title: Total vertebrectomy (Th2) and dissection of the subclavian artery for a superior sulcus tumor invading the spine: A case report.
abstract: BACKGROUND
  Surgery for primary lung cancer invading the spine remains challenging. Here, we present a case of superior sulcus tumor (SST) with vertebral invasion, successfully resected with total vertebrectomy (Th2) and dissection of involved apical chest wall and the subclavian artery (SCA).
  
  
  METHODS
  A 62-year-old man was referred with the diagnosis of lung squamous cell carcinoma originating from left upper lobe (clinical stage IIIA/T4N0M0) involving the thoracic vertebrae (Th2) as well as the apical chest wall including three ribs (1st, 2nd and 3rd) and SCA. After induction concurrent chemo-radiotherapy, we achieved complete resection by three-step surgical procedures as follows: first, the anterior portion of involved chest wall including SCA was dissected through the trans-manubrial approach (TMA); next, the posterior portion of involved chest wall including ribs was dissected and left upper lobectomy with nodal dissection was performed through posterolateral thoracotomy; finally, total vertebrectomy (Th2) was performed through posterior mid-line approach.
  
  
  CONCLUSIONS
  This tumor was existence of anterior and posterior position in pulmonary apex region. So that, it is very important for complete resecting this complicated tumor to work out operation's strategy.
  
  
  CONCLUSIONS
  Surgery may be indicated for SST invading the spine, when complete resection is expected.
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan. Electronic address: okasou@med.uoeh-u.ac.jp.
authors.forename: Soichi
authors.initials: S
authors.lastname: Oka
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsumiya
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Syuichi
authors.initials: S
authors.lastname: Shinohara
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Kuwata
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Takenaka
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Chikaishi
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Hirai
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Imanishi
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
authors.affiliation: Department of Orthopedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Nakamura
authors.affiliation: Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Tanaka
keywords: Lung cancer; Transmanubrial approach (TMN); Vertebrectomy