Primary chest wall tumors: early and long-term results of surgical treatment

Objectives: A retrospective study of primary chest wall tumors (PCWTs/CWTs) was conducted to review their clinical, radiological and pathological feat ures, as well as the early and long-term results of surgical management. Ma terials and methods: From 1986 through 1996, 41 patients (18/44% male, 23/5 6% female, aged 15-78 years) with PCWTs were treated in our department. Res ults: Twenty-three patients (nine male, 14 female, mean age 36 years) had a benign CWT: enchondroma, five patients; fibrous dysplasia, four patients; neurilemoma, three patients; osteochondroma, two patients; granular cell tu mor, two patients; fibroma, two patients; lipoma, two patients; fibrolipoma , one patient; eosinophilic granuloma, one patient; aneurysmal bone cyst, o ne patient. Eighteen patients (nine male, nine female, mean age 59 years) h ad a malignant CWT: plasmacytoma, five patients; chondrosarcoma, two patien ts; osteosarcoma, two patients; fibrosarcoma, two patients; desmoid tumor, two patients; leiomyosarcoma, one patient; malignant fibrous histiocytoma, one patient; tendon sheath sarcoma, one patient; hemangiosarcoma, one patie nt; neurinosarcoma, one patient. The ribs were involved in 21 patients, the sternum in five patients, and the soft tissue in 17 patients. Distinction between benign and malignant CWT was not possible using radiographic criter ia alone, and diagnosis was always confirmed histologically. Surgical treat ment consisted of wide resection in 29 patients (15 benign/14 malignant CWT s), with the use of synthetic mesh in five cases, and excisional or incisio nal biopsy in 12 patients. There was no perioperative mortality. Two patien ts with a benign CWT (fibroma, one patient; neurilemoma, one patient) had a local recurrence at 13 and 26 months after resection, respectively, and un derwent wide resection (recurrence rate 8.7%). Follow-up at 3-13 years reve aled one non-tumor-related death in patients with benign CWT (overall morta lity rate 4.3%) and no other local recurrence. The overall 5- and 10-year s urvival in patients with malignant CWT was 33.3%. Conclusions: We believe t hat all CWTs should be considered malignant until proven otherwise. Wide re section with tumor-free margins is required in order to provide the best ch ance for cure in both benign and malignant lesions. (C) 2001 Elsevier Scien ce B.V. All rights reserved.