title: The "rib-like" technique for surgical treatment of sternal tumors: lessons learned from 101 consecutive cases.
abstract: BACKGROUND
  Sternal tumors represent a rare subgroup of chest wall neoplasms in which indication, surgical issues, and long-term results are rarely reported. Thus, in this study we reevaluated our experience in sternal replacement from a series of 101 consecutive cases during the last 30 years.
  
  
  METHODS
  Clinical records of patients who underwent sternal resection between January 1980 and December 2008 were reviewed. The technique of reconstruction after sternectomy varied over time, including mesh replacement in 52 patients (group A), rigid prosthesis in 27 patients (group B), and the "rib-like" technique, a semi-rigid tridimensional prosthesis reproducing the shape of native ribs, in 22 patients (group C). Postoperative outcomes and long-term survival were analyzed.
  
  
  RESULTS
  Of 101 patients, 42 underwent resection for primary chest wall tumors, 30 for breast cancer, 15 for locally advanced tumors, 11 for metastatic disease, and 3 for benign disease. One patient died postoperatively. The overall major complications rate was similar between groups. Local infection required prosthetic removal in 7 patients of groups A and B (9%). No infection occurred in group C (p = 0.02). Median survival exceeded 60 months for primary sternal tumors and 22 months for other cancer (p = 0.01). The worst survival was recorded in radioinduced sarcoma (17 months) and in patients who underwent previous resection before salvage sternectomy (18 months).
  
  
  CONCLUSIONS
  Results from this study showed that an adequate sternal resection should be done at the first operation and that improving prosthetic integration with surrounding tissues may reduce the local complication rate.
authors.affiliation: Thoracic Surgery Department, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Francesca
authors.initials: F
authors.lastname: Bravi
authors.forename: Luca
authors.initials: L
authors.lastname: Tavecchio
authors.forename: Andrea
authors.initials: A
authors.lastname: Spano
authors.forename: Umberto
authors.initials: U
authors.lastname: Cortinovis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Nava
authors.forename: Ugo
authors.initials: U
authors.lastname: Pastorino
mesh_terms: D001859:Bone Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012272:Ribs; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D056346:Sternotomy / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome