Expanding the scope of the orthopaedic oncology practice: our experience with resection and reconstruction of chest wall tumors

Background: Few studies exist discussing the orthopaedic oncologist's role with resection of chest wall tumors. The primary goal of this study was to evaluate our experience and outcomes with resection and reconstruction of chest wall tumors. Methods: A retrospective review of patients who underwent resection of benign or malignant chest wall tumors at our institution between 1992 and 2009 was conducted. Only resections of the bony thorax were included. Median follow-up was 25 months (range 1-227 months). Results: Twenty-five patients underwent bony thoracic resection at our institution. Three of these patients had benign tumors: giant cell tumor, chondromyxoid fibroma, and an osteochondroma causing dysphagia. Thoracic or pediatric surgeons assisted in 16 of these cases. Plastic surgery assisted with soft-tissue reconstruction in eight cases. Only five of 22 (23%) patients with a malignant tumor had a positive margin at the time of resection. The 5-year and 10-year survival based on Kaplan-Meier Survival curve was 83%. Patients with chondrosarcoma had a significantly greater recurrence-free survival than all other malignant histiotypes ( 83% compared with 50%). Respiratory complications were minimal, with 52% extubated on the day of surgery and an average time until extubation of 1.7 days. Six patients had chronic pain at latest follow-up. Conclusions: While rarely a substantial portion of orthopaedic residency or even musculoskeletal oncology fellowship training, resections of the bony thorax can be performed successfully and safely by orthopaedic oncologists. By following appropriate sarcoma principles, optimal results can be obtained with minimal perioperative morbidity.