Forms of sternal reconstruction in oncology

INTRODUCTION. Chest wall tumors represent a variety of morphological forms and variants of lesions. According to different authors, primary malignant tumors of the chest wall account for 0.2–2 % of all malignant neoplasms. Of them, soft tissue sarcomas constitute about 45 %. Metastatic tumors of the chest wall occur much more frequently and most commonly develop from malignant tumors of the mammary, prostate and thyroid glands, lungs, kidneys and ovaries.

MATERIALS AND METHODS. The standard of the treatment of primary and metastatic tumors of the chest wall is combination or comprehensive therapy. In some cases, preoperative care allows to create a more favorable environment for performing surgical treatment being considered the best option for chest wall tumors. The choice of a technique for the replacement of the post-resection chest wall defect is of special importance to preserve the physiological chest volume, to restore chest rigidity, to prevent paradoxical respiration and to seal the pleural cavity.

RESULTS. There are different surgical techniques for skeleton reconstruction. A wide range of materials used for a skeleton reconstruction include bone tissues obtained from patient’s own body (bone autoplasty, autografts), polymeric mesh (polypropylene, polytetrafluoroethylene (Gore-Tex), bone cement (polymethyl methacrylate), stainless steel and titanium constructions as well as titanium bars and rib clips (STRATOS). In spite of a large number of techniques for sternal reconstruction described in the literature, searching for new materials and ways of their usage appears relevant.

CONCLUSION. Our clinical case studies demonstrate that modern reconstructive techniques combined with careful surgical planning allow to perform radical surgery with a successful outcome preventing serious postoperative complications.

1. Davydov M. I., Aliyev M. D., Teplyakov V. V., Polotsky B. E., Stilidi I. S., Sobolevsky V. A., Karpenko V. Yu. Treatment of locally advanced chest wall tumors. Two cases from practice // Bulletin of N. N. Blokhin Russian Research Centre of Oncology of the RAMS. 2003;2(1):93–96. (In Russ.).

2. Bagheri R., Haghi S. Z., Kalantari M. R., Sharifian Attar A., Salehi M., TabariA., Soudaneh M. Primary malignant chest wall tumors: analysis of 40 patients // J. Cardiothorac. Surg. 2014;(9):106. Doi: 10/1186/1749–8090-9-106.

3. Bernard J. Park, Raja M. Flores, Chest Wall Tumors // General Thoracic Surgery / eds by W. Thomas Shields, Joseph LoCicero, Carolyn E. Reed, Richard H. Feins. Lippincott Williams & Wilkins, 2011:669–672.

4. David E. A., Marshal M. B. Review of Chest Wall Tumors: A Diagnostic, Therapeutic, and Reconstructive Challenge // Semin. Plast. Surg. 2011;25(1):16–24. Doi: 10.1016/j.Ejcts.2009.12.046.

5. Zheravin A. A., Gyunter V. E., Anisenya I. I., Garbukov E. Yu. et al. Chest wall reconstruction using nickelid-titanium in cancer patients // Sibirsky Oncol. Zhurnal. 2015;(3):31–38. (In Russ.).

6. Teplyakov V. V., Karpenko V. Yu., Derzhavin V. A., Pikin O. V., Bukharov A. V. et al. Surgical treatment of patients with tumors of the upper chest wall // Bone and soft tissue sarcomas and skin tumors. 2011;(3):18–27. (In Russ.).

7. Davydov M. I., Aliyev M. D., Sobolevsky V. A. et al. Surgical treatment of malignant thoracic wall tumors // Bulletin of N. N. Blokhin Russian Research Centre of Oncology of the RAMS. 2008;19(1):35–40. (In Russ.).

8. Akiba T., Marushima H., Nogi H., Kamiya N., Kinoshita S., Takeyama H., Morikawa T. Chest Wall Reconstruktion using Gore-Tex Dual Mesh // Ann. Thorac. Cardiovasc. Surg. 2012;18(2):166–169.

9. Teplyakov V. V., Karpenko V. YU., Ilyushin A. L. i dr. Hirurgicheskoe lechenie zlokachestvennyh opuholej grudnoj stenki // Hirurgiya: Zhurnal im. N. I. Pirogova. 2010;(9):36–41. (In Russ.).