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. 2024 Oct 15:79:100468.
doi: 10.1016/j.clinsp.2024.100468. eCollection 2024.

Predictors of postoperative complications after sternectomy on oncologic patients

João Paulo Cassiano de Macedo  1 , Pedro Henrique Xavier Nabuco-de-Araujo  2 , Benoit Jacques Bibas  3 , José Ribas M de Campos  3 , Paulo M Pêgo-Fernandes  3 , Ricardo M Terra  2
Affiliations

Predictors of postoperative complications after sternectomy on oncologic patients

João Paulo Cassiano de Macedo et al. Clinics (Sao Paulo). .

Abstract

Background: Chest wall tumors are uncommon. The surgical objective is local disease control and the relief of symptoms. Due to the heterogeneity of cases, the great variety of reconstructions, size of resection, and clinical and surgical outcomes are still uncertain.

Methods: Patients were submitted to sternectomies for tumors between 1997 and 2019. Oncological, and surgical characteristics were taken into consideration. The outcomes were related to the size of resection and classified into local and systemic complications. The authors used univariate and multivariate analyses to determine predictors of complications. Survival analysis and Kaplan-Meier curves were obtained.

Results: Thirty resections were performed due to metastatic disease. Partial sternectomy was accomplished in 48.8 %, followed by subtotal in 40 %. Primary closure using Pectoralis major was performed in 48.8 %, and Latissimus dorsi in 35.5 %. Polypropylene mesh was used in 86.6 % of reconstructions. The prosthesis removal was necessary in 6.66 %. Respiratory failure was evidenced in 6.66 %. The resection area was a predictor of local and systemic complications (p = 0.0029; p = 0.0004 respectively) in univariate analysis. However, the size of resection was the only predictor of systemic complications regarding multivariate analysis (p = 0.014, 95 % CI 1.00‒1.07).

Conclusion: The size of the resection was related to systemic complications, and the mesh reconstruction resulted in a low percentage of prosthesis removal and respiratory failure. This suggests a high resistance to local issues and a low respiratory failure rate.

Keywords: Chest wall resection; Chest wall tumor; Reconstruction.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
(A) Metastatic chest wall tumor after mastectomy. (B) Defect size after resection. The blue line represents the side-to-side measure, and the green line represents the top-to-bottom measure.
Fig 2
Fig. 2
Kaplan-Meier curve.
See this image and copyright information in PMC

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