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BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level of evidenceLevel IV therapeutic care/management.

Objective As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons9 mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk. Design Retrospective analysis of prospectively collected data. Setting All NHS centres in the geographical north west of England that undertake cardiac surgery in adults. Participants All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002. Main outcome measures Surgeon specific postoperative mortality and predicted mortality by EuroSCORE. Results 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients. Conclusions It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.

A man aged 28 years, with neurofibromatosis type 1, presented with abdominal pain and visible right lower chest swelling. He had cutaneous neurofibromas and several café-au-lait spots. CT scan of the chest and abdomen revealed a giant mass most likely originating from the right 7th intercostal nerve, extending downwards into the abdomen causing massive hepatic compression. A Trucut biopsy showed malignant peripheral nerve sheath tumour. Radical surgical resection with wide margins was performed. The chest wall and diaphragm were reconstructed with improvised surgical technique with excellent results. Final histopathology report revealed a triton tumour of the intercostal nerve.

Fibromatosis is a slow-growing monoclonal proliferation of fibroblasts. Although histologically benign it is locally invasive and can recur, however, without metastatic potential. Extra-abdominal fibromatosis is not common. Surgical resection is the cornerstone of treatment and radiation therapy is used in incomplete resection, however, its role is not proved through prospective randomised trials. This article presents a 17-year-old Iranian girl with chest wall fibromatosis located just behind the right breast. The patient was operated with positive margin, however, we decided to postpone radiation therapy because of potential risks.

An 80-year-old man, presented with local relapse, bony and lung metastasis 1 year following a resection of a sacral chordoma. He required chemotherapy and several procedures for improving his neurological symptoms in the cervical, thoracic and sacral vertebrae. Chordoma was diagnosed based on the morphological and immunohistochemistry results, which showed positive CK-8, CK-19, S-100, cadherin and negative CK-7 and CK-20. At the same time an anterior 9×11×15 cm sternal mass was noticed (figures …

Introduction Surgical resection is the best chance of cure for most patients with non-small cell lung cancer (NSCLC), for whom 5-year survival is otherwise poor. Selection of patients for surgery should include an estimation of the likely post-operative mortality risk but the tool often used in UK practise is a predictive score that was developed using a French database of thoracic surgical procedures, not specific to lung cancer. Methods We used data from the National Lung Cancer Audit linked with Hospital Episode Statistics to estimate the influence of pre-operative patient and tumour factors, and the type of procedure on the odds of death at 30 and 90 days after potentially curative surgery for NSCLC. We used logistic regression to determine which factors were associated with early post-operative mortality and then calculated the percentage of patients who died within 90 days of surgery, stratified by the strongest predictors of early post-operative mortality. Results We identified 12,096 patients who had potentially curative surgery for NSCLC in England between January 2004 and March 2010. Three per cent (n=387) and 6% (n=792) of patients died within 30 and 90 days respectively. Of the 12 clinical and socio-demographic factors assessed, age and type of procedure were consistently the most important predictors of early post-operative mortality: Odds ratio (OR) for death at 30 days for pneumonectomy compared with lobectomy 3.03, 95% confidence interval (CI) 2.32–3.94; and for each year increase in age OR 1.06, 95% CI 1.04–1.07. Performance status, co-morbidity score and sex and were also significantly associated with the outcomes. Table 1 shows the percentage of patients who died within 90 days of either lobectomy or pneumonectomy, stratified by age and performance status. Conclusion The estimation of post-operative mortality risk is a crucial part of management of patients with NSCLC. Overall mortality following surgery for NSCLC in England is currently 3% at 30-days and 6% at 90-days. We present UK data, stratified by age and performance status, which could be used in clinical practise to assist with the estimation of early post-operative mortality risk.

EDITOR—Partridge provides no evidence to support his claims that cardiothoracic surgeons are less likely than thoracic surgeons to stage the extent of lung cancer objectively and assess the patients' fitness; he points out that they have “competing demands from a waiting list for coronary artery surgery.”1 He also says that relying on cardiothoracic surgeons to do lung resections may mean that some do too few to maintain competence. …