title: Sternal resection for sarcoma, recurrent breast cancer, and radiation-induced necrosis.
abstract: BACKGROUND
  The purpose of this study was to investigate the long-term outcome and technical feasibility of sternal resection.
  
  
  METHODS
  We performed a 25-year retrospective study of 68 patients who underwent a sternectomy for sarcoma, recurrent breast cancer (BC) or radiation-induced necrosis between 1981 and 2006 in two tertiary referral centres (Erasmus Medical Center/Daniel den Hoed Cancer Center and Netherlands Cancer Center/Antoni van Leeuwenhoek Hospital, Netherlands). Patients were treated with curative intent and followed until May 2009. Medical records were reviewed for patient characteristics, indications for surgery, surgical technique, postoperative complications, and survival.
  
  
  RESULTS
  Sternal resection was performed in 43 sarcoma patients, 17 recurrent BC and 8 patients with radiation-induced necrosis with additional rib resection in the majority of patients and with clavicle resection in 13% of patients. Additional scapula, lung, breast or axilla resection, or both, was performed in 10%. Two patients died postoperatively (3%). Mild complications occurred in 24%, and severe complications (namely, pulmonary complications and reinterventions) in 16% of patients. Radical resection was achieved in 80% and 53% of sarcoma and recurrent BC patients, respectively. Five-year overall survival was 64% and 40% in sarcoma and recurrent BC patients, respectively, with 5-year disease-free survivals of 52% and 15%, respectively.
  
  
  CONCLUSIONS
  Sarcomas, recurrent BC, and radiation-induced necrosis can be successfully managed by sternal resection and reconstruction with curative intent. Low mortality and acceptable morbidity rates justify this operation in a palliative setting as well. Disease-free survival is poor among recurrent BC patients.
authors.affiliation: Department of Surgical Oncology, Erasmus Medical Center/Daniel den Hoed Cancer Center, Rotterdam, Netherlands. l.koppert@erasmusmc.nl
authors.forename: Linetta B
authors.initials: LB
authors.lastname: Koppert
authors.forename: Albertus N
authors.initials: AN
authors.lastname: van Geel
authors.forename: Titia E
authors.initials: TE
authors.lastname: Lans
authors.forename: Carmen
authors.initials: C
authors.lastname: van der Pol
authors.forename: Frits
authors.initials: F
authors.lastname: van Coevorden
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000601:surgery; D001943:Breast Neoplasms / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery; D013249:Sternum / Q000098:blood supply / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult