Sternal replacement with alumina ceramic prosthesis after oncological resection

No gold standard method exists for sternal replacement. A ceramic prosthesis (CERAMIL) was developed with the aim to comply with “ideal” sternal substitute requirements. We conducted a multicentric post-market surveillance study, independent of the manufacturer, to evaluate the safety and the effectiveness of the device. CERAMIL is a porous alumina sternal prosthesis. Appropriate size is per-operatively chosen using templates. The device is anchored with sutures after mediastinum protection with mesh. No metallic fixation is needed. Between March 2015 and October 2022, 53 non-infected malignant sternal tumors were treated in 19 centers from 7 countries. Thirty-seven female (70 %) and 16 male (30 %) patients with a median age of 56 (13–79) underwent the procedure. Indications were sternal cancers (n = 25) and metastasis (n = 28). Twenty-nine grade ≥ IIIA-complications occurred in 15 patients (28 %); 9 of them were early reoperated (17 %). Chest wall stability was achieved for all patients. One postoperative death occurred because of septic complications. Median intensive care unit and hospital lengths of stay were respectively 2 (0–44) and 13 days (6–52). Eight patients presented non-free margins (15 %), 2 patients experienced palliative resection (4 %). After 14 months of median follow-up (1,5–67), 5 prosthesis removals were required (9 %): 4 wound infections, 1 hemomediastinum. Seven patients died during the follow-up (13 %): 1 postoperative death, 6 cancer evolutions. Sternal replacement with the CERAMIL prosthesis could be a promising technique with acceptable outcomes to manage this challenging condition. The easy implantation technique ensuring chest wall stability is a device key advantage.