title: Subclavian artery resection and reconstruction for thoracic inlet neoplasms.
abstract: BACKGROUND
  To update the long-term outcomes after subclavian artery (SA) resection and reconstruction during surgery for thoracic inlet (TI) cancer through the anterior transclavicular approach.
  
  
  METHODS
  Between 1985 and 2014, 85 patients (60 men and 25 women; mean age, 52 years) underwent en bloc resection of thoracic-inlet non-small cell lung cancer (NSCLC) (n=69), sarcoma (n=11), breast carcinoma (n=3) or thyroid carcinoma (n=2) involving the SA. L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 18 patients or a posterior midline approach in 15 patients. Resection extended to the chest wall (>2 ribs, n=60), lung (n=76), and spine (n=15). Revascularization was by end-to-end anastomosis (n=48), polytetrafluoroethylene (PTFE) graft interposition (n=28), subclavian-to-common carotid artery transposition (n=8), or grafting of the autologous superficial femoral artery in an anterolateral thigh free flap (n=1). Complete R0 resection was achieved in 75 patients and microscopic R1 resection in 10 patients. Postoperative radiation therapy was given to 51 patients.
  
  
  RESULTS
  There were no cases of postoperative death, neurological sequelae, graft infection or occlusion, or limb ischemia. Postoperative morbidity consisted of pneumonia (n=16), phrenic nerve palsy (n=2), recurrent nerve palsy (n=4), bleeding (n=4), acute pulmonary embolism (n=1), cerebrospinal fluid leakage (n=1), chylothorax (n=1), and wound infection (n=2). Five-year survival and disease-free survival rates were 32% and 22%, respectively. Long-term survival was not observed after R1 resection.
  
  
  CONCLUSIONS
  Subclavian arteries invaded by TI malignancies can be safely resected and reconstructed through the anterior transclavicular approach, with good long-term survival provided complete R0 resection is achieved.
authors.affiliation: Department of Thoracic, Vascular and Heart-Lung Transplantation, Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France. o.mercier@ccml.fr.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Department of Thoracic Surgery, Sun Yet Sen University Cancer Center, Guangzhou, 510060, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Su
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lahon
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Delemos
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France; Thoracic Oncology Institute, Institut Gustave Roussy, Villejuif, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Chevalier
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Dartevelle
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000637:transplantation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013908:Thoracotomy; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D055815:Young Adult
keywords: Artery/arteries; cancer; lung cancer surgery; sarcoma; thoracic inlet (TI)