia, thoracic skeleton instability, resulting in delayed plastic surgery.

RESULTS

There were no lethal outcomes. Complications were noted in 3 (20%) patients after lobectomy for NSCLC with chest wall reconstruction. There was air discharge through the pleural drains (n=1), paroxysmal atrial fibrillation (n=1), and pleurisy (n=1), which were relieved by conservative treatment. There was no long-term thoracic skeleton instability

CONCLUSION

TiNi implants are made of the optimal reinforcing material; they can successfully replace postresection chest wall defects, yielding good functional and cosmetic results.

Keywords:

non-small cell lung cancer

chest wall resection and reconstruction

postresection defect replacement

rib prosthesis

titanium-nickelide implant

Authors:

Topolnitskiy E.B.

Siberian State Medical University;
Tomsk Regional Clinical Hospital;
National Research Tomsk State University

SPIN RSCI: 6744-9541
Scopus AuthorID: 35197267200
ResearcherID: T-5818-2018
ORCID: 0000-0002-5674-0177

Shefer N.A.

Tomsk Regional Oncology Dispensary

SPIN RSCI: 3662-7399
Scopus AuthorID: 57211683932
ResearcherID: HJY-1484-2023
ORCID: 0000-0002-0011-8370

Marchenko E.S.

Tomsk State National Research University

SPIN RSCI: 7116-2901
Scopus AuthorID: 24832211500
ResearcherID: E-9914-2017
ORCID: 0000-0003-4615-5270

Chekalkin T.L.

Tomsk State National Research University

SPIN RSCI: 4746-5418
Scopus AuthorID: 6505948547
ResearcherID: B-2776-2014
ORCID: 0000-0001-5831-3091

Yasenchuk Yu.F.

Tomsk State National Research University

Received:

21.11.2020

Accepted:

17.01.2021

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