Complete surgical resection following chemoradiation is recommended in patients with resectable non-small cell lung cancer that invades the superior sulcus. Several approaches have been proposed based on the site of invasion. 1 We demonstrate a case who underwent anterior transclavicular approach (the Dartevelle approach) for non-small cell lung cancer invading the anatomical territory in the vicinity of the sternoclavicular joint (Video 1). Institutional review board approval was waived, owing to the single case report nature, individual informed consent was not required.
CLINICAL SUMMARYA 65-year-old male ex-smoker presented with left shoulder pain and abnormalities on chest radiography, and computed tomography revealed a left apical mass (4 cm). He had history of tracheostomy due to purulent tonsillitis 10 years ago. His pulmonary function was normal (forced expiratory volume in 1 second 105%; diffusing capacity for carbon monoxide 121%). A transbronchial biopsy specimen revealed squamous cell carcinoma. A fluorine 18-fluorodeoxyglucose-positron emission tomography did not show any nodal or distant metastases. The results of an endobronchial ultrasound-guided biopsy of the mediastinal lymph nodes (station 4R and 7 were sampled; 4L was not amenable to biopsy due to its small size), as invasive mediastinal staging, were negative for malignancy. We observed tumor invasion of the left subclavian vein and the sternal attachment of the first rib and anterior aspect of the second rib (cT4N0M0, Figure 1, A). Magnetic resonance imaging confirmed the invasion of the chest VIDEO 1. Anterior transclavicular (Dartevelle) approach for lung cancer invading the superior sulcus. Video available at: https://www.jtcvs.org/ article/S2666-2507(21)00590-3/fulltext.