흉벽에 발생한 원발성 종양에 대한 고찰

Clinical Review of Primary Chest Wall Tumors

  • 백효채 (연세대학교 의과대학 흉부외과학교실) ;
  • 강정한 (연세대학교 의과대학 흉부외과학교실) ;
  • 최성실 (연세대학교 의과대학 흉부외과학교실) ;
  • 정경영 (연세대학교 의과대학 흉부외과학교실)
  • 발행 : 2003.03.01

초록

원발성 흉벽종양은 흉부의 연조직이나 뼈 또는 연골에서 다양하게 발생할 수 있는 종양으로서 전체 원발성 종양의 약 l∼2%를 차지한다. 수술적 절제술은 만성 궤양이나 심한 통증이 있는 환자에서 효과적인 치료법이며 조직학적 진단 및 수술방법에 따라서 장기생존이 가능할 수 있다. 대상 및 방법: 1976년 9월부터 2001년 3월까지 원발성 흉벽종양을 가진 125명(양성종양 86명, 악성종양 39명) 의 환자에서 수술적 절제술을 시행하여 수술결과와 예후에 영향을 미치는 요소들을 해석하고자 하였다. 결과: 양성종양은 수술적 치료로 재발 없이 완전 치료가 되었으며 악성종양은 대부분 광범위 절제술을 시행하였으며 환자에 따라 수술 후 보조요법을 병행하였다. 양성종양 중 신경초종이 가장 많았으며 악성종양은 악성섬유성조직구종이 가장 많은 빈도를 보였다. 악성종양의 경우 3년 생존율이 76.0%, 10년 생존율이 60.5%이었다. 수술과 관련된 사망은 없었으며 외래 추적 중 사망한 환자의 원인은 원격 전이에 의한 장기부전 이었으며 11명에서 재발하였다. 안전거리 절제면을 4 cm 이상과 미만으로 구분하였을 때 두 군간의 생존율에 차이가 없었다. 결론: 양성종양의 경우 수술적 치료로 재발 없이 완치가 가능하였으며 악성종양도 비교적 좋은 장기생존율을 나타내었다. 안전거리 4 cm는 예후에 미치는 영향은 발견할 수 없었으나 재발 시에는 예후가 좋지 않았다.

Primary chest wall tumors originate from soft tissue, bone or cartilage of the chest wall and it comprises 1∼2% of all primary tumors. Resection of tumor is often indicated for chronic ulceration or pain, and long-term survival might be achieved after surgery depending on the histology and the surgical procedure. Material and Method: Retrospective study of 125 primary chest wall tumors (86 benign, 39 malignant) operated between Sep. 1976 to Mar 2001 were reviewed and their clinical outcomes were analyzed. Follow-up data were collected at the outpatient clinic. Result: All patients with benign tumors were treated by excision without recurrence or death, and most malignancies were treated by wide resection. Malignant fibrous histiocytoma and chondrosarcoma constituted 46.2% of the malignant neoplasm. There was no operative death. The overall 3-year survival for patients with primary malignant neoplasm was 76.0%, and the 10-year survival was 60.5%. All deaths were disease-related and the tumor recurred in 11 patients. There was no significant difference in survival between patients with resection margins less than 4 cm and those with resection margins greater than 4 cm. Conclusion: Chest wall resection offers excellent results for benign chest wall tumors and substantial long-term survival for malignant diseases. Safe resection margin of 4 cm or more did not correlate with the survival rate although the tumor recurrence correlated with poor survival.

키워드

참고문헌

  1. Ann Thorac Surg v.41 Primary chest wall tumors: Factors affecting survival King RM;Pairolero PC;Trast VF(et al.) https://doi.org/10.1016/S0003-4975(10)63067-6
  2. Curr Probl Surg v.20 Resection of tumors of the chest wall Le Roux BT;Shama DM. https://doi.org/10.1016/S0011-3840(83)80007-0
  3. Ann Thorac Surg v.34 Initial and long term results in the management of primary chest wall neoplasms Graeber GM;Snyder RJ;Fleming AW(et al.) https://doi.org/10.1016/S0003-4975(10)60906-X
  4. Arch Surg v.124 Local recurrent mammary carcinoma failing multimodality therapy: a solution McCormack PM;Bains MS;Burt ME;Martini N;Chaglassian T;Hidalgo DA, https://doi.org/10.1001/archsurg.1989.01410020028003
  5. Ann Thorac Surg v.11 Primary chest wall tumors Threlkel JB;Adkins RB Jr, https://doi.org/10.1016/S0003-4975(10)65482-3
  6. Eur J Cardiothorac Surg v.11 Mearns surgical treatment of primary malignant chest wall tumors Sabanathan S;Shah R;Shah R;Alan J, https://doi.org/10.1016/S1010-7940(97)00090-0
  7. J Thorac Cardiovasc Surg v.52 Tumors of the thoracic skeleton: review of 34 cases Ochsner A;Lucas GL;McFarland GB.
  8. Ann Thorac Surg v.39 Primary chest wall tumors Sabanathan S;Salama FD;Morgan WF;Harvey JA;Putnam JB. https://doi.org/10.1016/S0003-4975(10)62515-5
  9. Yonsei Med v.35 Chest wall implantation of carcinoma after needle aspiration biopsy Paik HC;Lee DY;Lee HK(et al.) https://doi.org/10.3349/ymj.1994.35.3.349
  10. Ann Thorac Surg v.58 Chest wall neoplasms and their management Anderson BO;Burt ME. https://doi.org/10.1016/0003-4975(94)91691-8
  11. International trends in general thoracic surgery(2nd Ed.) Chest wall tumors: surgical management Eschapass H;Gaillard J;Henry E;Vassallo B;Lacheb M.
  12. Ann Thorac Surg v.32 Chest wall reconstruction Pairolero PC;Amold PG. https://doi.org/10.1016/S0003-4975(10)61751-1
  13. Plast Reconstr Surg v.63 Use of pectoralis major muscle flaps to repair defects of the anterior chest wall Amold PG;Pairolero PC. https://doi.org/10.1097/00006534-197902000-00008
  14. Ann Thorac Surg v.40 Chondrosarcoma of the chest wall: factors affecting survival McAfee MK;Pairolero PC;Bergstralh EJ(et al.) https://doi.org/10.1016/S0003-4975(10)60344-X
  15. Eur J Cardiothorac Surg v.4 Chest wall reconstruciton after resection of primary malignant chest wall tumors Eng J;Sabanathan S;Mearns AJ. https://doi.org/10.1016/1010-7940(90)90223-M
  16. Ann Surg v.199 Chest wall reconstruction: experience with 100 consective patients Arnold PG;Pairolero PC. https://doi.org/10.1097/00000658-198406000-00011
  17. Plast Reconstr Surg v.98 Chest wall reconstruction an account of 500 consecutive patients Arnold PG;Pairolero PC. https://doi.org/10.1097/00006534-199610000-00008
  18. Ann Plast Surg v.46 Thoracic reconstruction with the omentum: indications, complications, results Hultman CS;Culbertson JH;Johns GE(et al.) https://doi.org/10.1097/00000637-200103000-00007
  19. Ann Thorac Surg v.73 Chest wall resection and reconstruction: A 25-year experience Mansour KA;Thourani VH;Losken A(et al.) https://doi.org/10.1016/S0003-4975(02)03527-0
  20. J Thorac Cardiovasc Surg v.101 Adjuvant brachytherapy for treatment of chest wall sarcoma Wallner KE;Nori D;Burt M.