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J Thorac Cardiovasc Surg 2007;134:801-803
© 2007 The American Association for Thoracic Surgery

Brief Communication

Anterior transclavicular approach to malignant tumors of the thoracic inlet: Importance of the scapulothoracic articulation

^a Division of Thoracic Surgery, Toronto General Hospital and Toronto Western Hospital, University of Toronto, Canada
^b Division of Orthopaedic Surgery, Toronto General Hospital and Toronto Western Hospital, University of Toronto, Canada.

Received for publication April 16, 2007; accepted for publication May 14, 2007.

^_* Address for reprints: Marc de Perrot, MD, MSc, Division of Thoracic Surgery, Toronto General Hospital, 9N-961, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. (Email: marc.deperrot@uhn.on.ca).

The first 20% of the full text of this article appears below.

The anterior transclavicular approach for lung cancer invading the thoracic inlet was described by Dartevelle and colleagues.¹ Although this approach provides excellent exposure to the thoracic inlet, it has often been criticized because of potential deformity and dysfunction of the shoulder related to resection of the clavicle. However, the proximal part of the clavicle plays a minor role in the stability and function of the shoulder as long as the integrity of the scapulothoracic articulation is preserved.^2,3 The scapulothoracic articulation is formed by the attachment of the scapula to the chest wall through the trapezius, latissimus dorsi, rhomboid, levator scapulae, and serratus anterior muscles.^4,5 Thus, preservation of these muscles and their nerves is crucial to achieve good functional and cosmetic results. We emphasize the importance of preserving the spinal accessory, dorsal scapular, and long thoracic nerves that are running in the posterior cervical triangle and innervate the trapezius, rhomboid, and serratus anterior muscles, and we document the good functional and cosmetic results obtained with this approach despite resection of the clavicle if the scapulothoracic articulation is preserved.

Clinical Summary

The anterior transclavicular approach has been described in detail,¹ and we will therefore limit our description to some specific points only. An incision is made along the sternocleidomastoid muscle and extended horizontally along the third rib. The extension of the incision ranges from the level of the jaw down to the third rib to permit optimal exposure of the thoracic inlet and pulmonary hilum. . . . [Full Text of this Article]

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