title: Surgical access to tumors of the cervicothoracic junction.
abstract: BACKGROUND
  Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. These approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.
  
  
  METHODS
  Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.
  
  
  RESULTS
  Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external-beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3-47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.
  
  
  CONCLUSIONS
  The combined "trap door" technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sterno-clavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging.
authors.affiliation: Department of Surgery (Head and Neck and Thoracic Services), Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Kraus
authors.forename: J
authors.initials: J
authors.lastname: Huo
authors.forename: M
authors.initials: M
authors.lastname: Burt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013903:Thoracic Surgery / Q000379:methods*; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000601:surgery; D016896:Treatment Outcome