To target the standard to sternal resections for cancer even in apparently extreme situations and to report the better treatment for the better prognosis.
Our experience is 102 sternal tumor resections during last decade: 37 primary tumors, 31 local relapses or metastases from breast cancers, 19 other tumors and 15 radionecroses. There were 11 total sternectomies, 39 subtotal (>50%), and 52 partial (<50%). The procedure was associated to 70 rib resections, 16 of the clavicles, 26 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 64 patients, prosthetic material in 18, myocutaneous or muscle flaps in 5, and other in 15. A radical resection was in 92 cases and palliative in 10.
There were 2 peri-operative deaths, and 3 necroses of the flap. Sixty-two patients with radical surgery were alive and disease free at the end of the follow-up, 86% of survival in primary tumors, 11.6vs0% in secondary tumors and 42.7% in breast cancer relapses.
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. Major en bloc resections can be performed with zero mortality, minimal morbidity and acceptable hospitalisation times provided that all of the steps are standardised. Resection offers a significant and permanent palliative solution in breast cancer relapse and radionecroses.
All patients with sternal neoplasms must be valued by oncologic surgeon not only by medical oncologic point of view.
Cosimo Lequaglie, None.