(P 459) EXPERIENCE IN THE USE OF INDIVIDUALIZED 3D-IMPLANTS IN THE RECONSTRUCTION OF DEFECTS IN PATIENTS WITH TUMORS OF THE CHEST WALL

Objective: Primary tumors of the chest wall account for, according to a number of authors, from 1 to 5% in the total structure of neoplasms, while about 60% of them are malignant neoplasms (MN), which are represented by bone sarcomas (55% of cases) and soft tissues ( 45% of cases) [1, 2].
Metastatic lesions of the ribs and sternum, in contrast to primary tumors, are observed 2-4 times more often [5]. Almost 30% of lesions of the sternum and ribs are secondary [3], most often these are metastases of breast cancer (BC), prostate, lung, kidney, thyroid and ovary.
The lesion can be localized both in the sternum in isolation, and with the involvement of the chest wall.[4] The great rarity of this pathology, the complexity of the anatomical localization predispose to great technical difficulties that arise in the combined treatment of these patients and technical problems that arise during the surgical removal of these formations. There are few data in the literature on this topic. [5, 6, 7, 8] The paper presents the first experience of the National Medical Research Center of Oncology in the treatment of patients with tumor lesions of the chest wall.

Methods: At the National Medical Research Center of Oncology named after N.N. Blokhin from 2019 to 2023, 52 surgical interventions were performed in patients with primary and metastatic tumors of the chest wall. Resections of the rib or ribs, sternum were performed with simultaneous reconstruction with local tissues, displaced flaps, as well as using various synthetic and metal materials.
The rapid development of additive technologies has made it possible to define a new stage in reconstructive plastic surgery and onko orthopedy. Since 2020, at the NMRC of Oncology named after N.N. Blokhin, 19 operations were performed using individualized 3D implants in patients with tumors of the chest wall.
All patients underwent replacement of the defect with an individualized implant made according to anthropometric data.

Results: Since 2019, 52 patients with tumor lesions of the chest wall have been operated in the Department of General Oncology. In 19 of them, the defect was replaced with an individual 3D titanium implant during extensive resections. Our study presents a rather heterogeneous group of patients, the most common tumor being chondrosarcoma (36%). 17 cases of primary malignant tumors (89%) and 2 patients with metastatic lesion of the sternum, when resection of the chest wall was required (11%). The operation was radical in 15 patients (78%). Five patients died from progression (26%), among which, at the time of surgery, three had distant metastases and the operation was symptomatic. The longest follow-up period in our study was 35 months.

Conclusion: The use of new surgical technology can significantly improve the results of treatment in patients with tumor lesions of the chest wall, however, the results obtained suggest that more careful selection of patients and a special multidisciplinary approach are required when determining indications for surgical treatment.