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Gold Standard for Sternectomies and Plastic Reconstructions After Resections for Primary or Secondary Sternal Neoplasms

From the Department of Oncologic Thoracic Surgery, Istituto Nazionale Tumori, Milan, Italy.

Correspondence: Address correspondence and reprint requests to: Cosimo Lequaglie, MD, Divisione di Oncologia Chirurgica Toracica, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano MI, Italy; Fax: 39-02-2360486; E-mail: lequaglie{at}istitutotumori.mi.it

Background: Between January 1980 and December 1999, 88 patients underwent the surgical resection of sternal tumors: 30 primary malignant tumors, 28 local relapses or metastases from breast carcinomas, 16 other types of tumor, and 14 radionecroses.

Methods: The sternectomies were total in 8 cases, subtotal in 32, and partial in 48. Prosthetic materials covered by flaps of myocutaneous or muscle tissue were used in 55 patients, prosthetic material alone in 13, myocutaneous or muscle flaps alone in 5, and other techniques in the remaining 15. The resection was radical in 78 cases and palliative in the other 10.

Results: Forty-eight of the subjects who underwent radical surgery were alive and disease free at the end of the follow-up period. The expected 10-year survival of the patients treated for primary tumors is approximately 85% (Kaplan-Meier), and that of the patients with relapsing breast carcinomas is the same as after 5 years (41.8%).

Conclusions: In our experience, the treatment of neoplasms by means of a broad sternal resection followed by a reconstruction based on the use of prosthetic materials is an effective and safe solution that considerably improves the quality of life and makes it possible to perform curative broad radical resections in the case of primary sternal resections.

Key Words: Sternectomy • Sternal tumor • Plastic repair • Long-term survival

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