title: Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet.
abstract: Standard treatment for lung cancer presenting as a superior sulcus tumor is induction chemoradiotherapy followed by surgery, which yields rates of about 70% complete resection and 50% 5-year survival rate. However, the surgical technique to achieve complete resection for superior sulcus tumor invading major anatomical sites including the subclavian artery is challenging. The anterior transcervical thoracic approach applied by Dartevelle and colleagues provides excellent exposure of the subclavian vessels. Grunenwald and associates have improved on this approach to preserve the clavicle and sternoclavicular joint. We applied the transmanubrial osteomuscular-sparing approach in two patients. In both cases, exposure of the subclavian vessels was excellent. In one case, the subclavian artery was resected and reconstructed with a polytetrafl uoroethylene graft. This patient has continued to show recurrence-free survival for more than 5 years. We outline our experience and review the literature on the surgical approach for superior sulcus tumor invading the anterior part of the thoracic inlet.
authors.affiliation: Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan. hmatsugu@tcc.pref.tochigi.lg.jp
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Matsuguma
authors.forename: Rie
authors.initials: R
authors.lastname: Nakahara
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Haruko
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akiko
authors.initials: A
authors.lastname: Ui
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D013348:Subclavian Artery / Q000473:pathology / Q000601:surgery*; D013350:Subclavian Vein / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D019616:Thoracic Surgical Procedures; D013908:Thoracotomy; D016896:Treatment Outcome