OBJECTIVES: Chest wall resection for non-small cell lung cancer (NSCLC) with chest wall invasion is rare and technically demanding, requiring complete resection and durable reconstruction. Although titanium-based devices are increasingly used, NSCLC-specific outcome data remain limited. We evaluated short- and mid-term outcomes of titanium plate-based chest wall reconstruction in NSCLC. METHODS: We retrospectively reviewed 16 consecutive patients who underwent en bloc pulmonary and chest wall resection with titanium plate reconstruction for NSCLC between 2013 and 2019. Indications included resection of ≥ 3 ribs or anticipated instability. Reconstruction used perforated titanium plates tailored to defect geometry. Postoperative complications, late reconstruction-related events, and oncologic outcomes were analysed. RESULTS: Preoperative therapy was administered in 8 patients (50%), including chemoradiotherapy in 7. R0 resection was achieved in 94%. Defects were predominantly posterior, with reconstruction adjacent to the scapula in 12 patients (75%). Thirty-day postoperative complications occurred in 9 patients (56%), consisting predominantly of pulmonary events. Postoperative chemotherapy was given to 6 patients (38%). During a median follow-up of 24 months (mean 54 months), two late complications occurred: chest wall haematoma and empyema. Only one chest wall local recurrence was observed. No structural failure or scapular impingement occurred. Five-year recurrence-free and overall survival rates were 35% and 63%, respectively. CONCLUSIONS: Titanium plate-based chest wall reconstruction enables extensive en bloc resection for NSCLC with chest wall invasion while maintaining mid-term structural stability. With appropriate patient selection and follow-up, this technique provides acceptable mid-term outcomes with durable structural stability.
Kanzaki et al. (Tue,) studied this question.