title: Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: case report.
abstract: BACKGROUND
  The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for anterior superior sulcus tumors.
  
  
  METHODS
  A patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 (suspected anonymous vein invasion) underwent chemo-radiation induction therapy with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe "en block" with the anterior part of the first and second rib was removed. The whole procedure was conducted with the patient in the supine position; no rib retractors were used. The definitive stage was ypT0N0M0. The patient had an uneventful hospital stay and at the 9 months follow-up she was free from disease and post-thoracotomy syndrome.
  
  
  CONCLUSIONS
  In our opinion such hybrid VATS procedure has several advantages: starting with thoracoscopy it is possibleto exclude previously undetected pleural dissemination and to precisely define the tumor location as well as limits of the thoracic wall resection; time could be spared maintaining the patients in the supine position for both surgical times; postoperative pain and post-thoracotomy syndrome could be minimized avoiding the use of any rib retractor.
authors.affiliation: Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital University of Milan, Via Francesco Sforza, 35, Milan, 20122, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rosso
authors.affiliation: Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital University of Milan, Via Francesco Sforza, 35, Milan, 20122, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palleschi
authors.affiliation: Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital University of Milan, Via Francesco Sforza, 35, Milan, 20122, Italy. paolo.mendogni@unimi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mendogni
authors.affiliation: Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital University of Milan, Via Francesco Sforza, 35, Milan, 20122, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010178:Pancoast Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods
keywords: Anterior Pancoast; Chest wall; Lung cancer; Transmanubrial approach; VATS lobectomy