Partial upper sternotomy for anterosuperior mediastinal surgery: an institutional experience.

BACKGROUND: Median sternotomy is the traditional approach used to resect anterior mediastinal masses or access the anterosuperior compartment of the mediastinum. A partial upper sternotomy is an alternative, less invasive technique. Our goal in this study is to analyze the circumstances under which partial upper sternotomy is appropriate and to determine the outcomes of these patients.

METHODS: From January 1994 to July 2008, 35 patients underwent partial upper sternotomy, solely or as part of a larger procedure. We analyzed these patients to determine the utility of this approach, the ability to achieve complete resection, and outcomes.

RESULTS: Of the 35 patients, 13 patients underwent resection for thymoma (9 stage I, 4 stage II), 5 for cervical node dissection, 7 for thymic hyperplasia, 3 for thyroid resection, 3 for esophagectomy, 2 for thymic cyst, 1 for bronchogenic cyst, and 1 for thymic cholesterol granuloma. Median age of patients was 51 (range 28-79) years with 54% (n = 19) males. There were no intraoperative complications or deaths within 30 days. Median length of stay was 3 days. Complete resection was possible for all patients who underwent resection for thymic masses, hyperplasia, or cystic mediastinal structures (n = 24). There were no recurrences on long-term follow-up for those with thymomas.

CONCLUSIONS: Partial upper median sternotomy is a safe and effective means of accessing the anterosuperior mediastinum. It is an alternative to full sternotomy and provides a less invasive means of resecting small anterior mediastinal masses as well as accessing the thoracic inlet.