Primary Chest Wall Tumors Research Articles

Complex chest wall reconstruction after failure: a literature review.

Primary and secondary chest wall tumors (bone, breast, and soft tissue), congenital defects, and chest wall osteoradionecrosis often require extensive full-thickness local excisions to guarantee safe oncological margins (in cases of tumors) and complex reconstruction to provide stabilization and good biomechanical results avoiding postoperative respiratory failure. Thus, a personalized approach is required when dealing with chest wall defects, and reconstruction is planned. This review summarizes failed chest wall reconstruction procedures, identifies causes of failure, and highlights principles for complex chest wall reconstruction post-failure. We performed a narrative review of the literature on PubMed, Scopus, ScienceDirect, and Google Scholar, including all the relevant studies published from 1970. The available experiences in literature are only anecdotic and no current guidelines or rules exist on this topic, also given to its rarity. Proper pre-surgical planning and a multidisciplinary team (MDT) discussion are crucial for complex cases such as infections and radiation-induced chest ulcers after previous surgical treatment. Procedures should eventually include thoracic wall debridement, necrotic tissue excision, pulse-jet lavage, prosthesis removal, and vacuum assisted closure (VAC) therapy as a bridge for chest wall re-reconstruction. Sternotomy wounds require wire and prosthesis removal, and the use of meshes or bone allografts. This review aims to summarize experiences and highlight surgical and oncologic principles for complex chest wall reconstruction after failure. This review summarizes literature experiences to identify common key points for chest wall reconstruction after failure and to give some advice to surgeons managing this rare, challenging surgery.

Anterior Chest Wall Sarcoma: An Aggressive Tumor

Abstract Patients with chest wall tumors present diagnostic and therapeutic challenges. The differential diagnosis of these tumors is broad because they can present a heterogeneous spectrum of diseases such as primary benign or malignant tumors, metastasis, local extension of adjacent tumors, and infectious or inflammatory conditions. Among that, primary chest wall tumors are rare.

Scoliosis After Resection of Primary Pediatric Chest Wall Tumors

BackgroundScoliosis is one of the long-term consequences of surgical resection of pediatric chest wall tumors. This study aimed to identify the risk factors associated with scoliosis development following the resection of chest wall tumors. MethodsRetrospective cohort study of 64 children who underwent resection of malignant chest wall tumors from 2009 to 2022. Univariate and multivariate analyses were used to investigate factors associated with scoliosis development. ResultsThe median age at the time of surgery was 7 years (range, 3–21), with 33 (51.6%) patients undergoing surgery before the age of 10 years. The most common histology was Ewing sarcoma (n = 57). A median of 3 (range, 1–5) contiguous ribs were resected. A total of 34 (53.1%) patients had anterior CWTs and 30 (46.9%) had posterior CWTs. Concomitant partial lung and diaphragmatic resection were performed in 12 patients (lung, n = 7; diaphragm, n = 5). Scoliosis convex towards the resection side developed in 21 (32.8%). The primary risk factors for scoliosis were resecting 3 or more ribs (OR 6.44) and resection of the posterior rib segment (OR 5.49). Patients with a tumor resection below 10 years old were not associated with a higher risk of scoliosis. ConclusionsScoliosis following resection of a primary malignant pediatric chest wall tumor is associated with resection involving three or more ribs and resection of the posterior rib sector. Type of StudyRetrospective observational. Level of EvidenceIV.

Should wide chest wall resections and reconstruction intimidate thoracic surgeons?

This study aimed to compare patients in whom wide chest wall resection and reconstruction or primary closure was performed. A total of 63 patients who underwent chest wall resection and reconstruction between January 2018 and December 2022 were included in the retrospective study. The patients were divided into two groups: the first group, which included 31 patients (14 males, 17 females; mean age: 44.6±16.4 years; range, 16 to 71 years) who were closed primarily, and the second group, constituting 32 patients (25 males, 7 females; mean age: 54.6±17.2 years; range, 9 to 80 years) who underwent reconstruction with plates and meshes. There was no significant difference between the two groups in terms of smoking and diabetes. Primary chest wall or metastatic tumor was determined in 33 patients; benign tumor and trauma were determined in 30 patients. The difference between the two groups in mean defect diameter (p=0.009), mean number of plates used (p<0.001), and mean hospital stay (p<0.001) was statistically significant. However, there was no significant difference in terms of complications (p=0.426). Wide chest wall resection and reconstruction is a safe and feasible surgical procedure when compared with primary closure.

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0.

Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

Oncological results in primary and secondary malignant chest wall tumors.

This study aims to evaluate the oncological results of primary and secondary chest wall tumors treated with curative resections and to investigate possible prognostic factors. Between January 2010 and December 2021, a total of 77 patients (53 males, 24 females; median age: 59 years; range, 3 to 87 years) who underwent curative resection for malignant chest wall tumors were retrospectively analyzed. Each tumor was staged according to its histological type. Age, sex, tumor diameter, tumor type (primary/secondary), histological tumor type, grade, stage, complete resection, rib resection, reconstruction, neoadjuvant and adjuvant therapy, recurrence, and survival data were recorded. Of the chest wall tumors, 33 (42.9%) were primary and 44 (57.1%) were secondary (local invasion, metastasis). Nine (11.7%) patients had positive surgical margins. Chest wall resection was most commonly performed due to lung cancer invasion (46.8%), followed by Ewing sarcoma (13%). Recurrence was observed in 34 (44.2%) patients. The five-year recurrence-free survival rate was 42.7% and the five-year overall survival rate was 58.6%. There was no significant difference between the primary and secondary tumors in terms of recurrence-free and overall survival (p=0.663 and p=0.313, respectively). In the multivariate analysis, tumor grade and rib resection were found to be independent prognostic factors for both recurrence-free survival (p=0.005 and p<0.001, respectively) and overall survival (p=0.048 and p=0.007, respectively). Successful oncological results can be achieved in wellselected patients with primary and secondary chest wall tumors. The grade of the tumor should be taken into account while determining the neoadjuvant or adjuvant treatment approach and surgical margin width. Rib resection should not be avoided when necessary.

Comparing Pediatric and Adult Primary Chest Wall Tumors

Comparing Pediatric and Adult Primary Chest Wall Tumors

Robotic chest wall resection for primary benign chest wall tumors and locally advanced lung cancer: an institutional case series and national report.

Limited data exists for robotic chest wall resection; we report institutional and national experience of robotic chest wall resection. In this comparative retrospective case series we describe patients who underwent robotic chest wall resection at our institution and enrich this case series with data from the National Cancer Database (NCDB). We describe our preoperative workup, operative technique, and postoperative care. Outcomes included conversion to open, length of stay, readmissions, and 30- and 90-day mortality. The results are descriptively reported and compared. We describe 6 patients institutionally and 96 NCDB patients. At our institution 66.7% were males, median age was 70.0 (range, 39-91) years, and 50% were primary chest wall tumors. Median tumor size was 5.25 (range, 2.3-8.3) cm. Outcomes were as follows: no open conversions, median length of stay 3 (range, 1-6) days, no unplanned 30-day readmissions or 90-day mortality. In the NCDB, 55.2% were males with median age of 68.5 (range, 30-89) years. Median tumor size was 3.90 (range, 2.4-6.0) cm. NCDB outcomes were as follows: 18.8% open conversion, median length of stay 7 (range, 5-10) days, 3.1% unplanned 30-day readmission, and 8.3% 90-day mortality. Our institutional case series had 18.0 months median follow-up (range, 6-54 months) with no functional deficits. Median survival in NCDB was 49.6 months. Robotic chest wall resection is feasible and is performed nationally with acceptable short- and long-term outcomes. Our institutional experience reports our technique, resultant short hospital stay, and excellent functional outcomes.

Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction, our institutional experience

Primary chest wall tumours are not very common. Chondrosarcomas is most common tumour arising from the chest wall. It occurs more often during the third and fourth decade of life. Chondrosarcomas are resistant to conventional chemotherapy and radiotherapy. Wide margin surgical excision remains the best available treatment approach. For chondrosarcomas involving the chest wall, surgical excision may result in chest wall defects that may require reconstruction to obliterate dead space, restore chest wall rigidity, preserve respiratory mechanics, maintain pulmonary function, protect intrathoracic organs, provide soft tissue coverage and minimize deformity. In this article we present a series of 3 cases of chondrosarcoma of anterior chest wall managed at government Royapettah hospital, Kilpauk medical college, Chennai. A 71-year-old male patient, a case of 22×20 cm giant chondrosarcoma arising from anterior left chest wall involving 2nd to 8th ribs. We did wide local excision and reconstruction of chest wall with a synthetic bone cement (methyl methacrylate) construct, sandwiched between two layers of polypropylene mesh. A 38-year-old male patient, a case of 8×6 cm chondrosarcoma of left anterior chest wall involving 9th rib, we did wide excision of tumor along with 8th, 9th, 10th ribs and defect reconstructed with prolene mesh. A 37-year-old male patient, a case of 5×4 cm chondrosarcoma arising from left 4th rib. We did wide excision along with 4th rib and primary closure. Patients with chondrosarcomas generally have a good prognosis when optimally diagnosed and treated. Our case series is interesting due to the different sizes of chondrosarcomas at presentation, which are managed differently. Complete resection with wide surgical margin remains the best available treatment, but post resection chest wall reconstruction is posing a great surgical challenge.

The Role of Surgery in Primary Chest Wall Tumors: Over 20 Years' Experience in Resection and Reconstruction.

Primary chest wall tumors comprise a heterogeneous group of neoplasms arising from soft tissues and bones. While surgical excision is the standard of care for benign tumors, the management of malignant tumors requires multimodal treatment. We conducted a predictive analysis of outcome, recurrence-free and overall survival. We retrospectively reviewed the clinical and pathological records of all patients treated in our center between 1998 and 2020. 53 patients (15-85 years) were treated in our department. The average tumor diameter was 65 ± 35 mm (10-160 mm). Negative margins were obtained in 48 patients (90.6%), whereas in the remaining 5, R1 resection was accomplished. Median overall survival was 63,03 months (1-282 months). Overall survival was 90% at 1 year, 78% at 2 years, and 61% at 5 years. Our analysis identified tumor diameter, postoperative complications, and high grade of malignancy as factors that can influence prognosis. The treatment of primary chest wall tumors remains a very challenging process. Different histological types preclude definition of an unequivocal approach. Complete resection with healthy margins remains a definitive cornerstone in the treatment of these cancers as part of a more comprehensive approach.

Contemporary outcomes of surgical resection for chest wall chondrosarcoma

ObjectiveChondrosarcoma is the most common primary malignant chest wall tumor and is historically associated with poor prognosis. Recommendations regarding surgical excision are on the basis of small, single-institution studies. We used a large national database to assess outcomes of surgery for chest wall chondrosarcoma (CWC) hypothesizing that surgical excision remains standard of care. MethodsThe National Cancer Databases for bone and soft tissue were merged to identify patients with chondrosarcoma from 2004 to 2018. Clinical and demographic characteristics of CWC were compared with chondrosarcoma from other sites. The primary outcome was overall survival described using Kaplan–Meier estimate. Univariable and multivariable Cox analysis was used to determine risk factors for poor survival among CWC patients who underwent surgery. Multivariable analysis of predictors of margin status was performed because of worse prognosis associated with positive margins. ResultsAmong 11,925 patients with chondrosarcoma, 1934 (16.2%) had a CWC. Relative to other sites, CWC was associated with older age, male sex, White race, surgical resection, and care at a nonacademic institution. CWC was associated with 1-, 3-, 5-, and 10-year survival of 91.5%, 82.0%, 75.5%, and 62.7%, respectively. In univariable analysis, survival was associated with surgery (hazard ratio, 0.02; P < .001) and adversely affected by positive margins (hazard ratio, 2.66; P < .001). Multivariable analysis showed larger tumor size was independently associated with increased risk for positive margins (odds ratio, 1.04; 95% CI, 1.011-1.075). ConclusionsCWC represents a different cohort of patients relative to chondrosarcoma from other sites. Surgical excision remains the optimal treatment, and positive margins are associated with poor prognosis.

Primary Diffuse Large B Cell Lymphoma Presenting as Chest Wall Mass: A Case Report

Primary chest wall masses or tumors can be of two types, either benign or malignant. Diffuse large B cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL). Though an aggressive malignancy, with timely and appropriate treatment, approximately two-third of all patients can be cured. We present a rare case of DLBCL presenting as chest wall mass. This case suggests the possibility of the presence of primary malignant B cell lymphoma, with the presentation as a chest wall lesion.&#x0D; Keywords: Chest mass, Diffuse large B cell lymphoma, Mass, Non- Hodgkin’s lymphoma.

Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience.

The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from not only bone or cartilage of the chest wall but also from associated subcutaneous tissue from muscle and blood vessels. Secondary tumors refer to a direct invasion of the chest wall by neoplasms located elsewhere in the body, mainly metastases from breast cancer and lung cancer. En-bloc surgical excision of the lesion should ensure adequate negative margins to avoid local recurrence, and a full thickness surgical resection is often required, and it can result in important chest-wall defects such as skeletal instability or impaired breathing dynamics. The reconstruction of large defects of the chest wall can be complex and often requires the use of prosthetic and biologic mesh materials. This article aims to review the literature on these tumor entities, focusing on the main surgical techniques and the most recent advances in chest-wall resection and reconstruction. We also report on the institutional experience our center.

