CASI CLINICI   

Chirurgia 2015 April;28(2):89-93

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Partial sternal resection for metastasis to the sternal body and reconstruction with titanium plates: report of two cases

Shimizu J. ¹, Murata S. ², Arano Y. ³, Kamesui T. ¹, Moriya M. ¹, Hayashi S. ¹

¹ Department of Surgery, Hokuriku Central Hospital, Oyabe, Japan; ² Department of Chest Surgery, Toyama Rosai Hospital, Uozu, Japan; ³ Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Japan

We presented two cases of partial sternal resection for metastasis to the sternal body and reconstruction with titanium plates. Case 1 was a 67-year-old woman who underwent breast-preserving surgery for left breast cancer (pT1N0M0, Stage I) in 1995. In 2010, she was admitted with a diagnosis of right carcinomatous pleurisy. Pleural biopsy suggested lung adenocarcinoma. While treatment regimens were changed from carboplatin + gemcitabine to gefitinib to pemetrexed to docetaxel and finally to erlotinib, she remained in complete remission (CR) for 32 months. However, positron emission tomography (PET) performed in 2012 and 2013 revealed accumulation of fluorodeoxyglucose (FDG) in the sternal body. In August 2013, a metastatic sternal tumor was diagnosed, and surgery was performed to relieve pain. An area from the lower manubrium to the middle sternal body was resected en bloc, and two 142-mm titanium reconstruction plates were longitudinally aligned and fixed to the residual sternum to reconstruct the chest wall. The pathological diagnosis of the sternal tumor was a metastatic adenocarcinoma from lung cancer To date, up to 12 months after surgery, the patient is being treated with erlotinib on an outpatient basis. Case 2 was a 69-year-old woman who underwent breast-preserving surgery for right breast cancer (pT1N0M0, Stage I) in 2004. In 2008, a right parasternal lymph node metastasis was detected. Despite chemotherapy, the patient was determined to have progressive disease (PD) because the mass grew and bilateral lung metastases occurred. Chest computed tomography revealed a 5-cm mass in the area from the right half of the sternal body to the costal cartilage/soft tissues. Surgery was performed in 2009 to relieve severe chest pain. The chest wall over the right two-thirds of the middle sternal body, including the third to fourth right costal cartilages, intercostal muscle, and soft tissue, was resected en bloc, and two 170-mm titanium reconstruction plates were longitudinally aligned and fixed to the residual sternum for sternal reconstruction. The pathological diagnosis was metastasis of breast cancer. Although chemotherapy was added after surgery, she died of bilateral lung metastases 14 months after sternal resection. In both cases, there was no evidence of flail chest after surgery, and cancer pain also disappeared. Because sternal resection substantially affects respiration/circulation, reconstruction of the chest wall is necessary. Artificial materials are required to be non-irritating, to show excellent histocompatibility, and to provide sufficient supporting strength and durability. The titanium reconstruction plates thus appeared to be an optimal material.