Ribcage procedure after neoadjuvant chemoradiotherapy for non-small cell lung cancer involving the chest wall
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ORIGINAL ARTICLE
Ribcage procedure after neoadjuvant chemoradiotherapy for non‑small cell lung cancer involving the chest wall Hiroaki Nomori1 · Koichi Honma2 · Kazufusa Shoji3 · Ayumu Otsuki4 · Yue Cong5 · Hiroshi Sugimura5 · Yu Oyama6 Received: 11 December 2019 / Accepted: 30 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the “ribcage” procedure for tumors involving the chest wall after induction chemoradiotherapy. Methods This was a single center retrospective study conducted from 2012 to 2018. The “ribcage” procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure. Results Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients. Conclusion Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence. Keywords Lung cancer · Chest wall invasion · Surgery · Induction chemoradiotherapy · Ribcage
Introduction
Date and number of IRB approval: January 25th in 2014, 14-005. * Hiroaki Nomori [email protected]‑net.ne.jp 1
Department of Thoracic Surgery, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa city, Chiba 277‑8661, Japan
2
Department of Pathology, Kameda Medical Center, Chiba, Japan
3
Department of Radiology, Kameda Medical Center, Chiba, Japan
4
Department of Thoracic Pulmonary Medicine, Kameda Medical Center, Chiba, Japan
5
Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan
6
Department of Medical Oncology, Kameda Medical Center, Chiba, Japan
The chest wall is the most frequent site of direct involvement of non-small cell lung cancer (NSCLC). Tumors involving the chest wall are usually treated with either en bloc rib resection or parietal pleurectomy; however, en bloc rib resection results in chest wall deformity with a significant decrease in pulmonary function caused by paradoxical respiration, and parietal pleurectomy leads to local recurrence [1, 2]. Patients with T3/T4 NSCLC are frequently treated with induction chemoradiotherapy (ICRT) followed by surgery, and the outcomes are often successful [3, 4]. However, if tumor involvement at the chest wall is
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