Chest Wall Tumors (T.H.T. Tumors)
The study of chest wall tumors is of particular interest, as these tumors include tumors of various histological types, which have different origins, behavior, treatment methods and prognosis.
They constitute 0.04% of all tumors in the human body, and 5% of thoracic tumors.
Thoracic wall tumors are divided into malignant and benign, with a ratio of 1:1.
Although more than a hundred years have passed since the first operation to remove a thoracic wall tumor was performed, radical resection, mainly of malignant tumors, and the restoration of the resulting defect, remain a challenge for the surgeon, and often the cooperation of doctors from various specialties is necessary, both for the selection of the best therapeutic intervention and for the performance of the necessary surgical intervention.
Malignant tumors are divided into primary, secondary, that is, the primary focus is outside the rib cage, and the third group includes malignant tumors of the organs enclosed in the rib cage, and extend invasively towards the chest wall.
Malignant tumors in a percentage of 55% originate from the bony skeleton (85% from the ribs, and 15% from the sternum), while 45% originate from the soft tissues. Tumors of the scapula and clavicle are very rare.
The majority of tumors of the scapula are treated surgically, and when it is a malignant tumor, the resection must be wide, with clear resection margins, and when the defect is greater than 5-6 cm, then it is necessary to restore the defect with a graft. It is important, perhaps even mandatory, to perform a histological biopsy, before any therapeutic manipulation, in order to make a decision on the type of treatment. It should be mentioned here that not all tumors of the scapula are treated with surgery. Some malignant tumors are treated with chemotherapy with or without radiotherapy, followed by surgery. The treatment of metastatic tumors of the scapula requires special attention, in the sense that the primary lesion is under complete control, there is no other metastatic disease in other vital organs, and it cannot be treated effectively in any other way.
When the defect of the tibial plateau is more than 5-6 centimeters, and is not covered by the scapula or when it is a large, full-thickness defect, then the use of a graft is required. The restoration is absolutely necessary because there needs to be hardness and, in certain areas, complete rigidity of the tibial plateau, and at the same time allow respiratory movements. The graft is necessary to protect the intrathoracic organs, which at the same time prevents the formation of a hernia, the reduction of the space of the thoracic cavities, paradoxical breathing, and finally ensures the final desired aesthetic result.
There are many types of grafts. The first category includes synthetic grafts, absorbable and non-absorbable, and the second category includes biological grafts such as muscle, bone, autografts, and cadaveric allografts or heterografts.
The characteristics that synthetic grafts must meet according to Leroux and Shana are to have the necessary rigidity, to be inert, to be easily integrated, to be easily adapted to the area of the defect, to have satisfactory resistance to tension, to be radiolucent, so that it is easy to monitor local recurrence. They should also not cause an inflammatory reaction, nor stimulate the immune system, their removal should not be necessary in case of infection, they should not erode adjacent tissues, they should not be destroyed over time, their purchase cost should not be expensive and they should be available in large sizes.
The choice of the type of graft depends on the extent of the defect, the experience and preference of the surgeon, the age of the patient, the area of the defect, the cost of the graft, and local conditions, whether there is infection or not.
After this brief reference to chest wall tumors and their treatment, as a conclusion one could say that this is a group of tumors of different origin, prognosis, and different treatment methods. Most of the time, it is treated surgically by an experienced Thoracic Surgeon, supported by a team of doctors from various specialties, in order to carry out the most appropriate treatment, preferably in a well-organized center that provides the required materials and has experienced medical and nursing staff.
