PURPOSE: To target the gold standard to sternal resections for cancer even in extreme situations.
METHODS: 107 sternal tumor resections are during last decade: 37 primary tumors, 35 local relapses or metastases from breast cancers, 20 other tumors and 15 radionecroses. There were 14 total sternectomies, 41 subtotal (>50%), and 52 partial (<50%). The average size of the sternal resection (including the ribs) was 142.5 cm2 (15 × 9.5 cm), the largest being 580 cm2 (29 × 20 cm). The procedure was associated to 75 rib resections, 18 of the clavicles, 30 of the lung, 20 of the pericardium. The breaches in the soft tissue and bone were repaired using: prosthetic materials covered by myocutaneous or muscle tissue in 66 patients, prosthetic material in 20, myocutaneous or muscle flaps in 6, and other in 15. A radical resection was in 97 cases and palliative in 10.
RESULTS: There were 2 peri-operative deaths due to multi-organ failure, and morbidity was limited to 16 cases. Fiftheen patients presented complications at the site of the surgical wound. The last patient developed bilateral pulmonary aspergillosis successfully treated with antifungal therapy. Sixty-seven patients with radical surgery were alive and disease free at the end of the follow-up. Kaplan-Meier survival percentage calculated at 10 years was 86% of survival percentage in primary tumors, 11.6 versus 0% in secondary tumors and 42.7% in breast cancer relapses, respectively.
CONCLUSION: The treatment of sternal tumors by means of a broad sternal resection followed by a reconstruction based on the use of prosthetic materials is an efficacious and safe solution that improves the quality of life and makes it possible to perform curative broad radical resections in the case of primary tumors. Resection offers a significant and permanent palliative solution in breast cancer relapse and radionecroses.
CLINICAL IMPLICATIONS: Major en bloc resections can be performed with zero mortality, minimal morbidity and acceptable hospitalisation times provided that all of the steps are standardised.
DISCLOSURE: Cosimo Lequaglie, No Financial Disclosure Information; No Product/Research Disclosure Information