Chest wall tumors are rare diseases with complex causes. On the condition that medical treatment is limited, surgery is considered to be an effective treatment. However, with the complex structure of organs adjacent to chest wall tumors, the surgery puts integrity and important functions of chest wall at stake and is thus very difficult and risky. Over the years, under the leadership of Director Li Shanqing, the Department of Thoracic Surgery of PUMCH has completed many surgeries of complex chest wall tumor resection and chest wall reconstruction every year. The PUMCH multidisciplinary team works hard and earnestly to remove the chest wall tumor, as risky as a “bomb”, for one patient after another.

The 58-year-old Mr. Li had undergone surgery to remove an egg-sized chest wall tumor several years ago at another hospital, and the postoperative pathological result showed proliferative myositis. However, the tumor quickly recurred continuously increasing in size and severely affecting Mr. Li's right upper limb movement.

Mr. Li then visited the clinic of Department of Thoracic Surgery, PUMCH for a consultation. After thorough inquiry and physical examinations, Director Li Shanqing determined that the tumor might not be simply proliferative myositis and surgery should be performed as soon as possible. However, the resection of such a large tumor will leave a huge defect in the chest wall, which would affect chest wall integrity and respiratory function. The Department of Thoracic Surgery thus invited the Department of Plastic Surgery to join in the consultation and customized a comprehensive surgical plan for Mr. Li.

▲Mr. Li’s preoperative chest CT

During the surgery, it was discovered that Mr. Li’s tumor was close to the right axillary vessels and brachial plexus. With careful and meticulous operation, the thoracic surgery team removed the huge “bomb” on the chest wall, completely preserved the blood supply and function of the patient’s right upper limb, and used titanium rods to reconstruct his ribs and sternum. Then the plastic surgery team took over and repaired the soft tissue defect of the anterior chest wall by transferring the right latissimus dorsi myocutaneous flap, which greatly reserved the integrity and aesthetics of the patient’s chest wall.

As expected, the postoperative pathological result reported that the tumor on the chest wall of the patient was not proliferative myositis but fibromatosis. The meticulous care of doctors and nurses helped Mr. Li fully recover.

The Department of Thoracic Surgery, PUMCH has accumulated an abundance of experience in the diagnosis, treatment and management of complex chest wall tumors. Working earnestly with the multidisciplinary team, it has opened the door of hope for many patients with intractable and rare diseases. The preoperative multidisciplinary diagnosis and treatment, individualized surgical design, customized reconstruction materials and advanced equipment during surgery help achieve the goal of complete resection, minimal damage and function preservation . After the surgery, multidisciplinary ward rounds and comprehensive care help patients recover quickly.

Written by Zhang Jiaqi, Guo Chao and Hong Chengwei

Pictures courtesy of Sun Liang and the Department of Thoracic Surgery

Translated by Liu Haiyan

Edited by Guo Chao and Wang Yao