Öz
Background: There are discussions about which patients should be reconstructed after the resection of malignant chest wall tumors, which reconstruction technique and material will be used. In this study, we aimed to compare the clinical results and costs of 2 separate materials we use for reconstruction.
Material and Method: Between 15 January 2010 and December 2019, 15 patients who underwent chest wall resection with the diagnosis of malignant chest wall tumor were reconstructed with graft consisting of prolene mesh and methylmethacrylate. 11 patients used titanium plaque and prolene mesh to close the defect. Patients who used methylmethacrylate for skeletal reconstruction were called the MM group, and patients who used titanium plaque were called the TP group. The diagnosis was chondrosarcoma in 8, local recurrence of ductal carcinoma of the breast in 8, chest wall invasion of non-small cell lung carcinoma in 5, ewing sarcoma in 2, osteosarcoma, plasmacytoma and colon carcinoma metastasis in one patient.
Results: 13 of 26 patients were female and 13 were male. The mean age was 59 ± 6,4. The mean number of resected ribs was 3.74 ± 1.26 (3-6). Apart from rib resection, lungs in 5, partial sternum in 5, and diaphragmatic resection in 1 patient were performed. Soft tissue reconstruction was performed in 12 patients. While there was a statistically significant difference between MM group and TP group in terms of intensive care unit stay (p˂0.05) and hospital stay (p˂0.05), there was no statistically significant difference in terms of age, sex, number of resected ribs, postoperative complications and recurrence. When cost analysis was made, it was determined that TP group had higher cost. Average invoice amount in TP group: 17765±6784 lira, and 15650±4306 lira in MM group. However, no statistically significant difference was found between the two groups in terms of cost.
Conclusion: For reconstruction after resection of the malignant tumors of the chest wall, combinations of methymetacrylate and prolene mesh or titanium plaque and prolene mesh are safe methods with low mortality and morbidity. In the titanium plaque group, intensive care unit and hospital stay were shorter, but the cost was higher.
Anahtar Kelimeler
Kaynakça
- 1. Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002;73:1720-5; discussion 1725-6.
- 2. Petrella F, Casiraghi M, Mariolo AV et al. Rigid prosthesis removal following chest wall resection and reconstruction for cancer. Shanghai Chest 2018;2:64. 3. Petrella F, Radice D, Borri A, et al. Chest wall resection and reconstruction for locally recurrent breast cancer: From technical aspects to biological assessment. Surgeon 2016;14:26-32.
- 4. le Roux BT, Shama DM. Resection of tumors of the chest wall. Curr Probl Surg 1983;20:345-86.
- 5. Tensini I. Sopra il mio nuovo processo di amputazione della mammella. Gazzetta Med Ital 1906;57:141-2.
- 6. Seder CW, Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis 2016;8:S863-S871.
- 7. Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstructions of full-thickness oncological chest wall defects. Ann Surg 2003;238:794-801.
- 8. Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg 2006;81:279-85.
- 9. Deschamps C, Tirnaksiz BM, Darbandi R, et al. Early and long-term results of prosthetic chest wall recontruction. J Thorac Cardiovasc Surg 1999;117:588-91.
- 10. Ng CS. Recent and Future Developments in Chest Wall Reconstruction. Semin Thorac Cardiovasc Surg 2015;27(2):234-9.
- 11. Chapelier AR, Missana MC, Couturaud B, Fadel E, Fabre D, Mussot S, et al. Sternal resection and reconstruction for primary malignant tumors. Ann Thorac Surg 2004;77(3):1001-6
- 12. Ferraro P, Cugno S, Liberman M, et al. Principles of chest wall resection and reconstruction. Thorac Surg Clin 2010;20:465-73.
- 13. Thomas PA, Brouchet L. Prosthetic reconstruction of the chest wall. Thorac Surg Clin 2010;20:551-8
- 14. Sanna S, Brandolini J, Pardolesi A, et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017;3:95.
- 15. Dell'Amore A, Cassanelli N, Dolci G, et al. An alternative technique for anterior chest wall reconstruction: the sternal allograft transplantation. Interact Cardiovasc Thorac Surg 2012;15:944-7.
- 16. Marulli G, Dell'amore A, Calabrese F, et al. Safety and Effectiveness of Cadaveric Allograft Sternochondral Replacement After Sternectomy: A New Tool for the Reconstruction of Anterior Chest Wall. Ann Thorac Surg 2017;103:898-905.
- 17. Iarussi T, Pardolesi A, Camplese P, et al. Composite chest wall reconstruction using titanium plates and mesh preserves chest wall function. J Thorac Cardiovasc Surg 2010;140:476-7.
- 18. Tamburini N, Grossi W, Sanna S, Campisi A, Londero F, Maniscalco P, Dolci G, Quarantotto F, Daddi N, Morelli A, Cavallesco G, Dell'Amore A. Chest wall reconstruction using a new titanium mesh: a multicenters experience. J Thorac Dis. 2019 Aug;11(8):3459-3466.
Göğüs duvarı malign tümörlerinin rezeksiyonu sonrası uygulanan rekonstrüksiyon yöntemlerinin karşılaştırılması
Öz
Giriş: Malign göğüs duvarı tümörlerinin rezeksiyonu sonrası hangi hastalarda rekonstrüksiyon yapılması gerekliliği, hangi rekonstrüksiyon tekniğinin ve materyalinin kullanılacağı konusunda tartışmalar mevcuttur. Bu çalışmada rekonstrüksiyon için kullandığımız 2 ayrı materyalin klinik sonuçları ve maliyetlerini karşılaştırmayı amaçladık.
