title: Management of superior sulcus tumors: experience with 139 cases treated by surgical resection.
abstract: BACKGROUND
  The management of non-small cell carcinomas of the lung involving the superior sulcus remains controversial. The goal of this retrospective study was to evaluate the role of surgery, radiotherapy, and chemotherapy for the treatment of superior sulcus tumors, to define the best surgical approach for radical resection, and to identify factors influencing long-term survival.
  
  
  METHODS
  Between 1983 and 1999, 139 patients underwent surgical resection of superior sulcus tumors in seven thoracic surgery centers. According to the classification of the American Joint Committee, 51.1% of cancers were stage IIB, 13.7% stage IIIA, 32.4% stage IIIB, and 2.9% stage IV.
  
  
  RESULTS
  The resections were performed with 74.1% using the posterior approach and 25.9% using an anterior approach. A lobectomy was accomplished in 69.8% of the cases and a wedge resection in 22.3%. Resection of a segment of vertebrae or subclavian artery was performed, respectively, in 19.4% and 18% of the cases. Resection was complete in 81.3% of cancers. The overall 5-year survival rate was 35%. Preoperative radiotherapy improved 5-year survival for stages IIB-IIIA. Surgical approach, postoperative radiotherapy, or chemotherapy did not change survival.
  
  
  CONCLUSIONS
  The optimal treatment for superior sulcus tumors is complete surgical resection. The surgical approach (anterior/posterior) did not influence the 5-year survival rate. Preoperative radiotherapy should be recommended to improve outcome of patients with a superior sulcus tumor.
authors.affiliation: Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Bobigny, France. emartinod@wanadoo.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Martinod
authors.forename: Alexandre
authors.initials: A
authors.lastname: D'Audiffret
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Wurtz
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.forename: René
authors.initials: R
authors.lastname: Jancovici
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pierre
authors.initials: P
authors.lastname: Fuentes
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Azorin
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate