A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach
Affiliation(s)
Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
ABSTRACT
A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.
A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.
KEYWORDS
Surgery, Transmanubrial Osteomuscular Sparing Approach, Fibrosarcoma, The First Rib Tumor, Chest Wall Reconstruction
Surgery, Transmanubrial Osteomuscular Sparing Approach, Fibrosarcoma, The First Rib Tumor, Chest Wall Reconstruction
Cite this paper
Ayabe, T. , Tomita, M. , Mori, H. , Chosa, E. and Nakamura, K. (2015) A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach. Open Journal of Thoracic Surgery, 5, 35-42. doi: 10.4236/ojts.2015.53008.
Ayabe, T. , Tomita, M. , Mori, H. , Chosa, E. and Nakamura, K. (2015) A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach. Open Journal of Thoracic Surgery, 5, 35-42. doi: 10.4236/ojts.2015.53008.
References
[1] Dahlin, D.C. and Unni, K.K. (1986) Bone Tumors: General Aspects and Data on 8542 Cases. Charles C. Thomas, Springfield. [2] Di Rienzo, G., Surrente, C., Lopez, C. and Urgese, A.L. (2010) Transmanubrial Osteomuscular Sparing Approach: Different Indications. Interactive Cardiovascular and Thoracic Surgery, 11, 482-484.
http://dx.doi.org/10.1510/icvts.2010.243238 [3] Pranikoff, T., Hirschl, R.B. and Schnaufer, L. (1995) Approach to Cervicothoracic Neuroblastomas via a Trap-Door Incision. Journal of Pediatric Surgery, 30, 546-548.
http://dx.doi.org/10.1016/0022-3468(95)90127-2 [4] Cormier, J.M. (1970) Voie, d’abord and de Partere sous-claviere. In: Patel, J. and Leger, L., Eds., Nouveau traite de technique Chirugicale. Tume V, Masson et Cie, Paris, 107-140. [5] Dartevelle, P.G., Chapelier, A.R., Macchiarini, P., Lenot, B., Cerrina, J., Ladurie, F.L., Parquin, F.J. and Lafont, D. (1993) Anterior Transcervical-Thoracic Approach for Radical Resection of Lung Tumors Invading the Thoracic Inlet. The Journal of Thoracic and Cardiovascular Surgery, 105, 1025-1034. [6] Grunenwald, D. and Spaggiari, L. (1997) Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors. The Annals of Thoracic Surgery, 63, 563-566.
http://dx.doi.org/10.1016/S0003-4975(96)01023-5 [7] Spaggiari, L. and Pastorino, U. (1999) Transmanubrial Approach with Antero-Lateral Thoracotomy for Apical Chest Tumor. The Annals of Thoracic Surgery, 68, 590-593.
http://dx.doi.org/10.1016/S0003-4975(99)00630-X [8] Shah, A.A. and D’Amico, T.A. (2010) Primary Chest Wall Tumors. Journal of the American College of Surgeons, 210, 360-366.
http://dx.doi.org/10.1016/j.jamcollsurg.2009.11.012 [9] Smith, S.E. and Keshavjee, S. (2010) Primary Chest Wall Tumors. Thoracic Surgery Clinics, 20, 495-507.
http://dx.doi.org/10.1016/j.thorsurg.2010.07.003 [10] Faber, L.P., Somers, J. and Templeton, A.C. (1995) Chest Wall Tumors. Current Problems in Surgery, 32, 661-747.
http://dx.doi.org/10.1016/s0011-3840(05)80007-3 [11] Hughes, E.K., James, S.L., Butt, S., Davies, A.M. and Saifuddin, A. (2006) Benign Primary Tumours of the Ribs. Clinical Radiology, 61, 314-322.
http://dx.doi.org/10.1016/j.crad.2005.12.005 [12] Gladish, G.W., Sabloff, B.M., Munden, R.F., Truong, M.T., Erasmus, J.J. and Chasen, M.H. (2002) Primary Thoracic Sarcomas. Radiographics, 22, 621-637.