Materyal ve metod: 2010 ocak ile 2019 aralık arası malign göğüs duvarı tümörü tanısı ile göğüs duvarı rezeksiyonu uygulanan 15 hastaya prolen meş ve metilmetakrilattan oluşan sandaviç greft ile rekonstrüksiyon uygulanırken, 11 hastaya defekti kapatmak için titanyum plak ve prolen meş kullanıldı. İskelet rekonstrüksiyonu için metilmetakrilat kullanılan hastalar MM grubu, titanyum plak kullanılan hastalar ise TP grubu olarak adlandırıldı. Tanı 8 hastada kondrosarkoma, 8 hastada memenin duktal karsinomunun lokal nüksü, 5 hastada küçük hücreli dışı akciğer karsinomunun göğüs duvarı invazyonu, 2 hastada ewing sarkomu, birer hastada osteosarkoma, plazmositoma ve kolon karsinomu metastazı idi.
Bulgular: 26 hastanın 13’ü bayan, 13’ü erkek idi. Ortalama yaş 59±6,4 idi. Ortalama rezeke edilen kaburga sayısı 3.74±1.26 (3-6) idi. Kaburga rezeksiyonu dışında 5 hastada akciğer, 5 hastada parsiyel sternum ve 1 hastada diyafragma rezeksiyonu uygulandı. Toplam 12 hastada yumuşak doku rekonstrüksiyonu uygulandı. MM grubu ile TP grubu arasında yoğun bakım yatış (p˂0.05) ve hastane yatış süresi (p˂0.05) açısından istatistiksel olarak anlamlı fark saptanırken, yaş, cinsiyet, rezeke edilen kaburga sayısı, postoperatif komplikasyon ve nüks açısından istatistiksel olarak anlamlı fark saptanmadı. Maliyet analizi yapıldığında TP grubunun daha yüksek maliyete sahip olduğu saptandı. TP grubunda ortalama fatura miktarı: 17765±6784 lira, MM grubunda 15650±4306 lira idi. Ancak her iki grup arasında maliyet açısından istatistiksel olarak anlamlı fark saptanmadı.Sonuç: Göğüs duvarının malign tümörlerinin rezeksiyonu sonrası rekonstrüksiyon için metilmetakrilat ile prolen meş yada titanyum plak ile prolen meş kombinasyonları mortalite ve morbiditesi düşük, güvenli yöntemlerdir. Titanyum plak grubunda yoğun bakım ve hastane yatış süresi daha kısa olmakla birlikte maliyetin daha fazla olduğu saptanmıştır.
Anahtar Kelimeler
Kaynakça
- 1. Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002;73:1720-5; discussion 1725-6.
- 2. Petrella F, Casiraghi M, Mariolo AV et al. Rigid prosthesis removal following chest wall resection and reconstruction for cancer. Shanghai Chest 2018;2:64. 3. Petrella F, Radice D, Borri A, et al. Chest wall resection and reconstruction for locally recurrent breast cancer: From technical aspects to biological assessment. Surgeon 2016;14:26-32.
- 4. le Roux BT, Shama DM. Resection of tumors of the chest wall. Curr Probl Surg 1983;20:345-86.
- 5. Tensini I. Sopra il mio nuovo processo di amputazione della mammella. Gazzetta Med Ital 1906;57:141-2.
- 6. Seder CW, Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis 2016;8:S863-S871.
- 7. Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstructions of full-thickness oncological chest wall defects. Ann Surg 2003;238:794-801.
- 8. Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg 2006;81:279-85.
- 9. Deschamps C, Tirnaksiz BM, Darbandi R, et al. Early and long-term results of prosthetic chest wall recontruction. J Thorac Cardiovasc Surg 1999;117:588-91.
- 10. Ng CS. Recent and Future Developments in Chest Wall Reconstruction. Semin Thorac Cardiovasc Surg 2015;27(2):234-9.
- 11. Chapelier AR, Missana MC, Couturaud B, Fadel E, Fabre D, Mussot S, et al. Sternal resection and reconstruction for primary malignant tumors. Ann Thorac Surg 2004;77(3):1001-6
- 12. Ferraro P, Cugno S, Liberman M, et al. Principles of chest wall resection and reconstruction. Thorac Surg Clin 2010;20:465-73.
- 13. Thomas PA, Brouchet L. Prosthetic reconstruction of the chest wall. Thorac Surg Clin 2010;20:551-8
- 14. Sanna S, Brandolini J, Pardolesi A, et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017;3:95.
- 15. Dell'Amore A, Cassanelli N, Dolci G, et al. An alternative technique for anterior chest wall reconstruction: the sternal allograft transplantation. Interact Cardiovasc Thorac Surg 2012;15:944-7.
- 16. Marulli G, Dell'amore A, Calabrese F, et al. Safety and Effectiveness of Cadaveric Allograft Sternochondral Replacement After Sternectomy: A New Tool for the Reconstruction of Anterior Chest Wall. Ann Thorac Surg 2017;103:898-905.
- 17. Iarussi T, Pardolesi A, Camplese P, et al. Composite chest wall reconstruction using titanium plates and mesh preserves chest wall function. J Thorac Cardiovasc Surg 2010;140:476-7.
- 18. Tamburini N, Grossi W, Sanna S, Campisi A, Londero F, Maniscalco P, Dolci G, Quarantotto F, Daddi N, Morelli A, Cavallesco G, Dell'Amore A. Chest wall reconstruction using a new titanium mesh: a multicenters experience. J Thorac Dis. 2019 Aug;11(8):3459-3466.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2020 |
| Kabul Tarihi | 6 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 3 Sayı: 1 |
