Surgical treatment of chest wall tumors

Chest wall tumors have long represented challenging clinical entities for s urgeons. Until recently, incorrect diagnosis, incomplete resection, or inab ility to perform successful reconstruction of large thoracic wall defects l ed to high rates of perioperative morbidity and mortality. The latter were primarily associated with infections of the pleural cavity, respiratory fai lure, and paradoxical breathing. The long-term prognosis was also poor owin g to a high percentage of local relapse. During the same operating procedur e,vide resection and reconstruction of the thoracic wall are performed succ essfully. Improvement of the prognosis reported in large series of patients with resection leads to surgical treatment being considered the best optio n for primary tumors and for selected secondary tumors of the chest wall. B ecause positive margins are the most important risk factor for local recurr ence, adequate margins of healthy tissue surrounding the tumors have a cons iderable impact on disease-free and overall survival. Involvement of ribs, sternum, superior sulcus, or spine is not considered a technical limitation to surgical resection. Nowadays correct management cannot be precluded by tumor size, site, or contiguous structure involvement because concurrent re construction with prosthetic materials and myocutaneous flaps is feasible. Surgery provides the best chance of cure in patients with chest wall tumors . Therefore the surgical strategy must be based on the features of the indi vidual's disease.