http://dx.doi.org/10.1148/radiographics.22.3.g02ma17621 [13] Régnard, J.F., Icard, P., Guibert, L., de Montpreville, V.T., Magdeleinat, P. and Levasseur, P. (1999) Prognostic Factors and Results after Surgical Treatment of Primary Sarcomas of the Lung. The Annals of Thoracic Surgery, 68, 227-231.
http://dx.doi.org/10.1016/S0003-4975(99)00398-7 [14] Bacha, E.A., Wright, C.D., Grillo, H.C., Wain, J.C., Moncure, A., Keel, S.B., Donahue, D.M. and Mathisen, D.J. (1999) Surgical Treatment of Primary Pulmonary Sarcomas. European Journal of Cardio-Thoracic Surgery, 15, 456-460.
http://dx.doi.org/10.1016/S1010-7940(99)00045-7 [15] Gordon, M.S., Hajdu, S.I., Bains, M.S. and Burt, M.E. (1999) Soft Tissue Sarcomas of the Chest Wall. Results of Surgical Resection. The Journal of Thoracic and Cardiovascular Surgery, 101, 843-854. [16] de Perrot, M., Kurt, A.M., Robert, J.H., Borisch, B. and Spiliopoulos, A. (1999) Clinical Behavior of Solitary Fibrous Tumors of the Pleura. The Annals of Thoracic Surgery, 67, 1456-1459.
http://dx.doi.org/10.1016/S0003-4975(99)00260-X [17] Keel, S.B., Bacha, E., Mark, E.J., Nielsen, G.P. and Rosenberg, A.E. (1999) Primary Pulmonary Sarcoma: A Clinicopathologic Study of 26 Cases. Modern Pathology, 12, 1124-1131. [18] McAfee, M.K., Pairolero, P.C., Bergstralh, E.J., Piehler, J.M., Unni, K.K., McLeod, R.A., Bernatz, P.E. and Payne, W.S. (1985) Chondrosarcoma of the Chest Wall: Factors Affecting Survival. The Annals of Thoracic Surgery, 40, 535-541.
http://dx.doi.org/10.1016/S0003-4975(10)60344-X [19] Pfannschmidt, J., Geisbüsch, P., Muley, T., Dienemann, H. and Hoffmann, H. (2006) Surgical Treatment of Primary Soft Tissue Sarcomas Involving the Chest: Experiences in 25 Patients. The Thoracic and Cardiovascular Surgeon, 54, 182-187.
http://dx.doi.org/10.1055/s-2005-872973 [20] Walsh, G.L., Davis, B.M., Swisher, S.G., Vaporciyan, A.A., Smythe, W.R., Willis-Merriman, K., Roth, J.A. and Putnam Jr., J.B. (2001) A Single-Institutional, Multidisciplinary Approach to Primary Sarcomas Involving the Chest Wall Requiring Full-Thickness Resections. The Journal of Thoracic and Cardiovascular Surgery, 121, 48-60.
http://dx.doi.org/10.1067/mtc.2001.111381 [21] Incarbone, M. and Pastorino, U. (2001) Surgical Treatment of Chest Wall Tumors. World Journal of Surgery, 25, 218-230.
http://dx.doi.org/10.1007/s002680020022 [22] King, R.M., Pairolero, P.C., Trastek, V.F., Piehler, J.M., Payne, W.S. and Bernatz, P.E. (1986) Primary Chest Wall Tumors: Factors Affecting Survival. The Annals of Thoracic Surgery, 41, 597-601.
http://dx.doi.org/10.1016/S0003-4975(10)63067-6 [23] Graeber, G.M., Snyder, R.J., Fleming, A.W., Head, H.D., Lough, F.C., Parker, J.S., Zajtchuk, R. and Brott, W.H. (1982) Initial and Long-Term Results in the Management of Primary Chest Wall Neoplasms. The Annals of Thoracic Surgery, 34, 664-673.
