Sternal/para-sternal resection for parasternal local recurrence in breast cancer

Background: Locoregional recurrence occurs in a significant number of patients with breast cancer. This can result in substantial morbidity and mortality. Chest wall resection is well-documented for palliation and local control in chest wall relapse; an extension of this surgery is parasternal or sternal resection. Methods: A retrospective review of medical records of eighteen women who underwent sternal or parasternal resection with curative intent between 1998 and 2007 was undertaken. Results: 12 patients had total sternal resection, five patients had sub-total sternal resection and one patient had resection of tumour and ribs. 17 patients required the insertion of a composite Marlex (R) methyl-methacrylate chest wall prosthesis, followed by soft tissue reconstruction with a pectoralis major or latissimus dorsi flap, in the majority of cases. In-hospital and 30-day mortality was 0%. One and two-year overall survival was 87% and 80% respectively. The median recurrence-free survival was 18 months (95% Cl 4-31 months). There was local and distant recurrence in one patient (5%), local recurrence in two patients (11%) and distant recurrence in eight patients (44%), with 15 out of 18 patients (77%) remaining free from local recurrence at 5 years. Conclusions: En bloc sternal resection for parasternal recurrence in breast cancer involves extensive surgery but in our experience can be performed with very low mortality and morbidity. In selected patients it provides good long term local control, relief of pain and improved cosmesis. (C) 2010 Elsevier Ltd. All rights reserved.