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European Spine Journal

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01-10-2015 | Ideas and Technical Innovations

Chest wall reconstruction after en bloc Pancoast tumour resection with the use of MatrixRib and SILC fixation systems: technical note

Authors: Marcin Czyz, Emmanuel Addae-Boateng, Bronek M. Boszczyk

Published in: European Spine Journal | Issue 10/2015

Abstract

Study design

Technical note.

Objective

In cases in which partial resection of the rib cage is accomplished with vertebrectomy, reconstruction of the chest wall may be challenging. That is because of lack of the anchor point which normally would be a proximal end of a rib or transverse process. We report a straightforward technique for chest wall reconstruction with the novel use of two systems of fixation commonly applied in spinal practice.

Methods

The operation of a squamous cell carcinoma (Pancoast tumour) of the right lung infiltrating T2, T3 and T4 vertebrae was performed though T4 lateral thoracotomy. Posterior instrumentation with transpedicular screws T1–3–5 on the left and T1–5 on the right side was followed with the right upper lobectomy and hemivertebrectomy. The laminae and facet joints of T2–T4 vertebrae were removed on the side of the tumour. An osteotomy was performed medial to the pedicle at the lateral aspect of the dural sac on the side of the tumour. Proximal parts of four adjacent ribs were removed allowing radical en bloc resection with tumour-free margins. The distal end of each of four rib plates used (MatrixRib Precontoured Plate system) was attached to the proximal end of the rib. The proximal end of the plate was then attached to the rod of posterior fixation construct with the use of a flexible polyethylene terephthalate (PeT) band of the SILC™ fixation system. The other end of the PeT band was then passed through the top-loading clamp subsequently attached to the rod of the posterior fixation.

Results

The patient did not require additional procedures for chest wall reconstruction. On the 7-month follow-up, in chest CT he was found with satisfactory expansion of the remaining lung tissue with proper spinal alignment and anatomical shape of the rib cage.

Conclusions

The reported technique can be applied for chest wall reconstruction in cases of total or subtotal vertebrectomy accomplished with the resection extending towards rib cage. It appears to be straightforward, safe and effective allowing good cosmetic and functional outcome.

Collaud S, Fadel E, Schirren J, Yokomise H, Bolukbas S, Dartevelle P, Keshavjee S, Waddell TK, de Perrot M (2014) En bloc resection of pulmonary sulcus non-small cell lung cancer invading the spine: a systematic literature review and pooled data analysis. Ann Surg. doi:10.1097/SLA.0000000000000797

Collaud S, Waddell TK, Yasufuku K, Pierre AF, Darling GE, Cypel M, Rampersaud YR, Lewis SJ, Shepherd FA, Leighl NB, Cho J, Bezjak A, Tsao MS, Keshavjee S, de Perrot M (2013) Long-term outcome after en bloc resection of non-small-cell lung cancer invading the pulmonary sulcus and spine. J Thorac Oncol 8:1538–1544. doi:10.1097/01.JTO.0000437419.31348.a4 CrossRefPubMed

Deslauriers J, Tronc F, Fortin D (2013) Management of tumors involving the chest wall including pancoast tumors and tumors invading the spine. Thorac Surg Clin 23:313–325. doi:10.1016/j.thorsurg.2013.05.001 CrossRefPubMed

Foroulis CN, Zarogoulidis P, Darwiche K, Katsikogiannis N, Machairiotis N, Karapantzos I, Tsakiridis K, Huang H, Zarogoulidis K (2013) Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment. J Thorac Disease 5(Suppl 4):S342–S358. doi:10.3978/j.issn.2072-1439.2013.04.08

Setzer M, Robinson LA, Vrionis FD (2014) Management of locally advanced pancoast (superior sulcus) tumors with spine involvement. Cancer Control J Moffitt Cancer Cent 21:158–167

Torre W, Garcia-Franco C, Tamura A, Gurpide A, Lopez-Picazo J, Aristu J, Moreno M, Pardo J (2009) Role of surgery in a multidisciplinary approach to superior sulcus tumors (SST): morbidity and prognostic factors for long-term success after resection. Thorac Cardiovasc Surg 57:353–357. doi:10.1055/s-0029-1185786 CrossRefPubMed

Kent MS, Bilsky MH, Rusch VW (2004) Resection of superior sulcus tumors (posterior approach). Thorac Surg Clin 14:217–228. doi:10.1016/S1547-4127(04)00013-1 CrossRefPubMed

Komagata M, Nishiyama M, Imakiire A, Kato H (2004) Total spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine. Case report. J Neurosurg 100:353–357CrossRefPubMed

Mazel C, Balabaud L, Bennis S, Hansen S (2009) Cervical and thoracic spine tumor management: surgical indications, techniques, and outcomes. Orthop Clin North Am 40:75–92, vi–vii. doi:10.1016/j.ocl.2008.09.008

10.

Mazel C, Grunenwald D, Laudrin P, Marmorat JL (2003) Radical excision in the management of thoracic and cervicothoracic tumors involving the spine: results in a series of 36 cases. Spine 28:782–792. doi:10.1097/01.BRS.0000058932.73728.A8 (discussion 792) PubMed

11.

Okubo K, Wada H, Fukuse T, Yokomise H, Inui K, Ike O, Mizuno H, Aoki M, Hitomi S (1995) Treatment of Pancoast tumors. Combined irradiation and radical resection. Thorac Cardiovasc Surg 43:284–286. doi:10.1055/s-2007-1013229 CrossRefPubMed

12.

York JE, Walsh GL, Lang FF, Putnam JB, McCutcheon IE, Swisher SG, Komaki R, Gokaslan ZL (1999) Combined chest wall resection with vertebrectomy and spinal reconstruction for the treatment of Pancoast tumors. J Neurosurg 91:74–80CrossRefPubMed

13.

Mazel C, Hoffmann E, Antonietti P, Grunenwald D, Henry M, Williams J (2004) Posterior cervicothoracic instrumentation in spine tumors. Spine 29:1246–1253CrossRefPubMed

14.

Gandhi S, Walsh GL, Komaki R, Gokaslan ZL, Nesbitt JC, Putnam JB Jr, Roth JA, Merriman KW, McCutcheon IE, Munden RF, Swisher SG (1999) A multidisciplinary surgical approach to superior sulcus tumors with vertebral invasion. Ann Thorac Surg 68:1778–1784 (discussion 1784–1775) CrossRefPubMed

15.

Jain S, Sommers E, Setzer M, Vrionis F (2008) Posterior midline approach for single-stage en bloc resection and circumferential spinal stabilization for locally advanced Pancoast tumors. Technical note. J Neurosurg Spine 9:71–82. doi:10.3171/SPI/2008/9/7/071 CrossRefPubMed

16.

Kienzle HF, Huzly A, Bahr R (1987) Thoracic wall reconstruction following extensive resection. Zentralbl Chir 112:451–456PubMed

17.

Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D (2014) Pancoast tumors: characteristics and preoperative assessment. J Thorac Disease 6(Suppl 1):S108–S115. doi:10.3978/j.issn.2072-1439.2013.12.29

18.

Ng CS, Ho AM, Lau RW, Wong RH (2014) Chest wall reconstruction with MatrixRib system: avoiding pitfalls. Interact CardioVasc Thorac Surg 18:402–403. doi:10.1093/icvts/ivt515 PubMedCentralCrossRefPubMed

19.

Clemens MW, Evans KK, Mardini S, Arnold PG (2011) Introduction to chest wall reconstruction: anatomy and physiology of the chest and indications for chest wall reconstruction. Semin Plast Surg 25:5–15. doi:10.1055/s-0031-1275166 PubMedCentralCrossRefPubMed

20.

Mahabir RC, Butler CE (2011) Stabilization of the chest wall: autologous and alloplastic reconstructions. Semin Plast Surg 25:34–42. doi:10.1055/s-0031-1275169 PubMedCentralCrossRefPubMed

21.

Pettiford BL, Luketich JD, Landreneau RJ (2007) The management of flail chest. Thorac Surg Clin 17:25–33. doi:10.1016/j.thorsurg.2007.02.005 CrossRefPubMed

22.

Richardson JD, Franklin GA, Heffley S, Seligson D (2007) Operative fixation of chest wall fractures: an underused procedure? Am Surg 73:591–596 (discussion 596–597) PubMed

23.

Bille A, Okiror L, Karenovics W, Routledge T (2012) Experience with titanium devices for rib fixation and coverage of chest wall defects. Interact CardioVasc Thorac Surg 15:588–595. doi:10.1093/icvts/ivs327 PubMedCentralCrossRefPubMed

24.

Haddock NT, Weichman KE, Saadeh PB (2012) Reconstruction of a massive thoracic defect: the use of anatomic rib-spanning plates. J Plast Reconstr Aesthet Surg 65:e253–e256. doi:10.1016/j.bjps.2012.04.042 CrossRefPubMed

Title: Chest wall reconstruction after en bloc Pancoast tumour resection with the use of MatrixRib and SILC fixation systems: technical note
Authors: Marcin Czyz
Emmanuel Addae-Boateng
Bronek M. Boszczyk
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4164-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chest wall reconstruction after en bloc Pancoast tumour resection with the use of MatrixRib and SILC fixation systems: technical note

Abstract

Study design

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Objective

Methods

Results

Conclusions

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