title: Benefits of rib head resection via costotransverse ligament release method for T3 lung cancer in the paravertebral space.
abstract: OBJECTIVE
  Lung cancer located in the paravertebral region occasionally invades the rib head (T3) and not the spine (T4). In such cases, a costotransverse ligament release (CTLR) method may be useful for complete resection without performing a vertebrectomy.
  
  
  METHODS
  Eighteen patients with lung cancer underwent chest wall resection between 2001 and 2009 at our institutions. Of those, 7 who underwent chest wall removal with rib head resection via a CTLR method (group A) and 11 without rib head resection(conventional distal rib resection, group B) were retrospectively analyzed.
  
  
  RESULTS
  Three patients in group A underwent induction chemoradiotherapy. All rib head resections were performed via a CTLR approach without postoperative complications. There were no deaths within 30 day in group A and 1 in group B. The mean number of resected rib heads was 2.1 in group A, while 2.0 ribs were removed in group B. There was no significant difference for operation time between groups A and B(332±112 vs. 287±114 mins, p = 0.449). Local recurrence was seen in 0 patients in group A and 3 in group B(p = 0.13). The median survival time was 1489 and 727 day, respectively, while 5-year survival rates were 0.48 and 0.41, respectively.
  
  
  CONCLUSIONS
  A rib head resection via a CTLR method is an effective procedure for T3 lung cancer infiltrating the rib head.
authors.affiliation: Department of General Thoracic Surgery, Dokkyo Medical Uni versity, School of Medicine, Mibu, Tochigi, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Chida
authors.forename: Makio
authors.initials: M
authors.lastname: Hayama
authors.forename: Satoru
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishihama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oyaizu
authors.forename: Muneo
authors.initials: M
authors.lastname: Minowa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumura
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008022:Ligaments / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012272:Ribs / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult