Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet

Dartevelle, Philippe; Chapelier, Alain; Macchiarini, Paolo; Lenot, Bernard; Cerrina, Jacques; Ladurie, F. Le Roy; Parquin, François; Lafont, D

doi:10.1016/s0022-5223(19)33774-2

Cited by 321 publications

(113 citation statements)

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“…An L-shaped incision cervicotomy is made and includes a vertical presternocleidmastoid incision prolonged horizontally below the clavicle up to the delto-pectoral groove (Fig. 3) [13]. The incision is then deepened with cautery.…”

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confidence: 99%

Surgical Management of Superior Sulcus Tumors

Dartevelle

Macchiarini

1999

The Oncologist

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Superior sulcus tumor refers to any primary lung cancer presenting with constant pain in the nerve distribution of the eighth cervical, first and second thoracic nerve roots and Horner's syndrome caused by invasion of the stellate ganglion. The pain is steady, severe, and unrelenting, involving the shoulder, the vertebral margin of the scapula and ulnar distribution of the arm to the elbow and finally to the ulnar surface of the forearm, and the small and ring fingers of the hand (Pancoast‐Tobias syndrome). Weakness and atrophy of the hand muscles can also occur as the lesions spreads to involve the first and second ribs and vertebrae. Radiologically, there is a small shadow at the extreme apex of the lung with rib and possible vertebral body invasion. Pulmonary symptoms are less frequent because of the peripheral location of the lesions. Since Shaw and Paulson approached superior sulcus tumors in 1961 by using preoperative radiationtherapy (30 to 45 Gy in four weeks including the primary tumor, mediastinum and supraclavicular region) followed by surgical resection, this radiosurgical approach shortly became the standard treatment yielding better disease control and survival than that offered by other treatment modalities. It has now become evident that en bloc resection of the chest wall, involved adjacent structures as well as lobectomy must be considered the standard surgical approach for superior sulcus tumors combined with external radiation (preoperative, postoperative, or both). The goal of the operation is the complete and en bloc resection of the upper lobe in continuity with the invaded ribs, transverse processes, subclavian vessels, T1 nerve root, upper dorsal sympathetic chain and prevertebral muscles.

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confidence: 99%

Surgical Management of Superior Sulcus Tumors

Dartevelle

Macchiarini

1999

The Oncologist

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“…Other advantages of our procedure are that it does not de-stabilize the shoulder complex by clavicular disruption and it can be repeated if necessary without additional morbidity. 3 Our approach retains the option of extending the exposure by utilizing the techniques of Dartevelle et al 4 and Grunewald & Spaggiari 5 if the tumour is found intraoperatively to be invading surrounding structures. Many of these patients had elsewhere only been offered palliative treatment for distressing, potentially fatal progressive symptoms of upper mediastinal disease.…”

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confidence: 99%

How we do it: the anterior thoraco‐cervical approach to tumours of the thoracic inlet

Upile

Triaridis

Kirkland

et al. 2005

Clinical Otolaryngology

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KEYPOINTS: Tumours that arise in the thoracic inlet and superior mediastinum may be benign or malignant and present the surgeon with a difficult problem of access. The standard approach to the thoracic inlet from below offers limited exposure to the vascular and neural structures superior to the tumours. The anterior thoraco-cervical approach to the root of the neck and superior mediastinum combines the anterior cervical approach with a limited upper median sternotomy. If further access is required to achieve surgical clearance a full sternotomy split can be performed. The approach offers excellent exposure and helps to facilitate complete resection of benign and malignant tumours, which would otherwise be deemed inoperable or difficult to resect completely through other standard approaches. In contrast to previously described anterior transcervical thoracic approaches which required resection of part of the clavicle or manubrium as well as thoracotomy with increased morbidity, the anterior thoraco-cervical approach is associated with little morbidity and the postoperative stay is short.

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“…Surgery consists of a posteriolateral [18][19][20] approach, an anterior transclavicular [21,22] approach, partial sternotomy [23], and finally a combined vertebrectomy and reconstruction combined with chest wall reconstruction when the vertebral body is involved [24][25][26]. Vascular involvement and vertebral body involvement have historically been contraindications to surgical intervention; however, with advances in surgical techniques and better preoperative staging, tumors that were deemed unresectable may now undergo resection.…”

Section: Treatmentmentioning

confidence: 99%

Superior Sulcus Tumors: A Mini-Review

Archie¹,

Thomas

2004

The Oncologist

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The management and outcome for superior sulcus tumors have remained unchanged for 40 years. The rarity of these tumors has led to varying treatment techniques spanning decades, from which no solid conclusions can be drawn. Recent advances in combined-modality therapy have offered the first inkling that a paradigm shift is on the horizon. Here, we review the history and new advances in treating this challenging pulmonary neoplasm. The Oncologist 2004;9:550-555 The Oncologist 2004;9:550-555 www.TheOncologist.com Antonio, 7703 Floyd Curl Dr., San Antonio, Texas 78229, USA. Telephone: 210-616-5684; Fax: 210-949-5085; e-mail: cthomas@ctrc.net; Website: http://www.uthscsa.edu/radiationoncology Received January 27, 2004; accepted for publication May 10, 2004. ©AlphaMed Press 1083-7159/2004 In 1924, Pancoast [1] reported the clinical and radiographic findings associated with superior sulcus tumors. He initially thought that these tumors arose from epithelial rest cells from the fifth brachial cleft. Eight years later, Tobias [2] and Pancoast [3] simultaneously, correctly recognized that bronchogenic carcinoma was the primary cause of this syndrome. Correspondence: Charles R. Thomas Jr., M.D., Department of Radiation Oncology, University of Texas Health Science Center at San HISTORYSuperior sulcus tumors usually arise in the apex of the lung and may invade the second and third ribs, the brachial plexus, the subclavian vessels, the stellate ganglion, and adjacent vertebral bodies [4]. Pancoast syndrome is characterized by pain, which may arise in the shoulder or chest wall or radiate to the neck. Pain characteristically radiates to the ulnar surface of the hand. Horner's syndrome, which is composed of ptosis, meiosis, and anhydrosis, results from invasion of the paravertebral sympathetic chain. Weakness and atrophy of the hand and parasthesias are a common clinical finding resulting from invasion into the C8 and T1 roots of the brachial plexus. More infrequent manifestations include supraclavicular adenopathy, superior vena cava syndrome, and involvement of the phrenic or laryngeal nerves [5].Prior to the 1950s, superior sulcus tumors were uniformly fatal. Chardack and MacCallum [6] reported the The Oncologist ® Lung Cancer LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the diagnostic work-up for superior sulcus (Pancoast) tumors of the lung.2. List the major prognostic factors pertaining to outcome in patients with superior sulcus (Pancoast) tumors.3. Discuss the recent (SWOG 94-16) and current (SWOG-0220) intergroup trials for superior sulcus (Pancoast) tumors.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME by guest on May 9, 2018 http://theoncologist.alphamedpress.org/ Downloaded fromThis material is protected by U.S. Copyright law.Unauthorized reproduction is prohibited. For reprints contact: Reprints@AlphaMedPress.com first successful treatment with resection followed by postoperative radiation...

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Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet

Cited by 321 publications

References 20 publications

Surgical Management of Superior Sulcus Tumors

Surgical Management of Superior Sulcus Tumors

How we do it: the anterior thoraco‐cervical approach to tumours of the thoracic inlet

Superior Sulcus Tumors: A Mini-Review

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