STERNUM TUMOR SURGICAL TREATMENT METHOD: A CLINICAL CASE

Relevance: Sarcomas are relatively rare tumors. They make up 1% of all malignant neoplasms in adults, of which about 10-15% appear in the chest wall. Unlike primary tumors, metastatic bone tumors occur 2-4 times more often, while the sternum is affected in 9% of&#x0D; all metastatic bone lesions. A review of the literature and analysis of patients with chest wall tumors showed that surgical treatment might&#x0D; be the best option for primary and secondary chest wall tumors.&#x0D; Chondrosarcoma is the most common primary chest bone sarcoma and originates from the anterior segment of the ribs, less often from&#x0D; the sternum, scapula, or clavicle.&#x0D; The study aimed to present the outcome of a sternum sarcoma surgical treatment with a simultaneous reconstruction of an extensive&#x0D; postoperative defect at the Kazakh Institute of Oncology and Radiology (Almaty, Kazakhstan).&#x0D; Methods: The article reviews the literature on the treatment of chest wall tumors and describes a clinical case of a patient with&#x0D; chondrosarcoma of the sternum. After subtotal resection of the sternum 2-3 cm away from the tumor margins, the patient underwent&#x0D; reconstructive plastic surgery. Synthetic material was used to stabilize the chest wall, prevent paradoxical breathing, and replace&#x0D; the defect.&#x0D; Results: No recurrence of the primary process was registered after radical removal of the sternum tumor with the simultaneous reconstruction of the defect with synthetic material. Given the prevalence of the tumor, intraoperative suturing of the subclavian vein was&#x0D; performed, which led to vein thrombosis in the postoperative period.&#x0D; Conclusions: Early recognition and radical removal with adequate margins are essential to successful sternum tumor treatment. Complete excision with broadly negative microscopic margins at the first operation is paramount since local recurrence increases the risk of&#x0D; systemic metastasis and death. Thus, standard guidelines are required to ensure the proper treatment of chest wall sarcomas.

Giant Chondrosarcoma of Chest Wall

Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.

The size and sternal involvement of chest wall resections for malignant disease predict postoperative morbidity.

BackgroundChest wall resections/reconstructions are a validated approach to manage tumors invading the thorax. However, how resection characteristics affect postoperative morbidity and mortality is unknown. We determined the impact of chest wall resection size and location on patient short and long-term postoperative outcomes.MethodsWe reviewed all consecutive patients who underwent resections/reconstructions for chest wall tumors between 2003 and 2018. The impact of chest wall resection size and location and reconstruction on perioperative morbidity/mortality and oncological outcome were evaluated for each patient.ResultsNinety-three chest wall resections were performed in 88 patients for primary (sarcoma, breast cancer, n=66, 71%) and metastatic (n=27, 29%) chest wall tumors. The mean chest bony resection size was 107 (range, 15–375) cm2 and involved ribs only in 57% (n=53) or ribs combined to sternal/clavicular resections in 43% of patients (n=40). Chest defect reconstruction methods included muscle flaps alone (14%) prosthetic material alone (25%) or a combination of both (61%). Early systemic postoperative complications included pneumonia (n=15, 16%), atelectasis (n=6, 6%), pleural effusion (n=15, 16%) and arrhythmia (n=6, 6%). The most frequent long-term reconstructive complications included wound dehiscence (n=4), mesh infection (n=5) and seroma (n=4). Uni- and multivariable analyses indicated that chest wall resection size (>114 cm2) and location (sternum) were significantly associated with the occurrence of pneumonia and atelectasis [odds ratio (OR) =3.67, P=0.05; OR =78.92, P=0.02, respectively]. Disease-free and overall survival were 37±43 and 48±42 months for primary malignancy and of 24±33 and 48±53 months for metastatic chest wall tumors respectively with a mean follow-up of 46±44 months.ConclusionsChest wall resections present good long-term oncological outcomes. A resection size above 114 cm2 and the involvement of the sternum are significantly associated with higher rates of postoperative pneumonia/atelectasis. This subgroup of patients should have reinforced perioperative physical therapy protocols.

Case report on the approach to surgical management for a large chest wall chondrosarcoma.