http://dx.doi.org/10.1016/S0003-4975(10)60906-X [24] Kitada, M., Ozawa, K., Sato, K., Hayashi, S. and Sasajima, T. (2010) Resection of a Chondrosarcoma Arising in the Right First Rib: A Case Report. Annals of Thoracic and Cardiovascular Surgery, 16, 118-121. [25] McCormack, P., Bains, M.S., Beattie Jr., E.J. and Martini, N. (1981) New Trends in Skeletal Reconstruction after Resection of Chest Wall Tumors. The Annals of Thoracic Surgery, 31, 45-52.
http://dx.doi.org/10.1016/S0003-4975(10)61315-X [26] Graeber, G.M.J.D. and Pairolero, P.C. (1995) Primary Neoplasm. In: Pearson, G.F.D.J., Hiebert, C.A., Ginsberg, R.J., McKneally, M.F. and Urschel, H., Eds., Thoracic Surgery, Churchill Livingstone, Philadelphia, 1237-1251. [27] Arnold, P.G. and Pairolero, P.C. (1996) Chest-Wall Reconstruction: An Account of 500 Consecutive Patients. Plastic & Reconstructive Surgery, 98, 804-810.
http://dx.doi.org/10.1097/00006534-199610000-00008 [28] Sakellaridis, T., Gaitanakis, S. and Piyis, A. (2014) Rib Tumors: A 15-Year Experience. General Thoracic and Cardiovascular Surgery, 62, 434-440.
http://dx.doi.org/10.1007/s11748-014-0387-9 [29] Spaggiari, L., Calabrese, L., Gioacchino, G. and Pastorino, U. (1999) Cervico-Thoracic Tumors Resection through Transmanubrial Osteomuscular Sparing Approach. European Journal of Cardio-Thoracic Surgery, 16, 564-567.
http://dx.doi.org/10.1016/S1010-7940(99)00311-5 [30] Grunenwald, D. (1998) Hemivertebrectomy for Apical Chest Tumors: Is the Risk Justified? [Reply to Letter]. The Annals of Thoracic Surgery, 65, 1516-1517. [31] Fischer, S., de Perrot, M., Sekine, Y. and Keshavjee, S. (2001) Long-Term Survival after Multiple Resections of a Fibrosarcoma Involving the Lung and Chest Wall. European Journal of Cardio-Thoracic Surgery, 20, 421-423.
http://dx.doi.org/10.1016/S1010-7940(01)00806-5
[1] Dahlin, D.C. and Unni, K.K. (1986) Bone Tumors: General Aspects and Data on 8542 Cases. Charles C. Thomas, Springfield. [2] Di Rienzo, G., Surrente, C., Lopez, C. and Urgese, A.L. (2010) Transmanubrial Osteomuscular Sparing Approach: Different Indications. Interactive Cardiovascular and Thoracic Surgery, 11, 482-484.
http://dx.doi.org/10.1510/icvts.2010.243238 [3] Pranikoff, T., Hirschl, R.B. and Schnaufer, L. (1995) Approach to Cervicothoracic Neuroblastomas via a Trap-Door Incision. Journal of Pediatric Surgery, 30, 546-548.
http://dx.doi.org/10.1016/0022-3468(95)90127-2 [4] Cormier, J.M. (1970) Voie, d’abord and de Partere sous-claviere. In: Patel, J. and Leger, L., Eds., Nouveau traite de technique Chirugicale. Tume V, Masson et Cie, Paris, 107-140. [5] Dartevelle, P.G., Chapelier, A.R., Macchiarini, P., Lenot, B., Cerrina, J., Ladurie, F.L., Parquin, F.J. and Lafont, D. (1993) Anterior Transcervical-Thoracic Approach for Radical Resection of Lung Tumors Invading the Thoracic Inlet. The Journal of Thoracic and Cardiovascular Surgery, 105, 1025-1034. [6] Grunenwald, D. and Spaggiari, L. (1997) Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors. The Annals of Thoracic Surgery, 63, 563-566.
http://dx.doi.org/10.1016/S0003-4975(96)01023-5 [7] Spaggiari, L. and Pastorino, U. (1999) Transmanubrial Approach with Antero-Lateral Thoracotomy for Apical Chest Tumor. The Annals of Thoracic Surgery, 68, 590-593.
http://dx.doi.org/10.1016/S0003-4975(99)00630-X [8] Shah, A.A. and D’Amico, T.A. (2010) Primary Chest Wall Tumors. Journal of the American College of Surgeons, 210, 360-366.
http://dx.doi.org/10.1016/j.jamcollsurg.2009.11.012 [9] Smith, S.E. and Keshavjee, S. (2010) Primary Chest Wall Tumors. Thoracic Surgery Clinics, 20, 495-507.
http://dx.doi.org/10.1016/j.thorsurg.2010.07.003 [10] Faber, L.P., Somers, J. and Templeton, A.C. (1995) Chest Wall Tumors. Current Problems in Surgery, 32, 661-747.
http://dx.doi.org/10.1016/s0011-3840(05)80007-3 [11] Hughes, E.K., James, S.L., Butt, S., Davies, A.M. and Saifuddin, A. (2006) Benign Primary Tumours of the Ribs. Clinical Radiology, 61, 314-322.
http://dx.doi.org/10.1016/j.crad.2005.12.005 [12] Gladish, G.W., Sabloff, B.M., Munden, R.F., Truong, M.T., Erasmus, J.J. and Chasen, M.H. (2002) Primary Thoracic Sarcomas. Radiographics, 22, 621-637.
http://dx.doi.org/10.1148/radiographics.22.3.g02ma17621 [13] Régnard, J.F., Icard, P., Guibert, L., de Montpreville, V.T., Magdeleinat, P. and Levasseur, P. (1999) Prognostic Factors and Results after Surgical Treatment of Primary Sarcomas of the Lung. The Annals of Thoracic Surgery, 68, 227-231.
http://dx.doi.org/10.1016/S0003-4975(99)00398-7 [14] Bacha, E.A., Wright, C.D., Grillo, H.C., Wain, J.C., Moncure, A., Keel, S.B., Donahue, D.M. and Mathisen, D.J. (1999) Surgical Treatment of Primary Pulmonary Sarcomas. European Journal of Cardio-Thoracic Surgery, 15, 456-460.
http://dx.doi.org/10.1016/S1010-7940(99)00045-7 [15] Gordon, M.S., Hajdu, S.I., Bains, M.S. and Burt, M.E. (1999) Soft Tissue Sarcomas of the Chest Wall. Results of Surgical Resection. The Journal of Thoracic and Cardiovascular Surgery, 101, 843-854. [16] de Perrot, M., Kurt, A.M., Robert, J.H., Borisch, B. and Spiliopoulos, A. (1999) Clinical Behavior of Solitary Fibrous Tumors of the Pleura. The Annals of Thoracic Surgery, 67, 1456-1459.
http://dx.doi.org/10.1016/S0003-4975(99)00260-X [17] Keel, S.B., Bacha, E., Mark, E.J., Nielsen, G.P. and Rosenberg, A.E. (1999) Primary Pulmonary Sarcoma: A Clinicopathologic Study of 26 Cases. Modern Pathology, 12, 1124-1131. [18] McAfee, M.K., Pairolero, P.C., Bergstralh, E.J., Piehler, J.M., Unni, K.K., McLeod, R.A., Bernatz, P.E. and Payne, W.S. (1985) Chondrosarcoma of the Chest Wall: Factors Affecting Survival. The Annals of Thoracic Surgery, 40, 535-541.
http://dx.doi.org/10.1016/S0003-4975(10)60344-X [19] Pfannschmidt, J., Geisbüsch, P., Muley, T., Dienemann, H. and Hoffmann, H. (2006) Surgical Treatment of Primary Soft Tissue Sarcomas Involving the Chest: Experiences in 25 Patients. The Thoracic and Cardiovascular Surgeon, 54, 182-187.
http://dx.doi.org/10.1055/s-2005-872973 [20] Walsh, G.L., Davis, B.M., Swisher, S.G., Vaporciyan, A.A., Smythe, W.R., Willis-Merriman, K., Roth, J.A. and Putnam Jr., J.B. (2001) A Single-Institutional, Multidisciplinary Approach to Primary Sarcomas Involving the Chest Wall Requiring Full-Thickness Resections. The Journal of Thoracic and Cardiovascular Surgery, 121, 48-60.
http://dx.doi.org/10.1067/mtc.2001.111381 [21] Incarbone, M. and Pastorino, U. (2001) Surgical Treatment of Chest Wall Tumors. World Journal of Surgery, 25, 218-230.
http://dx.doi.org/10.1007/s002680020022 [22] King, R.M., Pairolero, P.C., Trastek, V.F., Piehler, J.M., Payne, W.S. and Bernatz, P.E. (1986) Primary Chest Wall Tumors: Factors Affecting Survival. The Annals of Thoracic Surgery, 41, 597-601.
http://dx.doi.org/10.1016/S0003-4975(10)63067-6 [23] Graeber, G.M., Snyder, R.J., Fleming, A.W., Head, H.D., Lough, F.C., Parker, J.S., Zajtchuk, R. and Brott, W.H. (1982) Initial and Long-Term Results in the Management of Primary Chest Wall Neoplasms. The Annals of Thoracic Surgery, 34, 664-673.
http://dx.doi.org/10.1016/S0003-4975(10)60906-X [24] Kitada, M., Ozawa, K., Sato, K., Hayashi, S. and Sasajima, T. (2010) Resection of a Chondrosarcoma Arising in the Right First Rib: A Case Report. Annals of Thoracic and Cardiovascular Surgery, 16, 118-121. [25] McCormack, P., Bains, M.S., Beattie Jr., E.J. and Martini, N. (1981) New Trends in Skeletal Reconstruction after Resection of Chest Wall Tumors. The Annals of Thoracic Surgery, 31, 45-52.
http://dx.doi.org/10.1016/S0003-4975(10)61315-X [26] Graeber, G.M.J.D. and Pairolero, P.C. (1995) Primary Neoplasm. In: Pearson, G.F.D.J., Hiebert, C.A., Ginsberg, R.J., McKneally, M.F. and Urschel, H., Eds., Thoracic Surgery, Churchill Livingstone, Philadelphia, 1237-1251. [27] Arnold, P.G. and Pairolero, P.C. (1996) Chest-Wall Reconstruction: An Account of 500 Consecutive Patients. Plastic & Reconstructive Surgery, 98, 804-810.
http://dx.doi.org/10.1097/00006534-199610000-00008 [28] Sakellaridis, T., Gaitanakis, S. and Piyis, A. (2014) Rib Tumors: A 15-Year Experience. General Thoracic and Cardiovascular Surgery, 62, 434-440.
http://dx.doi.org/10.1007/s11748-014-0387-9 [29] Spaggiari, L., Calabrese, L., Gioacchino, G. and Pastorino, U. (1999) Cervico-Thoracic Tumors Resection through Transmanubrial Osteomuscular Sparing Approach. European Journal of Cardio-Thoracic Surgery, 16, 564-567.
http://dx.doi.org/10.1016/S1010-7940(99)00311-5 [30] Grunenwald, D. (1998) Hemivertebrectomy for Apical Chest Tumors: Is the Risk Justified? [Reply to Letter]. The Annals of Thoracic Surgery, 65, 1516-1517. [31] Fischer, S., de Perrot, M., Sekine, Y. and Keshavjee, S. (2001) Long-Term Survival after Multiple Resections of a Fibrosarcoma Involving the Lung and Chest Wall. European Journal of Cardio-Thoracic Surgery, 20, 421-423.
http://dx.doi.org/10.1016/S1010-7940(01)00806-5