Superior Sulcus Tumors Research Articles

Case Report on an Interesting Case of Pancoast Tumor

Case Report on an Interesting Case of Pancoast Tumor

Multimodality therapy for lung cancer invading the chest wall: A study of the French EPITHOR database

ObjectivesAccording to a nation-based study, we intend to report the data of the patients operated on for lung cancer invading the chest wall, taking into consideration the completion of induction chemotherapy (Ind_CT), induction radiochemotherapy (Ind_RCT) or no induction therapy (0_Ind). Materials and methodsAll patients with a primary lung cancer invading the chest wall who underwent radical resection from 2004 to 2019 were included. Superior sulcus tumors were excluded. ResultsOverall, 688 patients were included: 522 operated without induction therapy, 101 with Ind_CT and 65 with Ind_RCT. Postoperative 90-day mortality was 10.7% in the 0_Ind group, 5.0% in the Ind_CT group, 7.7% in the Ind_RCT group (p = 0.17). Incomplete resection rate was 14.0% in the 0_Ind group, 6.9% in the Ind_CT group, 6.2% in the Ind_RCT group (p = 0.04). In the 0_Ind group, 70% of the patients received adjuvant therapies. Overall survival (OS) analysis disclosed the best long-term outcomes in the Ind_RCT group (5-year OS probability: 56.5% versus 40.0% and 40.5% for 0_Ind and Ind_CT groups, respectively; p = 0.035). At multivariable analysis, Ind_RCT (HR = 0.571; p = 0.008), age > 60 years old (HR = 1,373; p = 0.005), male sex (HR = 1.710; p < 0.001), pneumonectomy (HR = 1.368; p = 0.025), pN2 status (HR = 1.981; p < 0.001), ≥3 resected ribs (HR = 1.329; p = 0.019), incomplete resection (HR = 2.284; p < 0.001) and lack of adjuvant therapy (HR = 1.959; p < 0.001) were associated with OS. Ind_CT was not associated with survival (HR = 0.848; p = 0.257). ConclusionInduction chemoradiation therapy seems to improve survival. Therefore, the present results should be confirmed by a prospective randomized trial testing the benefit of induction radiochemotherapy for NSCLC invading the chest wall.

Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients

Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45-66 Gy delivered in 25-33 fractions over 5-6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45-66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3-4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4-94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.

Anatomic evaluation of Pancoast tumors using three-dimensional models for surgical strategy development.

Pancoast tumor resection planning requires precise interpretation of 2-dimensional images. We hypothesized that patient-specific 3-dimensional reconstructions, providing intuitive views of anatomy, would enable superior anatomic assessment. Cross-sectional images from 9 patients with representative Pancoast tumors, selected from an institutional database, were randomly assigned to presentation as 2-dimensional images, 3-dimensional virtual reconstruction, or 3-dimensional physical reconstruction. Thoracic surgeons (n=15) completed questionnaires on the tumor extent and a zone-based algorithmic surgical approach for each patient. Responses were compared with surgical pathology, documented surgical approach, and the optimal "zone-specific" approach. A 5-point Likert scale assessed participants' opinions regarding data presentation and potential benefits of patient-specific 3-dimensional models. Identification of tumor invasion of segmented neurovascular structures was more accurate with 3-dimensional physical reconstruction (2-dimensional 65.56%, 3-dimensional virtual reconstruction 58.52%, 3-dimensional physical reconstruction 87.50%, P<.001); there was no difference for unsegmented structures. Classification of assessed zonal invasion was better with 3-dimensional physical reconstruction (2-dimensional 67.41%, 3-dimensional virtual reconstruction 77.04%, 3-dimensional physical reconstruction 86.67%; P=.001). However, selected surgical approaches were often discordant from documented (2-dimensional 23.81%, 3-dimensional virtual reconstruction 42.86%, 3-dimensional physical reconstruction 45.24%, P=.084) and "zone-specific" approaches (2-dimensional 33.33%, 3-dimensional virtual reconstruction 42.86%, 3-dimensional physical reconstruction 45.24%, P=.501). All surgeons agreed that 3-dimensional virtual reconstruction and 3-dimensional physical reconstruction benefit surgical planning. Most surgeons (14/15) agreed that 3-dimensional virtual reconstruction and 3-dimensional physical reconstruction would facilitate patient and interdisciplinary communication. Finally, most surgeons (14/15) agreed that 3-dimensional virtual reconstruction and 3-dimensional physical reconstruction's benefits outweighed potential delays in care for model construction. Although a consistent effect on surgical strategy was not identified, patient-specific 3-dimensional Pancoast tumor models provided accurate and user-friendly overviews of critical thoracic structures with perceived benefits for surgeons' clinical practices.

