Upperhemisternotomy And Partial Resection Of A Metachronous Thyroid Carcinoma Sternal Metastasis; A Challenging Case.
SUNY, Syracuse, NY, USA.
Background:Thyroid cancer metastasis to the sternum is rare and is a difficult challenge. After the initial thyroid carcinoma surgery, there are no consensus treatment for sternal metastasis. Bone metastases do not respond well to radioiodine ablation. Surgery may be performed in solitary bone metastasis.
Methods:However none have been approached via a upper hemisternotomy for second time rerecurrence. Upperhemisternotomy has been shown to reduce postoperative pain, results in fewer iCU days, less LOS and less hospital costs. This case report describes a minimally invasive approach to a single solitary metastasis with upper hemisternotomy. Our group has previous extensive experience with minimally invasive cardiac and thoracic sternal procedures.
Results:The patient consented to this report. A 57 year old extremely active gentleman, previously underwent cervical partial thyroidectomy and cervical reresection for recurrence.
He presents with chest discomfort. CTPET demonstrated a 3x3x4 cm mass on the under surface of the right hand side of the sternum. He played tennis and desired a minimally invasive approach.
A T skin incision was made connecting his previous cervical incisions to just below the angle of Louis.
Upper hemisternotomy was performed and T’d off into the right fourth intercostal space. The sternum was opened and under the right hand upper aspect the mass could be palpated but not visualized. A different retractor allowed gradual elevation of the right upperhemisternum and improved visibility. The mass was identified as greyish in color, flat, densely adherent to the sternum, 4 mm to the right of the median sternotomy, overlying the first intercostral space and first rib articulation. A circumferential incision was made. The periosteteum of the inner table of the manubrium was harvested. The mass was removed intact. The sternum was reapproximated with sternal wires. Pain was minimal postoperatively. He was discharged on POD#2.
Conclusion:In summary, rarely isolated thyroid cancer bone metastases may present to the sternum. Surgical extirpation of thyroid cancer bone metastases is associated with improved survival. The upperhemi sternotomy approach may provide better outcomes with an improved quality of life in the case of isolated metastases that are amenable to resection.
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