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J Thorac Cardiovasc Surg 1999;117:626
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Subclavian artery involvement by apical chest tumors: A specific indication for the transmanubrial approach

Robert J. Korst, MD, Attending Surgeon, New York, NY

Thoracic Service, Memorial Sloan-Kettering Cancer Center, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021

Reply to the Editor:

We agree with Spaggiari and Pastorino that exposure of the subclavian artery for resection, although not commonly indicated, plays an important role in the operative approach to apical chest tumors. However, we believe that the hemi-clamshell approach provides adequate exposure to this vessel.

To expose the subclavian artery adequately through a hemi-clamshell incision, two maneuvers must be stressed. First, the incision and dissection must extend well up into the neck, similar to the cervical portion of the transmanubrial approach described by Spaggiari. This cervical dissection will expose the first several centimeters of the subclavian artery, well past the origin of the vertebral artery. Second, the anterior scalene muscle must be divided, which helps expose more length of the subclavian artery. The operative diagrams in our articleGo 1 do not depict the division of this muscle because vascular resection was not indicated in that particular patient. These two components of the dissection allow the subclavian artery to be exposed adequately for resection when involved by tumor.

References

  1. Korst RJ, Burt ME. Cervicothoracic tumors: results of resection using the "hemi-clamshell" approach. J Thorac Cardiovasc Surg 1998;115:286-95.[Abstract/Free Full Text]




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