Introduction and importancePrimary chest wall tumours are uncommon. Challenges arise in management due to delays in diagnosis and timing of treatment. The mainstay of treatment remains complete resection as adjuvant therapy has a limited role. Choice of repair and materials for chest wall reconstruction vary depending on the size and location of the defect. There are no published reports on management of chondrosarcomas arising from the rib in the Caribbean.Case presentationA 61-year-old female was referred from a rural clinic with a 10-month history of a progressively enlarging, painless right anterior chest wall lump. Computed Tomography (CT) shows features of a conventional chondrosarcoma arising from the ribs and including surrounding soft tissue, muscle and pleura. Surgical specimen confirms a grade 2 chondrosarcoma.Clinical discussionThis case illustrates the importance of a multidisciplinary team discussion. Differentiating a chondrosarcoma from a benign cartilaginous tumour requires consideration of clinical features, radiological characteristics and histological features. Chest wall reconstruction aims to preserve functional and structural integrity with adequate soft tissue coverage. The patient had good cosmesis as well as pulmonary function postoperatively and no recurrence at the 3 year follow up.ConclusionThis case highlights that the MDT is essential to a good outcome for the surgical management of a chest wall chondrosarcoma. Wide en-bloc resection followed by reconstruction using polypropylene mesh and a latissimus dorsi flap as a one-stage procedure can be successful.

Surgical Therapy of Malignant Lung and Chest Wall Tumours in Children

Primary lung and chest wall tumours as well as lung metastases are rare diseases in children. As part of multimodal cancer treatment, thoracic surgery can significantly improve survival in children suffering from paediatric solid tumours. The aim of the review article is to summarise the indications and the current surgical treatment options for malignant chest wall and lung tumours as well as to shed light on the current role of pulmonary metastasectomy in children.

Chest wall reconstruction with implantable cross-linked porcine dermal collagen matrix: Evaluation of clinical outcomes.

ObjectivesThe aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.MethodsWe retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.ResultsA total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.ConclusionsBiological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.

Video-Assisted Thoracic Surgery Technique for Chest Wall Resection

Chest wall resection is indicated in the management of operable primary chest wall tumors and lung cancers with chest wall invasion in carefully selected patients. Traditionally, chest wall resection has been performed via open thoracotomy, which is associated with significant postoperative pain and other associated morbidities. Furthermore, depending on the size and location of the resulting chest wall defect, chest wall reconstruction is warranted to maintain overall chest wall integrity, preserve inherent respiratory mechanics, and protect underlying intrathoracic structures. Video assisted thoracic surgery (VATS) techniques are an emerging and alternative technique to open chest wall resection, and have the potential benefit of minimizing the overall incision size, avoiding extensive rib spreading, and reducing tissue trauma. Given the technical challenges and lack of robust prospective outcomes data, VATS chest wall resection has not been widely adopted, but early reports appear to demonstrate its feasibility without apparent detriment to safety in selected patient populations. In this review, we detail relevant operative steps related to patient positioning and strategic port placement, anatomical dissection, and reconstruction options, as well as provide useful trouble shooting tips and tricks to help optimize outcomes following VATS chest wall resection. Chest wall resection is indicated in the management of operable primary chest wall tumors and lung cancers with chest wall invasion in carefully selected patients. Traditionally, chest wall resection has been performed via open thoracotomy, which is associated with significant postoperative pain and other associated morbidities. Furthermore, depending on the size and location of the resulting chest wall defect, chest wall reconstruction is warranted to maintain overall chest wall integrity, preserve inherent respiratory mechanics, and protect underlying intrathoracic structures. Video assisted thoracic surgery (VATS) techniques are an emerging and alternative technique to open chest wall resection, and have the potential benefit of minimizing the overall incision size, avoiding extensive rib spreading, and reducing tissue trauma. Given the technical challenges and lack of robust prospective outcomes data, VATS chest wall resection has not been widely adopted, but early reports appear to demonstrate its feasibility without apparent detriment to safety in selected patient populations. In this review, we detail relevant operative steps related to patient positioning and strategic port placement, anatomical dissection, and reconstruction options, as well as provide useful trouble shooting tips and tricks to help optimize outcomes following VATS chest wall resection. Commentary: Reasons to BotherOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewThe article by Hirji and colleagues is a well-illustrated primer for those wishing to embark on minimally invasive chest wall resection.1 Arguably, the popularity of this approach compared to VATS lobectomy has been tempered by the reasonable question, “Why bother avoiding thoracotomies if cutting through ribs anyway?” Full-Text PDF