Long-Term Results of Thoraco-Pleuro-Pneumonectomy (TPP) for Recurrent Thoracic Sarcomas

Excerpt

In 2014, we published a series of four consecutive cases of thoraco-pleuro-pneumonectomy (TPP) with en bloc resection of the entire lung, chest wall and diaphragm, and immediate rib-like reconstruction for recurrent thoracic sarcomas. The aim of surgery was to maximize the chance of long-term tumor control and possibly cure. We report here the long-term results of this extreme procedure, analyzing the oncologic follow-up of patients, along with the long-term functional and morphological changes of the rigid reconstruction using the rib-like technique. The four patients are alive and free from thoracic relapse after 69, 65, 64, and 54 months following TPP. The fourth patient, with Ewing’s Sarcoma, underwent chemotherapy, radiotherapy, and subsequent left nephrectomy for an extrathoracic metastasis that occurred 17 months after surgery. The long-term features of chest wall reconstruction show progressive changes in the shape and functionality of the three-dimensional, rib-like prosthesis. In selected patients with advanced low- to intermediate-grade recurrent thoracic sarcomas, one-stage TPP provides long-term tumor control. Prosthetic replacement requires substantial improvements to maintain the shape and functional profile of the artificial chest wall in the long run. …