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      Radical resection and reconstruction of the sternum for metastasis of hepatocellular carcinoma

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          Abstract

          Metastatic hepatocellular carcinoma of the sternum is rare and a few cases of surgical resection have been reported. Anterior chest wall reconstruction after radical resection of the sternum and ribs aims to protect the heart and lung from external damage and herniation and restore physiologic stability of the chest wall during respiration. A variety of reconstruction techniques using various materials have been reported, but so far there are no definitive guidelines for the reconstruction of chest wall defects. Recently, we encountered a rare case of metastatic cancer of the sternum from hepatocellular carcinoma in which radical resection of the sternum and ribs, and anterior chest wall reconstruction with acellular dermal matrix and titanium plates were performed.

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          Materials and techniques in chest wall reconstruction: a review

          Stefano Sanna, Jury Brandolini, Alessandro Pardolesi … (2017)
          Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.
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            Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors.

            Kwang-Hyub Han, Chae Yoon Chon, Moon Ki Kim … (2008)
            The survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and treatment modalities. Consequently, bone metastases from HCC are diagnosed more frequently. We investigated the clinical features, prognosis, treatment outcomes, and prognostic factors of HCC presenting with bone metastasis. Between June 2000 and April 2007, we recruited 37 consecutive HCC patients presenting with bone metastasis. These patients were divided into an untreated control group (n = 16) and a treated group (n = 21). The mean age of the patients was 61.1 years (male:female, 31:6). The most common cause of HCC was hepatitis B virus infection (56.8%). Twenty-two patients (59.5%) were of Child-Pugh class A and 15 (40.5%) were of Child-Pugh class B. Spinal metastasis was most common and noted in 21 patients (56.7%). The treatment modalities in the treated group included intra-arterial chemotherapy in nine patients (42.8%), systemic chemotherapy in five (23.8%), and both intra-arterial and systemic chemotherapy in seven (33.4%). The median survival of all patients was 6.2 months (range 0.7-46.6); that of untreated control group and the treated group was 2.9 (range 0.7-42.2) and 9.7 (range 0.9-46.6) months, respectively, with no significant difference (log-rank test, P = 0.081). Cox regression analysis revealed that the presence of ascites at the initial presentation was the only prognostic factor (P = 0.016). Although our study showed that locoregional and/or systemic chemotherapy did not provide significant survival prolongation compared to supportive care in patients with HCC initially accompanied by bone metastasis, a more large-scaled randomized study might be required.
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              Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma.

              Fu Chen, Bu-Chin Yu, Tse-Chiang Chen … (2009)
              To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection (SR) for extrahepatic metastatic lesions. Prognoses made on the basis of extrahepatic metastatic sites were also examined. The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group, 1- and 3-year survival rates were 24% and 7%, respectively, while for the non-resection group, the survival rates were 8% and 0%, respectively (P < 0.0001). Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases: median survivals were 32 mo with lung metastasis, 10 mo with bone metastasis, 6.1 mo with brain metastasis. SR can provide survival benefits for patients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.
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                Author and article information

                Contributors
                Young Chul Yoon: k07yyc@catholic.ac.kr
                Jiyun Lee: waspent10c@gmail.com
                Jin Yong Jeong:
                ORCID: http://orcid.org/0000-0002-2079-0279
                jeong74@catholic.ac.kr
                Journal
                Journal ID (nlm-ta): J Cardiothorac Surg
                Journal ID (iso-abbrev): J Cardiothorac Surg
                Title: Journal of Cardiothoracic Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1749-8090
                Publication date (Electronic): 29 July 2020
                Publication date PMC-release: 29 July 2020
                Publication date Collection: 2020
                Volume: 15
                Electronic Location Identifier: 202
                Affiliations
                [1 ]GRID grid.411947.e, ISNI 0000 0004 0470 4224, Department of General Surgery, Incheon St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; Seoul, Republic of Korea
                [2 ]GRID grid.411947.e, ISNI 0000 0004 0470 4224, Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431 Republic of Korea
                Author information
                http://orcid.org/0000-0002-2079-0279
                Article
                Publisher ID: 1247
                DOI: 10.1186/s13019-020-01247-3
                PMC ID: 7392652
                PubMed ID: 32727544
                SO-VID: 5b74f0b3-901a-499f-a2e0-6be7dde2d6ad
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 3 June 2020
                Date accepted : 20 July 2020
                Categories
                Subject: Letter to the Editor
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Surgery
                Keywords: resection,reconstruction,sternum,metastasis,malignancy
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: resection, reconstruction, sternum, metastasis, malignancy

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