Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction, our institutional experience

Abstract

Primary chest wall tumours are not very common. Chondrosarcomas is most common tumour arising from the chest wall. It occurs more often during the third and fourth decade of life. Chondrosarcomas are resistant to conventional chemotherapy and radiotherapy. Wide margin surgical excision remains the best available treatment approach. For chondrosarcomas involving the chest wall, surgical excision may result in chest wall defects that may require reconstruction to obliterate dead space, restore chest wall rigidity, preserve respiratory mechanics, maintain pulmonary function, protect intrathoracic organs, provide soft tissue coverage and minimize deformity. In this article we present a series of 3 cases of chondrosarcoma of anterior chest wall managed at government Royapettah hospital, Kilpauk medical college, Chennai. A 71-year-old male patient, a case of 22×20 cm giant chondrosarcoma arising from anterior left chest wall involving 2^nd to 8^th ribs. We did wide local excision and reconstruction of chest wall with a synthetic bone cement (methyl methacrylate) construct, sandwiched between two layers of polypropylene mesh.  A 38-year-old male patient, a case of 8×6 cm chondrosarcoma of left anterior chest wall involving 9^th rib, we did wide excision of tumor along with 8th, 9th, 10th ribs and defect reconstructed with prolene mesh.  A 37-year-old male patient, a case of 5×4 cm chondrosarcoma arising from left 4^th rib. We did wide excision along with 4th rib and primary closure. Patients with chondrosarcomas generally have a good prognosis when optimally diagnosed and treated. Our case series is interesting due to the different sizes of chondrosarcomas at presentation, which are managed differently. Complete resection with wide surgical margin remains the best available treatment, but post resection chest wall reconstruction is posing a great surgical challenge.