Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet |
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Authors: | Haruhisa Matsuguma Rie Nakahara Yoshinori Ishikawa Haruko Suzuki Akiko Ui Kohei Yokoi |
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Institution: | 1.Division of Thoracic Surgery,Tochigi Cancer Center,Tochigi,Japan;2.Division of Thoracic Surgery,Nagoya University Graduate School of Medicine,Nagoya, Aichi,Japan |
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Abstract: | Standard treatment for lung cancer presenting as a superior sulcus tumor is induction chemoradiotherapy followed by surgery,
which yields rates of about 70% complete resection and 50% 5-year survival rate. However, the surgical technique to achieve
complete resection for superior sulcus tumor invading major anatomical sites including the subclavian artery is challenging.
The anterior transcervical thoracic approach applied by Dartevelle and colleagues provides excellent exposure of the subclavian
vessels. Grunenwald and associates have improved on this approach to preserve the clavicle and sternoclavicular joint. We
applied the transmanubrial osteomuscular-sparing approach in two patients. In both cases, exposure of the subclavian vessels
was excellent. In one case, the subclavian artery was resected and reconstructed with a polytetrafl uoroethylene graft. This
patient has continued to show recurrence-free survival for more than 5 years. We outline our experience and review the literature
on the surgical approach for superior sulcus tumor invading the anterior part of the thoracic inlet. |
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