The role of the orthopaedic oncologist in chest wall resections and reconstructions

Tumors of the bony thorax are rare and present unique challenges in achieving optimal oncologic results. Negative margins can be quite difficult to obtain because of the proximity to vital structures, hence rendering wide resection challenging. Chest wall resections are also complex because of the necessity for restoration of a functional chest wall with adequate soft tissue coverage to prevent paradoxical respiration and to mitigate pulmonary complications. Traditionally, thoracic surgeons have treated chest wall tumors. However, at some centers, orthopaedic oncologists have performed resections and reconstructions of these tumors with minimal perioperative morbidity. Previous studies have shown both an increase in the number of wide resections and a survival benefit for the treatment of these tumors when care is provided at a sarcoma center of excellence with a multidisciplinary team. We recommend a multidisciplinary treatment algorithm for these tumors with a musculoskeletal oncologist, thoracic surgeon, and plastic surgeon to bring about successful wide resection of the tumor, restoration of functional chest wall kinetics, and appropriate soft tissue coverage.