Video-assisted thoracoscopic surgery for rib chondrosarcoma: unique surgical technique

INTRODUCTION

Chondrosarcomas usually present in males between the 4^th and 5^th decade of life.¹ It is the second most frequent primary solid neoplastic tumor of the bone after osteogenic sarcoma.² With respect to treatment, chondrosarcomas are not responsive to chemotherapy, radiotherapy and surgical resection with sufficient margins is considered as first line of therapy.

It is relatively rare for a chondrosarcoma to arise in the ribs.³

CASE REPORT

Here we reported the history, diagnostic evaluation and management of a patient presenting with anterior chest wall mass. A 50 year old male came with history of an incidental finding of a pleural based space occupying lesion. A CT Thorax was done which revealed a large well defined heterogeneously enhancing lesion broad based towards pleura in the right upper lobe region likely pleural in origin approximately 5.3×5×3.4 cm in size. CT guided biopsy revealed it to be a spindle cell neoplasm. Patient was taken up for surgery- video assisted thoracoscopic wide local excision of 2^nd rib chondrosarcoma under general anesthesia. Under thoracoscopic guidance needles were placed 1cm margins away from the tumour. The mass was excised enbloc with lateral margins being parts of 1^st, 2^nd and 3^rd ribs (Figure 1).

The chest wall defect was reconstructed using prolene mesh and PMMC flap was raised to cover the mesh (Figure 2). Post-operatively the patient did not require any mechanical ventilatory support, had a speedy recovery and was discharged on post-operative day 3 on oral analgesics.

DISCUSSION

In recent past, substantial insights have led to a better understanding of chondrosarcoma development at the molecular level, however surgical intervention remains the cornerstone of its management.⁴ In this case, we utilized thoracoscopic guidance for Ro resection of the tumor. Video-assisted thoracoscopic surgery (VATS) has revolutionized the approach to and management of many pulmonary and cardiac diseases over the past 2 decades. VATS has multiple advantages over traditional thoracotomy including less post-operative pain, shorter hospital stay, decreased post-operative complications like pulmonary atelectasis along with early recovery of respiratory function and less need for post-operative mechanical ventilation.⁵

By visualizing the tumor under thoracoscopic guidance, we were able to demarcate an appropriate 1 cm margin and hence avoid extensive resection. This helped in early post-operative recovery and lesser duration of hospital stay for the patient. The final histopathological report confirmed uninvolved margins and the patient did not require any adjuvant therapy (Figure 3).

CONCLUSION

By using thoracoscopic assistance for resection of anterior chest wall masses like rib chondrosarcoma, we enhance Ro resection outcomes as well as post-operative recovery of the patient.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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