Surgery for elastofibroma dorsi: optimizing the management of a benign tumor – an analysis of 70 cases

Background: Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the
tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements.
The present literature relies only on few small case series. The aim of this study was to analyze the surgical
management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique,
post-operative outcome and follow-up.
Methods: We conducted a single-center retrospective cohort analysis of patients operated for ED between
2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and
magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative
assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a musclesparing
approach was performed. An open-door follow-up policy was adopted. All clinical, radiological,
perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis
was performed to investigate risk factors for postoperative complications. Correlations analysis between
radiological and pathological measurements of elastofibroma was conducted.
Results: Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence
was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications
rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass
index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced
a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of
complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was
the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the
highest correlation with pathological size (r=0.819), US the lowest (r=0.421).
Conclusions: Marginal resection through a muscle-sparing approach is safe and effective for the treatment
of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the
absence of recurrence after complete resection, an open-door follow-up may be appropriate.