Fractures and other chest wall abnormalities after thoracotomy for esophageal cancer: A retrospective cohort study

• Published in: World journal of surgery Vol. 48; no. 3; pp. 662 - 672
• Main Authors: Van Wijck, Suzanne F. M., Barza, Athiná, Vermeulen, Jefrey, Eyck, Ben M., Van der Wilk, Berend J., Van der Harst, Erwin, Verhofstad, Michael H. J., Lagarde, Sjoerd M., Van Lieshout, Esther M. M., Wijffels, Mathieu M. E.
• Format: Journal Article
• Language: English
• Published: United States 01.03.2024
• Subjects: Chest Pain - surgery; chest wall injury; chronic pain; Esophageal Neoplasms - complications; Humans; Pneumonia - etiology; Quality of Life; Retrospective Studies; rib fractures; Rib Fractures - surgery; Thoracic Wall; thoracotomy; Thoracotomy - adverse effects; chest wall injury; chronic pain; thoracotomy; quality of life; rib fractures
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1002/wjs.12083

Background Chest pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. This study aimed to (1) determine the prevalence of thoracotomy‐related thoracic fractures on postoperative imaging and (2) compare complications, long‐term pain, and quality of life in patients with versus without these fractures. Methods This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 2010 and 2020 with pre‐ and postoperative CTs (<1 and/or >6 months). Disease‐free patients were invited for questionnaires on pain and quality of life. Results Of a total of 366 patients, thoracotomy‐related rib fractures were seen in 144 (39%) and thoracic transverse process fractures in 4 (2%) patients. Patients with thoracic fractures more often developed complications (89% vs. 74%, p = 0.002), especially pneumonia (51% vs. 39%, p = 0.032). Questionnaires were completed by 77 after a median of 41 (P25–P75 28–91) months. Long‐term pain was frequently (63%) reported but was not associated with thoracic fractures (p = 0.637), and neither were quality of life scores. Conclusions Thoracic fractures are prevalent in patients following a thoracotomy for esophageal cancer. These thoracic fractures were associated with an increased risk of postoperative complications, especially pneumonia, but an association with long‐term pain or reduced quality of life was not confirmed.