Long-Term Outcomes After Chemoradiotherapy and Surgery for Superior Sulcus Tumors

IntroductionSuperior sulcus tumors (SSTs) are uncommon, and their anatomical location can make treatment challenging. We analyzed late outcomes of patients with SST treated with concurrent chemoradiotherapy followed by surgical resection (trimodality) in a single tertiary institution. MethodsPatients with non–small cell SSTs, who underwent trimodality therapy between 2002 and 2017, were selected from a prospective institutional surgical database. Patients were uniformly staged with 18F-fluorodeoxyglucose–positron emission tomography, computed tomography scan of the chest and upper abdomen, and brain imaging. Patients undergoing resection of the lung plus chest wall were grouped as limited SST and those needing extensive resections (e.g., including the vertebral body) as extended SST. Kaplan-Meier survival analysis was performed to determine difference in survival. Multivariate Cox regression was used to identify prognostic factors. ResultsA total of 123 patients were identified with a median follow-up of 4.9 years (interquartile range: 1.6–8.9 y). The 90-day postoperative mortality and morbidity (Clavien-Dindo grades III–V) were 6.5% and 21.1%, respectively. Patients with a radical resection (R0: 92.7%) had better survival (p = 0.002), as did those who had major pathologic response (73%) (p = 0.001). Ten-year overall survival (OS) and disease-free survival were 48.1% and 42.6%, respectively. There were no differences in 90-day mortality (p = 0.31) and OS (p = 0.79) between extended SST and limited SST patients. ConclusionsIn patients with SST, trimodality resulted in a 10-year estimated OS and disease-free survival of 48.1% and 42.6%, respectively, which were improved after radical resection (R0) and major pathologic response. Survival for limited and extended resections was comparable, and distant relapse was the main pattern of failure. Better systemic treatments are therefore needed.

Prognostic difference between each T3 descriptor in T3N0-3M0 non-small-cell lung cancer.

The American Joint Committee on Cancer tumour-node-metastasis (TNM) staging manual is revised every few years. The current 8th edition of the TNM staging manual was published in 2017 and revised to reflect prognosis of patients with non-small-cell lung cancer (NSCLC) [1]. In particular, the T descriptors have been subdivided based on the largest dimension of the solid component, rather than tumour diameter. This is because tumour size is determined by the largest dimension of the solid component on computed tomography (clinical) or the invasive component (pathological). In the current 8th TNM staging, T3 descriptors include tumours larger than 5 cm but equal to <7 cm in greatest dimension (T-size), chest wall invasion (T-chest; parietal pleural invasion and Pancoast tumours), pericardium invasion (T-pericardium), phrenic nerve invasion (T-phrenic nerve) and additional tumour nodules in the same lobe (T-add). Cai et al. [2] evaluated survival disparities among the T3N0-3M0 NSCLC patients using the Surveillance, Epidemiology, and End Results database. A series of 28 159 eligible cases were included from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. The authors combined T-chest, T-pericardium and T-phrenic nerve into 1 group (T-invasion) due to the small number of cases in the T-pericardium and T-phrenic nerve. T-multiple was defined as the tumours having at least 2 T3 descriptors. As a result, the authors classified the T3 descriptors into 4 groups (T-size, T-invasion, T-add and T-multiple) and compared the prognostic differences. In this study, overall survival and cancer-specific survival were compared using the Kaplan–Meier method with a log-rank test and the prognostic factors of this cohort were determined using univariable and multivariable Cox regression models. The survival data showed that T-add patients had the best survival rates compared to other T3 patients. T-add patients had the best prognosis in both the pathological and clinical TNM stage cohorts, followed by T-size and T-multiple patients, and T-multiple patients had the worst prognosis. Multivariable Cox models indicated that T3 descriptors were an important prognostic factor. They concluded that the survival differences exist among the T3N0-3M0 NSCLC patients with different T3 descriptors and this should be taken into account in the next version of the TNM staging manual.

Pancoast and Tobias Syndrome Revealing Costal Ewing's Sarcoma about a Case

Pancoast and Tobias syndrome is usually caused by lung cancer. However, other causes can be described as in the case of our observation, hence the interest of histological confirmation in order to institute an adapted treatment.

