title: Transmanubrial osteomuscular sparing approach for sulcus superior tumours.
abstract: OBJECTIVE
  The authors report their initial experience with the transmanubrial osteomuscular sparing approach for resection of sulcus superior tumours. The feasibility of this technique is evaluated.
  
  
  METHODS
  Between February 2000 and March 2002 three patients with sulcus superior tumours were surgically treated using the transmanubrial osteomuscular sparing approach. The first two patients had a non-small cell carcinoma of the upper lobe. In the third patient a pathological diagnosis of a plasmocytoma of the first rib was made. In two cases the first thoracic root was resected.
  
  
  RESULTS
  In two patients a complete R0 resection was achieved. However, an additional posterolateral thoracotomy was necessary in two patients because the costovertebral angle was difficult to address. In one patient final histologic examination found microscopically positive margins.
  
  
  CONCLUSIONS
  We believe that the transmanubrial osteomuscular sparing technique enables us to approach and control the subclavian vessels and brachial plexus in an oncologically responsible way and permits a radical resection of tumours invading the thoracic inlet.
authors.affiliation: Department of Thoracic Surgery, Sint-Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. stephen.verbeke@belgacom.net
authors.forename: S J
authors.initials: SJ
authors.lastname: Verbeke
authors.forename: P J
authors.initials: PJ
authors.lastname: Knaepen
authors.forename: W B
authors.initials: WB
authors.lastname: Slooff
authors.forename: H W
authors.initials: HW
authors.lastname: Van Es
authors.forename: F M
authors.initials: FM
authors.lastname: Schramel
authors.forename: J M
authors.initials: JM
authors.lastname: van den Bosch
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010954:Plasmacytoma / Q000175:diagnosis / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D018570:Risk Assessment; D012494:Sampling Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome