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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 1025-1034, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PG Dartevelle, AR Chapelier, P Macchiarini, B Lenot, J Cerrina, FL Ladurie, FJ Parquin and D Lafont
We describe an original anterior transcervical-thoracic approach required
for a safe exposure and radical resection of non-small-cell lung cancer
that has invaded the cervical structures of the thoracic inlet. Through a
large L-shaped anterior cervical incision, after the removal of the
internal half of the clavicle, the following steps may be performed: (1)
dissection or resection of the subclavian vein; (2) section of the anterior
scalenus muscle and resection of the cervical portion of the phrenic nerve,
if invaded; (3) exposure of the subclavian and vertebral arteries; (4)
dissection of the brachial plexus up to the spinal foramen; (5) section of
invaded ribs; and (6) en bloc removal of chest wall and lung tumor, either
directly or through an extension of the cervical incision into the
deltopectoral groove. An additional posterior thoracotomy may be required
for resection of the chest wall below the second rib. Between 1980 and
1991, 29 patients underwent radical en bloc resection of the inlet tumor,
chest wall (ribs 1 and 2), and underlying lung, either through the anterior
transcervical approach alone (n = 9) or with an additional posterior
thoracotomy (n = 20). The inferior root of the brachial plexus, either
alone (n = 11) or with the phrenic nerve (n = 4), was involved and resected
in 15 patients (52%). Twelve patients (41%) had a vascular involvement that
included the subclavian artery alone (n = 3); subclavian artery and
subclavian vein (n = 3); subclavian artery, subclavian vein, and vertebral
artery (n = 2); subclavian artery and vertebral artery (n = 1); subclavian
vein alone (n = 1); vertebral artery alone (n = 1), or subclavian artery
and vertebral artery (n = 1). The subclavian artery was revascularized
either with a prosthetic replacement (n = 7) or an end-to-end anastomosis
(n = 2), and the median graft patency was 18.5 months (range, 6 to more
than 73 months); only 1 patient had postradiotherapy graft occlusion in the
revascularized artery 6 months after operation. We performed 14 wedge
resections, 14 lobectomies, and 1 pneumonectomy. There were no operative or
hospital deaths. Postoperative radiotherapy (median, 56 Gy) was given to 25
(86%) patients, either alone (n = 14) or in combination with adjuvant
systemic chemotherapy (n = 11). With a median follow-up time of 2.5 years,
overall 2- and 5-year survivals were 50% and 31%, respectively. This
transcervical-thoracic approach affords a safe exposure and radical
resection of non-small-cell lung cancer involving the thoracic inlet and
results in encouraging long-term survival.
ARTICLES
Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hopital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
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P. G. Dartevelle Extended Operations for the Treatment of Lung Cancer Ann. Thorac. Surg., January 1, 1997; 63(1): 12 - 19. [Abstract] [Full Text]
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A. R. Chapelier, E. A. Bacha, V. T. de Montpreville, E. M. Dulmet, M. Rietjens, A. Margulis, P. Macchiarini, and P. G. Dartevelle Radical Resection of Radiation-Induced Sarcoma of the Chest Wall: Report of 15 Cases Ann. Thorac. Surg., January 1, 1997; 63(1): 214 - 219. [Abstract] [Full Text]
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D. Grunenwald, C. Mazel, P. Baldeyrou, and P. Girard En Bloc Resection of Lung Cancer Invading the Spine Ann. Thorac. Surg., June 1, 1996; 61(6): 1878 - 1879. [Full Text]
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D. Grunenwald, C. Mazel, P. Girard, G. Berthiot, C. Dromer, and P. Baldeyrou Total Vertebrectomy for En Bloc Resection of Lung Cancer Invading the Spine Ann. Thorac. Surg., February 1, 1996; 61(2): 723 - 725. [Abstract] [Full Text]
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 B. C. Papsin, J. L. Freeman, A. Davis, and R. S. Bell Transclavicular Approach to the Neck, Thoracic Inlet, and Axilla Arch Otolaryngol Head Neck Surg, September 1, 1995; 121(9): 984 - 987. [Abstract] [PDF]
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H. Niwa and A. Masaoka Different approaches for management of apical invasive lung cancers J. Thorac. Cardiovasc. Surg., August 1, 1994; 108(2): 389 - 390. [Full Text]
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P. Dartevelle and P. Macchiarini Different approaches for management of apical invasive lung cancers J. Thorac. Cardiovasc. Surg., August 1, 1994; 108(2): 390 - 392. [Full Text]
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