Surgical management of superior sulcus tumors: A twenty-year experience of an oncological high volume referral centre.

Superior sulcus tumour, which affects the lung's apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years. Retrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 - December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS. 54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 - 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 - 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 - 12.5; p = 0.010). Superior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit.

Treatment patterns and outcomes in patients with Pancoast tumors: a national cancer database analysis.

Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymph node involvement are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation treatment, followed by surgical resection, as the standard of care. But many institutions choose upfront surgery. Our goal was to identify the treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB). The NCDB was queried from 2004 through 2017 to identify all patients who had undergone surgery for a Pancoast tumor. Treatment patterns, including the percentage of patients who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on the cohort who received upfront surgery. A total of 2,910 patients were included in the study. Overall 30- and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation treatment prior to surgery. Patients who received neoadjuvant chemoradiation treatment experienced significantly improved 90-day survival (P<0.01) and overall survival (P<0.01). When analyzing the cohort who received upfront surgery, there was a statistically significant difference in survival based on adjuvant treatment pattern (P<0.01). Patients in this group who received adjuvant chemoradiation had the best survival, whereas patients who received adjuvant radiation only or no treatment had the worst outcomes. Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases nationally. Patients who received neoadjuvant chemoradiation treatment had improved survival compared to patients who had upfront surgery. Similarly, when surgery is performed first, adjuvant chemoradiation treatment improved survival compared to other adjuvant strategies. These results suggest underutilization of neoadjuvant treatment for patients with node-negative Pancoast tumors. Future studies with a more clearly defined cohort are needed to assess the treatment patterns being utilized on patients with node-negative Pancoast tumors. It will be beneficial to see whether neoadjuvant treatment for Pancoast tumors has increased in recent years.

Two cases of Pancoast tumor where cervical root block was effective in pain relief, which resulted in continuation of cancer treatment

Two cases of Pancoast tumor where cervical root block was effective in pain relief, which resulted in continuation of cancer treatment

Endoscopic ultrasound to the rescue of pancoast tumour.

Dear Editor, A 48-year-old male presented with a two-month history of right-sided shoulder pain with right arm radiation and significant weight loss. A radiograph showed an opacity in the right upper zone. A 34 × 45 × 52 mm mass in the apex of the right lung was seen on contrast-enhanced computed tomography (CECT) [Figure 1a]. Magnetic resonance imaging (MRI) for local staging showed involvement of the right subclavian artery and nerve roots [Figure 1b]. A percutaneous biopsy was planned, but no safe window was available due to the clavicle and multiple vessels on the anterior aspect. Because of the proximity of the lesion to the oesophagus, the patient was referred for endoscopic ultrasound (EUS)-guided biopsy. EUS confirmed the findings of prior imaging [Figure 1c]. An initial attempt at EUS-guided fine-needle aspiration (FNA) with 22-G needle failed as the tumour was very hard. Hence, FNA of visualised subcarinal lymph nodes was performed with a 22-G needle followed by FNA of the tumour with a 19-G needle [Figure 2a]. After the procedure, the patient was observed for four hours and was discharged after confirming the absence of pneumothorax on chest radiograph. A final diagnosis of non-small cell carcinoma was made on pathological [Figure 2b] and cytological examination based on visualisation of clusters of large polygonal cells with round-to-oval vesicular pleomorphic nuclei with no evidence of malignancy in the mediastinal nodes. Because of an unresectable lesion, the patient was planned for a combination of induction chemotherapy and radiotherapy.Figure 1: (a) Contrast-enhanced computed tomography (CECT) of thorax showing a mass in the apex of the right lung. (b) Magnetic resonance imaging (MRI) showing involvement of the right subclavian artery (large arrow) and nerve roots of C8, T1, and T2 (small arrows), (c) Transoesophageal endoscopic ultrasound (EUS) showing a hypoechoic irregular lung mass located on top on lung parenchyma (asterisk) and encasing the subclavian artery anteriorly (arrow)Figure 2: (a) Endoscopic ultrasound-guided fine needle aspiration from lung mass, (b) Haematoxylin and eosin (H and E) staining of core lung mass biopsy, suggestive of non-small cell carcinoma of the lung (arrow)EUS has an established role in tissue acquisition from mediastinal lymph nodes, but data on EUS-guided sampling from lung mass remains limited. Transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided needle aspiration (EBUS-FNA) are the preferred modalities for the diagnosis and staging of lung cancer.[1] However, the tumour’s location at the apex of the lung makes them inaccessible to TBNA or EBUS-FNA. In such cases, tumours close to the oesophagus may be amenable to transoesophageal EUS-guided FNA. It also has the advantage of simultaneous sampling of mediastinal lymph nodes and other organs like the liver and adrenal for assessment of metastasis.[1] The present case highlights the utility of EUS for diagnosing lung tumours at inaccessible sites. A recent multicentric study from Italy reported the efficacy and safety of EUS-guided tissue sampling as a minimally invasive procedure for the diagnosis and staging of peri-oesophageal parenchymal lung lesions.[2] However, transoesophageal FNA from lung mass may be rarely associated with pneumothorax[3] and haemoptysis.[4] Hence, a check X-ray should be done to rule out pneumothorax before discharging the patient. Keeping in mind the possibilities of complications, EUS-FNA of the lung lesions should be done in centres with the availability of pulmonologist to immediately address the adverse events. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

