Comprehensive Analysis of Chest Wall Resection: Indications, Reconstruction, and Results: A Systematic Review

Abstract

Introduction: Chest wall neoplasms encompass primary, locally invasive, and metastatic tumours. Malignant chest wall tumours are typically uncommon, comprising roughly 5% of all thoracic neoplasms and 1 to 2% of all primary tumours. This systematic review addresses the imperative need for a comprehensive analysis of chest wall resection, focusing on indications, reconstruction techniques, and outcomes, to provide clinicians with evidence-based guidelines for optimal patient management. Aim: To comprehensively review indications for chest wall resection, explore reconstruction techniques, and analyse complications and outcomes associated with the procedure. Materials and Methods: A thorough electronic database search was performed on PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED utilising the search terms “Chest wall,” “Chest wall Resection,” and “Chest wall Reconstruction.” Fulltext articles published in English within a 20-year period (from 1999 to 2020) were selected based on pre-defined inclusion and exclusion criteria and subjected to analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: In total, 24 full-text records met the inclusion and exclusion criteria and underwent critical analysis for this systematic review. Chest wall sarcomas emerged as the primary indication for chest wall resection in the present study, with recurrent or locally advanced breast carcinoma also noted as significant causes. Various artificial soft meshes, notably Marlex or Goretex, were commonly employed for reconstruction, while soft-tissue coverage was achieved through various myocutaneous flaps, both pedicled and free. Respiratory complications predominated among the observed complications, with wound-related issues also documented. Conclusion: Patient selection is paramount in chest wall reconstruction, with the ideal method still under debate. However, prioritising minimal patient morbidity during reconstruction is crucial. Adherence to these principles can lead to better outcomes in terms of complications, survival, and quality of life, especially in appropriately selected patients.