Partial Upperhemisternotomy For Rerecurrent Thyroid Cancer
SuNY, Syracuse, NY, USA.
Objective:Sternal thyroid cancer metastases are rare and poses surgical challenges. They do not respond well to radioiodine ablation. Surgery is one option. Sternal thyroid metastases have nevered been approached via upper hemisternotomy(UH) before.
METHODS UH has been used for multitude other operations. We have extensive experience with this. It reduces postoperative pain, results in fewer iCU days, shorter LOS and less hospital costs.
This case describes a minimally invasive approach for a solitary upper retrosternal thyroid cancer metastasis with upper hemisternotomy.
Results: A 57 year old active gentleman, previously underwent cervical partial thyroidectomy, cervical reresection and irradiation. He presents with chest discomfort. CTPET demonstrated a 3x3x4 cm mass on the right upper sternal undersurface. UH was performed into the right third intercostal space. A single arm of the Favoloro retractor allowed gradual elevation of the right upperhemisternum. The mass was dark grey, flat, densely adherent to the sternum, 5 mm to the right of the median sternotomy, overlying the first intercostral space and first rib articulation. The periostium and inner table of the manubrium were excised with the mass intact. He was discharged home on POD#2.
Conclusions:In summary, rare isolated thyroid cancer bony metastases may present in the sternum. Surgical extirpation is associated with improved survival in a subgroup of patients with distant metastases limited to the bones. The upperhemi sternotomy approach is feasible, safe with excellent quality of life even in the presence of rerecurrence and radiation.
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