Influence of anterior tumor location on survival after resection of lung cancer invading the thoracic inlet (Pancoast tumors)

ObjectiveSuperior sulcus tumors are a challenging subset of non–small cell lung carcinomas invading the thoracic inlet. In this study, we determined whether the location of the tumor along the first rib had an influence on survival. MethodsWe performed a review of 92 consecutive patients undergoing surgery for non–small cell lung carcinomas invading the thoracic inlet between January 1996 and June 2021. Tumor location was categorized into anterior and posterior based on predefined zones. ResultsIn total, 21 tumors were located anteriorly (23%) and 71 posteriorly (77%). The rate of R0 resection (81% vs 87%; P = .4) and pathological complete response to induction therapy (33% vs 37%; P = .8) were similar between locations. After a median follow-up of 5.8 years (range, 0.8-24 years), 49 patients died for an overall survival of 48% (95% CI, 38%-59%) at 5 years. The 5-year survival was favorably influenced by R0 (vs R1) resection (51% vs 29%; P = .02), pathological complete response (vs no pathological complete response) (69% vs 31%; P = .03), posterior (vs anterior) location (56% vs 22%; P = .01), and ≤60 (vs >60) years of age (61% vs 37%; P = .007). Compared with posterior tumors, anterior tumors were associated with higher risk of systemic recurrence and significantly greater survival benefit from pathological complete response. Anterior tumors remained an independent predictor of worse survival in multivariate analysis (hazard ratio, 2.3; 95% CI, 1.2-4.5; P = .01). ConclusionsThe anatomical location of the tumor affects survival after resection of non–small cell lung carcinomas invading the thoracic inlet. Anterior tumors have greater propensity to metastasize and may derive greater benefit from optimal systemic therapy than posterior tumors.

PANCOAST TUMOR : A CASE REPORT

Introduction: Pancoast tumor, or superior sulcus tumor, is defined as a tumor that grows on the thoracic inlet or grows on a pleuropulmonary peak that is found beyond the initial cost. These tumors may invade upper ribs, muscle, vertebral, subclavian vessels, the inferior portion of brachial plexus, sympathetic nervous system, and stellate ganglion. Pancoast tumors are mostly caused by non-small cell lung cancer. Case description: A 59-year-old man came to the emergency room with complaints about a lack of pain in his left chest. Other symptoms reported by the patient include chest discomfort, stiffness, pain rising and subsiding on the left arm that may spread back and forth, and weight loss. Chest CT Scan with contrast shows a heterogeneous mass appears at the tip of the left lung, pushing the upper lobe of the left lung, bronchiectasis at the lower lobe of the left lung, destruction of the left coastal bones 1, 2, and 3, and tracheobronchial supero-inferior lymphadenopathy. Anatomical pathology results round cell tumors favor adenocarcinoma with poorly differentiated metastasis Discussion: Diagnosis of Pancoast tumor is supported by patient symptoms, imaging results, and biopsies. This patient's complaints and symptoms are unusual, leading doctors to believe that the cause is not a Pancoast tumor. Keep in mind that Pancoast Tumors aren't the only thing that can cause Pancoast syndrome, though they are the most common. The results of this patient's biopsy rule out other causes of Pancoast tumor and are consistent with the cause of Pancoast tumors, namely adenocarcinoma, a type of non-small cell lung cancer. Conclusion: Chronic and progressive complaints and unintentional weight loss become "red flags" that may indicate the start of the malignancy process. A good clinical approach can help detect these tumors early, improving the patient's prognosis.

