High-Grade Chondrosarcoma Involving the Xiphoid Process and Lower Sternum—The Continuing Role of Extended Open Chest Wall Surgery in the Era of Minimally Invasive Thoracic Surgery: A Case Report

Primary chondrosarcoma of the sternum is a rare malignancy whose anatomical location can create major diagnostic, resection, and reconstruction challenges. We report a 62-year-old man with severe obesity and a heavy smoking history who presented with a progressively enlarging, painful sternal swelling. Preoperative imaging conducted via computed tomography and positron emission tomography–computed tomography demonstrated a large heterogeneous mass at the anterior thoracoabdominal junction infiltrating the xiphoid process. CT-guided biopsy established grade III chondrosarcoma. Because of the tumor’s size, location, and infiltrative features, bilateral transverse thoraco-sternotomy (“Clamshell” Procedure) was performed. “En bloc” resection included the middle and lower sternum, involved soft tissues and adjacent costal arches, followed by prosthetic synthetic polypropylene mesh reconstruction. The final pathology documented tumor-free examined margins (R0), with an approximately 10 mm closest reported clearance. The postoperative course was prolonged and complex. The patient required 18 days of intensive care and tracheostomy on postoperative day 8 because of delayed awakening and intermittent oxygen desaturation. Wound dehiscence necessitated surgical revisions on postoperative days 29 and 44; during the second revision, the infected mesh was removed. The tracheostomy was removed on day 64, and the patient was discharged in a stable condition two days later. This case demonstrates that extensive open approaches remain indispensable for selected chest wall malignancies. It also emphasizes the importance of coordinated multidisciplinary perioperative care from diagnosis through recovery, while illustrating how reconstructive resources, patient risk, and infection can determine the procedure’s outcome.