title: Transmanubrial osteomuscular sparing approach: different indications.
abstract: The surgery of the cervico-thoracic inlet is a challenge for the thoracic surgeon. Several authors have described different approaches - with different degrees of invasiveness - to this anatomical area. We used the transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for six patients with five different indications: 1) left anterior Pancoast tumor; 2) glomus tumor originating from the inferior trunk (C8-T1 roots) of the right brachial plexus; 3) T1 vertebral tumor; 4) right internal jugular chain, Pirogoff confluence and subclavian artery metastatic lymph nodes from thyroid carcinoma; 5) chondrosarcoma of the first left rib. The results have been satisfactory from a surgical point of view, considering that the approach gave a good exposure of the operative field (especially at the cervical level), without cosmetic problems or functional limitations. In our experience, the transmanubrial osteomuscular sparing approach is a valid technique for the treatment of several kinds of tumors of the cervico-thoracic inlet, giving a good exposure of the operative field. In the case of anterior Pancoast tumors, the upper lobectomy may necessitate a further axillary thoracotomy, when fissural adherences are present.
authors.affiliation: Thoracic Surgery Unit, Vito Fazzi Hospital, Lecce, Italy. gaetano.dirienzo@libero.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Di Rienzo
authors.forename: Corrado
authors.initials: C
authors.lastname: Surrente
authors.forename: Camillo
authors.initials: C
authors.lastname: Lopez
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Urgese
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008371:Manubrium / Q000601:surgery*; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D035423:Thoracic Cavity / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000379:methods*