[Analysis and long-term survival in sternectomy with plastic reconstruction for primary and secondary neoplasms of...

From January 1980 to December 1999, 88 patients underwent surgical resection for tumours involving the sternum. Thirty were males, aged 16 to 76 years, and 58 females, aged 23 to 78 years (mean ages: 48 and 53 years, respectively). There were 30 primary malignant tumours, 28 local recurrences or distant metastases from breast cancer, 16 other tumours, and 14 radionecroses. Total sternectomy was performed in 8 cases, subtotal (> 50%) in 32, and partial (< 50%) in 48. Concurrent en-bloc resection of the anterior ribs was performed in 61 patients, and of the clavicle in 13. Resection was extended to the lung in 22 patients, to the pericardium in 17, to both in 2, to the diaphragm and pericardium in 4. Bone and soft tissue defects were repaired with prosthetic material associated with a muscular or myocutaneous flap in 55 patients, with prosthetic material alone in 13 cases, with a muscular or myocutaneous flap in 5 cases, and with other techniques in the remaining patients. The resection was considered to be macroscopically radical in 78 patients and palliative in 10 cases. There was one perioperative mortality and significant morbidity was limited to 13 cases. Among the patients treated with a radical intent, 48 were alive and disease-free at the end of follow-up. The 10-year survival rate was 85% in primary tumours. For breast cancer relapses, 10-year survival was the same as 5-year survival (41.8%). In our experience, an en-bloc sternal resection for a primary or secondary tumour, followed by plastic repair using prosthetic material and/or a myocutaneous flap, is a safe, effective treatment. This intervention permits the execution of extensive radical resections for sternal neoplasms, as well as enabling the patient to obtain a better quality of life. Long-term survival after radical sternectomy also depends on the histological type of the tumour.