Chest wall chondrosarcoma is a rare malignancy for which no standardized surgical guidelines exist, requiring instead a meticulous multidisciplinary approach. We report the case of an 80-year-old man in excellent general condition who presented with a progressively enlarging right thoracoabdominal mass over a four-year period, initially misdiagnosed as a lipoma. Imaging revealed a 24 cm chondrosarcoma extending from the 7th to the 11th ribs down to the anterior superior iliac spine. En bloc R0 resection was achieved, followed by combined thoracic and abdominal wall reconstruction using synthetic prosthetic material and complex soft-tissue coverage (latissimus dorsi flap, free thigh flap, and advancement abdominoplasty). Postoperative recovery was favorable, with immediate extubation and discharge on postoperative day 42. No recurrence was detected at one year. This case highlights the feasibility of extensive chest wall resection and reconstruction in an elderly patient and emphasizes the critical role of thorough preoperative multidisciplinary planning, in accordance with evidence-based principles, to optimize both oncologic and functional outcomes.

Redo cardiac surgery following a prior sternotomy presents significant technical challenges and increased risks due to potential injuries during sternal re-entry, mediastinal adhesions and hemorrhage. Endoscopically assisted coronary artery bypass grafting (CABG) offers a minimally invasive alternative approach, avoiding sternotomy while achieving complete revascularization and reducing operative morbidity. An 86-year-old male with prior CABG in 2011 who presented with recurrent angina due to graft occlusion and a circumflex lesion unsuitable for intervention. Revascularization was performed using thoracoscopic adhesiolysis and internal mammary harvesting, followed by a hand-sewn coronary anastomosis through a limited left thoracotomy under femoral cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative day 6. At one-month follow-up, he remained asymptomatic with preserved ventricular function. Endoscopically assisted coronary bypass grafting is a safe and feasible alternative in selected patients while reducing surgical trauma and allowing rapid recovery.