RESECTION OF STERNAL TUMORS - EXTENT, RECONSTRUCTION, AND SURVIVAL

Background. Resection of sternal tumors may be tailored to the patient and the location of the malignancy. Methods. We reviewed our results of sternectomy (typically 5-cm margins) performed in 30 patients over a 10-year period. Results. Thirteen patients had primary sternal sarco ma (six chondrosarcoma, five osteosarcoma, two other); 10 patients had local recurrence from breast cancer; 4 patients had metastases; 3 pat ients had other (two osteoradionecrosis, one malignant fibrous histioc ytoma). Morbidity occurred in 8 patients (26.7%): wound dehiscence, 2; wound infection, 1; hemorrhage, 1; pneumonia, 1; prolonged air leak, 1; empyema, 1; and bronchopleural fistula, 1. One patient, with multip le metastases, died from adult respiratory distress syndrome on day 25 (overall mortality, 3.3%; 1 of 30). The area of reconstruction ranged from 35 to 264 cm(2). The technique of reconstruction included muscle flap alone in 13 patients; muscle flap and mesh, 9; muscle nap and ri gid prosthesis (Marlex methylmethacrylate), 7; or other, 1 patient. Ni neteen patients (63%) were extubated within 24 hours after operation. Median intensive care unit stay was 2 days; median hospitalization, 6 days. Late local recurrence after resection occurred in 6 patients; 4 from breast cancer (3 patients had concurrent distant metastases). Fiv e-year actuarial survival after primary tumor resection was 73% and 33 % after resection of recurrent breast cancer (median, 21 months). Conc lusions. Partial sternectomy may be performed for primary sternal tumo rs with short hospitalization and good local control. Wider local exci sion or total sternectomy may minimize local re-recurrence of breast c arcinoma to the sternum.