Reconstruction of the Chest Wall in Primary and Secondary Tumors: A Systematic Review and Meta-Analysis Comparing Rigid Versus Flexible Materials.

Abstract

Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions. We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I² statistics. In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31). Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.