Resection of the chest wall for bone and soft tissue neoplasms in children

Abstract

Chest tumors are quite rare in children. Among them there are benign and malignant. In all cases, surgical intervention is needed; in malignant tumors, as a stage of treatment, it is aimed at removing the tumor and, if necessary, reconstructing the chest wall. Due to the different localization, local spread and involvement of underlying structures, the surgical approach may involve a large extent of chest wall resection, and a variety of plastic materials and techniques is quite wide. During the period from September 2012 to January 2022, 43 surgical interventions for neoplasms of the chest wall in children were performed in the Department of Oncology and Pediatric Surgery of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. In 11 (26.8%) cases, neoplasms were benign, 30 (73.2%) patients underwent surgical treatment for malignant tumors of various histogenesis. The surgery of the chest wall consisted of two stages. The first stage was a wide excision of the tumor within healthy tissues, performed en bloc with the involvement of underlying tissues and organs (diaphragm). If a malignant process and lung foci were detected, we simultaneously removed the foci on the affected side. The second stage was the reconstruction of the chest wall and diaphragm with local tissues or with the use of non-absorbable synthetic material (polymer meshes, dermal-derived bioprostheses, titanium meshes) shaped according to the size of the defect with a margin for fixation to the edges of the wound. Overall and relapse-free survival was evaluated. The maximum observation period was 9 years. The operative approach and the extent of surgical intervention depend on the size of the primary tumor site and its spread (multifocal lesion), the involvement of adjacent anatomical structures and are individual in each case. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology.