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What is Thoracic Wall En Bloc Resection?

The thoracic wall is comprised of the ribs, sternum, thoracic vertebrae, and nerves and the muscles associated with respiration, particularly the diaphragm. En bloc resection of the thoracic wall is a surgical technique used to remove one or more ribs from the rib cage. This is done to treat cancer of the ribs. A specialized mesh will replace the resected rib(s), and will protect the inner organs of the thoracic wall from damage.

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Thoracic Wall En Bloc Resection Procedure in Dogs

  1. A blood sample will be analyzed to ensure it is safe for the dog to undergo general anesthesia.
  2. General anesthesia will be administered intravenously. An endotracheal tube is put into place to administer anesthesia throughout the procedure. An x-ray is taken prior to surgery to visualize the mass.
  3. The thorax is shaved, cleaned, and clipped.
  4. The surgeon will incise the skin, subcutaneous tissues, and muscles respectively according to the location of the mass.
  5. An oscillating saw is used to cut the rib.
  6. A portion of polypropylene mesh is cut. This will replace the resected rib(s) to protect the inner contents of the thoracic wall.
  7. The mesh is sutured to the rib(s) and intercostal muscles.
  8. A thoracostomy tube is put into place to drain any fluid or air present.
  9. The overlying muscles are sutured to the graft. This is done to cover the edges of the graft.
  10. The subcutaneous muscles and skin are sutured to close the incision.
  11. Air is then drained from the thoracic cavity through the thoracostomy tube.
  12. The dog will be hospitalized for up to five days.

Efficacy of Thoracic Wall En Bloc Resection in Dogs

The efficacy of this procedure will vary based on the overall health of the dog and the severity of the cancer at the time of treatment. Even with treatment, the dog’s prognosis is typically poor to grave, especially if the tumors have metastasized. Osteosarcoma and chondrosarcoma are both highly malignant, and spread rapidly. En bloc resection of the thoracic wall is often palliative, or done to relieve the dog’s pain rather than to treat the underlying condition.

This procedure is very effective for benign tumors, although these types of tumors are rarely operated on due to the invasive nature of the surgery.

Thoracic Wall En Bloc Resection Recovery in Dogs

The thoracostomy tube will be removed after twenty-four hours. During hospitalization, the dog will be monitored for signs of pneumothorax, or the buildup of air in the thoracic cavity which causes lung collapse. Pain management medications will be administered throughout hospitalization.

On the return home, dogs should rest extensively according to surgeon instructions. They should not play or engage in activity. Some dogs may need to be confined to a crate. The dog may need to wear an Elizabethan collar or bandage to avoid aggravating the surgery site. Bandages should be changed each day, and kept clean and dry at all times. Owners should check the suture site daily, monitoring for swelling, bleeding, or drainage. If any of these occur, veterinary advice should be sought. The sutures will be removed within fourteen days of surgery. Additional follow-up appointments are scheduled as needed to monitor the condition and administer other treatments.

Cost of Thoracic Wall En Bloc Resection in Dogs

The cost of thoracic wall en bloc resection will vary based on standards of living and additional costs incurred. The price of thoracic wall resection, inclusive of diagnostic testing, postoperative hospitalization, and the cost of additional treatments, ranges from $3,000 to $10,000, with an average cost of $6,000.

Dog Thoracic Wall En Bloc Resection Considerations

Though the technique itself is highly effective and there are few postoperative complications associated with it, cancer recurrence is commonly seen. This is attributed to the metastatic nature of the disease.

Complications with en bloc resection of the thoracic wall include, but may not be limited to:

  • Pleural effusion: Buildup of fluid in the pleural cavity, near the lungs
  • Recurrence of the condition
  • Forelimb edema: Swelling of the forelimb due to effusion

Pleural effusion and forelimb edema typically resolve by themselves. However, owners should always consult their veterinarian as soon as complications arise.

Owners should note that this is an expensive procedure that may not cure the underlying condition or prevent recurrence. The surgeon will discuss the risks and benefits of the procedure with the owner prior to surgery, and will also explore other treatment options.

Thoracic Wall En Bloc Resection Prevention in Dogs

Cancer is difficult to prevent in dogs. Owners should be able to recognize the signs of cancer, and seek immediate veterinary attention as soon as symptoms arise to secure the best possible prognosis.