Hemi-clamshell approach for advanced primary lung cancer.
BACKGROUND
The hemi-clamshell approach provides a wide anterior view of the mediastinum, apical dome, and cervicothoracic area. However, only a few reports have been made regarding this technique.


METHODS
The hemi-clamshell approach was used in 24 patients, of whom 5 had a Pancoast tumor, 15 had mediastinal involvement, and 4 underwent mediastinal lymphadenopathy for left-sided lung cancer. Twenty-one of the patients received preoperative therapy.


RESULTS
Twenty-one operations were complete resections. In addition, 12 patients received cardio-vascular reconstruction and 5 a first rib resection. Postoperative major morbidity was 21 % (6/24) and mortality was 4.2 % (1/24). Nine patients died of systemic tumor relapse and 14 patients were alive after a median follow-up of 24 months (range 3 - 68 months) following the initial therapy. The 5-year survival rate of patients with mediastinal involvement was 37 % and that of 13 patients with postoperative stage I or II was 35 %.


CONCLUSIONS
The hemi-clamshell approach provides a wide exposure allowing a safe and complete removal of lung cancer that involves the mediastinum and apical thoracic dome, leading to a better long-term survival rate for patients with this disease.
Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan. ohta@surg1.med.osaka-u.ac.jp
M
M
Ohta
H
H
Hirabayasi
H
H
Shiono
M
M
Minami
H
H
Maeda
N
N
Sawabata
G
G
Matsumiya
S
S
Miyoshi
H
H
Matsuda
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome