Chest Wall Chondrosarcoma Management: Surgical Resection and STRATOS System Reconstruction
Chondrosarcoma accounts for the most frequent primary malignant bone tumor of the thoracic cage, presenting unique challenges in surgical clearance and stabilization.
- A 62-year-old male patient underwent surgical resection for a 9 × 7 cm grade 1 chondrosarcoma originating from the left tenth and eleventh ribs, Cureus reported.
- Reconstruction of the 11-12 × 8 cm chest wall defect utilized the Strasbourg Thoracic Osteosyntheses System (STRATOS) alongside polypropylene mesh.
- Postoperative histopathological examination confirmed a pathological classification of pT2 NX MX with positive surgical margins, prompting a planned course of radiotherapy.
Chest wall chondrosarcomas demonstrate limited responsiveness to both chemotherapy and radiotherapy, making surgical resection with negative histological margins the cornerstone of treatment. Preoperative evaluation generally involves cross-sectional imaging and staging assessment. Extensive resections often result in substantial defects that compromise structural integrity and respiratory mechanics, requiring reconstructive hardware such as synthetic meshes and titanium fixation systems.
The patient presented with a three-year history of a slowly growing, painless mass in the left costal region. Chest computed tomography revealed a heterogeneous mass with calcified components at the level of the tenth and eleventh ribs. Preoperative image-guided core-needle biopsy was omitted due to institutional scheduling constraints and the patient’s limited resources for repeated visits, which could have delayed treatment.
During the procedure performed under general anesthesia, surgeons observed an irregular, firm mass measuring approximately 12 × 10 cm. A left posterolateral thoracotomy allowed for en bloc resection of the anterolateral portions of the tenth and eleventh ribs, achieving a gross surgical margin of approximately 1 cm. Adherence to the serratus anterior muscle complicated wider soft-tissue excision.
Reconstruction of the resulting 11-12 cm by 8 cm defect employed two 0° titanium bars measuring approximately 12 cm in length. Fixation relied on three costal clips positioned on the posterior portion of the ninth rib, the posterior portion of the twelfth rib, and the anterior portion of the ninth rib. Polypropylene mesh was then secured to the intercostal and serratus anterior muscles using interrupted 2-0 polypropylene sutures.
Neoplastic involvement of the surgical margins was identified, though the precise anatomical site of the positive margin was not specified in the pathology report. Multiple scattered diaphragmatic nodules were also resected and repaired with U-shaped Monocryl sutures, though no definitive diagnosis of these nodules was documented.
The immediate postoperative course proceeded without immediate complications, and the pleural drain was removed on postoperative day 3. At approximately 10 weeks following surgery, the patient remained asymptomatic during oncological follow-up. Because of the positive surgical margins, radiotherapy was subsequently administered at a tertiary care center over 33 fractions, although detailed records regarding the total dose and clinical target volume were unavailable.
Similar surgical approaches have been documented in academic literature. Parsa Radfar, Andrei Gritsiuta, Margaux Marinelli, and Roman Petrov from the University of Texas Medical Branch demonstrated rigid chest wall reconstruction using the titanium STRATOS system following en bloc resection of a left lateral costal margin chondrosarcoma, achieving complete R0 resection and stable thoracic restoration, according to the 2026 abstracts presented by ECTSS.
Separately, PMC.ncbi.nlm.nih.gov reported on the management of a grade 2 chondrosarcoma in a 61-year-old female patient involving the third rib, where wide en bloc resection followed by polypropylene mesh and a latissimus dorsi flap yielded no recurrence at three-year follow-up.
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