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. 2017 Nov;9(11):4336-4346.
doi: 10.21037/jtd.2017.10.94.

Short and long-term results of sternectomy for sternal tumours

Stefano Bongiolatti  1 , Luca Voltolini  1 , Sara Borgianni  1 , Roberto Borrelli  1 , Marco Innocenti  2 , Giulio Menichini  2 , Leonardo Politi  1 , Giorgia Tancredi  1 , Domenico Viggiano  1 , Alessandro Gonfiotti  1
Affiliations

Short and long-term results of sternectomy for sternal tumours

Stefano Bongiolatti et al. J Thorac Dis. 2017 Nov.

Abstract

Background: We analyzed our experience in sternal resections (SRs) for primary or secondary neoplasm focusing on technical aspects of reconstruction, post-operative outcomes and long term survival.

Methods: From January 2005 to December 2015, 36 patients (24 males, 67%) underwent surgical excision of primary (chondrosarcoma n=18 patients, 50%; osteosarcoma n=2, 6%; Ewing sarcoma n=1, 3%; other n=2, 6%) or secondary (breast cancer n=7, 19%; kidney carcinoma n=2, 6%) sternal tumour. We performed n=30 partial sternectomy and n=6 total sternectomy with en-bloc resection of the sternocostal cartilages in all patient and extended resection in 7 patients. Stability was obtained with prosthetic material, rigid and non-rigid and a muscular flap: rigid material [Strasbourg Thoracic Osteosynthesis System (STRATOS), MedXpert GmbH] and muscle flap n=11 (30.6%); polytetrafluoroethylene patch and muscle flap n=6 (16.7%); muscle flap alone n=19 (52.8%).

Results: The 30-day mortality rate was 0, overall complication rate was 19%. The median ICU stay was 1.5 days and mean hospital stay was 10.6±5.9 days. We obtained a complete (R0) resection in all patients. Overall survival (OS) at 5 and 10 years were 59% and 40%; in the group of primary neoplasm OS rate at 5 and 10 years was 79% and 54%. Disease free survival (DFS) rate at 5 years was 61%. Higher grading was identified as negative prognostic factor.

Conclusions: Wide radical resections of anterior chest wall are basilar in a multimodality treatment for primary or metastatic neoplasm of the sternum. Stabilization with titanium bars and clips provides rigidity of chest wall with good functional results.

Keywords: Sternectomy; chest-wall prosthesis; chest-wall reconstruction; chondrosarcoma; titanium bars and clips.

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Conflict of interest statement

Conflicts of Interest: Presented at 30th EACTS Annual Meeting, 1–5 October 2016, Barcelona. Session: Chest wall and mediastinum.

Figures

Figure 1
Figure 1
Schema of the extent of resection.
Figure 2
Figure 2
Intraoperative image of resection of the manubrium and reconstruction with ePTFE convered with latissimus dorsi muscle flap. ePTFE, expanded-polytetrafluoroethylene.
Figure 3
Figure 3
(A) Intraoperative images of lower-third partial sternectomy for chondrosarcoma, rigid reconstruction with STRATOS and coverage with sliding PM flap; (B) chest X-ray in postoperative day 7 of the same patient. STRATOS, Strasbourg Thoracic Osteosynthesis System.
Figure 4
Figure 4
(A) Intraoperative images of upper-third partial sternectomy associated with resection of II, III and IV costal cartilage for chondrosarcoma and reconstruction with STRATOS covered by latissimus dorsi muscle flap (B). Chest X-ray in postoperative day 1 of the same patient (C). STRATOS, Strasbourg Thoracic Osteosynthesis System.
Figure 5
Figure 5
Overall 5- and 10-year survival curve.
Figure 6
Figure 6
Outcome of patients with primary or secondary sternal tumour, the 5-year overall survival for PSTs was 79%. PSTs, primary sternal tumours; SST, secondary sternal tumour.
Figure 7
Figure 7
Disease-free survival curve based on resectional status.
Figure 8
Figure 8
Survival of PST curve based on resectional status. PST, primary sternal tumour.
Figure 9
Figure 9
Survival curves based on histological grading of chondrosarcoma.
See this image and copyright information in PMC

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