Carcinoma Cervix with Delayed Occurrence of Solitary Lung Metastasis Resenting as Pancoast Tumor, A Case Report

Carcinoma Cervix with Delayed Occurrence of Solitary Lung Metastasis Resenting as Pancoast Tumor, A Case Report

Pancoast Tumor: Clinical Manifestations and Surgical Management

Pancoast tumors are an interesting pathological entity when it comes to talking about mediastinal tumors, the alterations they cause are deeply rooted in their location. The development of surgical techniques as well as new antitumor therapies have created a pillar on which therapy that generates high survival in these patients could be based. However, these treatments also carry their risks

Pancoast Tumor: Clinical Manifestations and Surgical Management

Pancoast Tumor: Clinical Manifestations and Surgical Management

Treatment Patterns and Outcomes in Patients with Pancoast Tumors: A National Cancer Database Analysis

INTRODUCTION: Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymphadenopathy are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation followed by surgery as standard of care. But many institutions choose upfront surgery. Our goal was to identify treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB). METHODS: The NCDB was queried from 2004 through 2017 for all patients who had undergone surgery for Pancoast tumors. Treatment patterns, including the percentage who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on patients who received upfront surgery. RESULTS: A total of 2,910 patients were included in the study. Overall 30-day and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation before surgery. Patients who received neoadjuvant chemoradiation experienced improved 90-day survival (OR 0.63, p < 0.01) and overall survival (OR 0.94, p < 0.01; Fig. 1). When analyzing patients who received upfront surgery, adjuvant chemoradiation treatment was associated with improved survival compared to no treatment after surgery (OR 0.87, p < 0.01).CONCLUSION: Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases. Neoadjuvant chemoradiation is associated with improved survival compared to upfront surgery. When surgery is performed first, adjuvant chemoradiation treatment improves survival. These results suggest significant underutilization of standard of care for patients with Pancoast tumors.

Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates.

ObjectivesEn-bloc complete resection remains the treatment of choice for localized chest wall (CW) tumors. Titanium bars reconstruction demonstrated encouraging results with satisfactory early outcomes. However, long-term outcomes remain under-reported. The purpose of this study is to evaluate long-term outcomes after CW resection and repair with titanium devices.MethodsFrom June 2012 to December 2018, we retrospectively reviewed all patients with CW tumors who underwent surgical resection and repair using titanium. Long-term outcomes were assessed.ResultsWe identified 87 patients who underwent CW tumor resections and titanium reconstruction. Sixty-eight patients were included in the study (excluding benign tumors, Pancoast tumors, palliative surgeries, or clavicle reconstruction). There were 29 sarcomas, 20 isolated CW metastases, eight lung cancers, four breast cancers, three thymic malignancies, two sarcomatoid mesothelioma, and one desmoid tumor. Complete resection was achieved in 64 patients (94%), while R1 resection in four patients (6%). Resection involved one rib in two patients, two ribs in thirteen, three ribs in eighteen, four ribs in nine, five ribs in two, seven ribs in one, partial sternum in fifteen, and full sternum in sixteen patients. No patient experienced flail chest. The 1-year, 3-year, and 5-year overall survival rates and disease-free survivals were 82.3%, 61.4%,57.3%, and 67.6%,57.3%,52.6%, respectively. Surgical site infection occurred in 18% (n = 12) of cases. Eleven of twelve patients had an early infection (<1 year), which required material removal in six patients. Asymptomatic connector unsealing occurred in 6% (n = 4), with only one re-intervention. Titanium allergy has never been reported. Chronic chest pain (lasting more than 3 months after surgery, with daily use of pain killer) was reported in 24% of patients. ConclusionCW resections with titanium reconstruction are associated with long-term survivors. Titanium devices were safe, reliable, and achieved satisfactory oncological results with low morbidity and implant-related complication rates.

EP05.03-003 Superior Sulcus (Pancoast) Tumors: A 11-Year Single-Centre Experience

The term Pancoast tumors (PT) encompasses any tumor located on the lung apex with extension into vital structures in the thoracic inlet, leading to the development of the characteristic clinical syndrome. The main goal of this study was to analyze the response to surgical-multimodal treatment and the outcome of patients with PT.