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McLaughlin K, Tan KS, Dycoco J, Chen MF, Chaft JE, Mankuzhy NP, Rimner A, Aly RG, Fanaroff RE, Travis WD, Bilsky M, Bains M, Downey R, Huang J, Isbell JM, Molena D, Park BJ, Jones DR, Rusch VW. Superior sulcus non-small cell lung cancers (Pancoast tumors): Current outcomes after multidisciplinary management. J Thorac Cardiovasc Surg 2023; 166:1477-1487.e8. [PMID: 37611845 PMCID: PMC11229055 DOI: 10.1016/j.jtcvs.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Despite neoadjuvant chemoradiotherapy, Pancoast tumors still present surgical and oncologic challenges. To optimize outcomes, we used a multidisciplinary care paradigm with medical and radiation oncology, and involvement of spine neurosurgery for most T3 and all T4 tumors. Spine neurosurgery permitted resection of transverse process for T3 and vertebral body resection for T4 tumors. METHODS Retrospective analysis of single institution, prospective database of patients undergoing resection for cT3 4M0 Pancoast tumors. Patients were grouped as cT3 with combined resection with spine neurosurgery (T3 Neuro), cT3 without spine neurosurgery (T3 NoNeuro), and cT4. Overall survival, progression-free survival were analyzed by Kaplan-Meier and compared between groups using log-rank test. Cumulative incidence of local-regional and distant recurrence were compared using Gray test. P value <.05 was considered significant. RESULTS From 2000 to 2021, 155 patients underwent surgery: median age was 58 years, and 81 were (52%) men. Most patients received neoadjuvant platinum-based neoadjuvant chemoradiotherapy (n = 127 [82%]). Operations were 48 cT3 Neuro, 41 cT3 NoNeuro, 66 cT4. R0 resection was achieved in 49 (94%) cT3 NoNeuro, 35 (85%) cT3 Neuro, and 57 (86%) cT4 patients (P = .4). Complete or major pathologic response occurred in 71 (55%) patients. Lower local-regional cumulative incidence was seen in cT3 Neuro versus cT3 NoNeuro (P = .05) and after major pathologic response. Overall survival and progression-free survival were associated with complete response, pathologic stage, and nodal status but not cT category. CONCLUSIONS This treatment paradigm was associated with a high frequency of R0 resection, complete response, and major pathologic response. cT3 and cT4 tumors had similar outcomes. Novel therapies are needed to improve complete response.
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Affiliation(s)
- Kaitlin McLaughlin
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica F Chen
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie E Chaft
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikhil P Mankuzhy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rania G Aly
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel E Fanaroff
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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The transmanubrial osteomuscular-sparing approach: a valuable adjunct to the head and neck surgical armamentarium. Curr Opin Otolaryngol Head Neck Surg 2020; 28:61-67. [PMID: 32011400 DOI: 10.1097/moo.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To describe and popularize the transmanubrial osteomuscular-sparing approach (TOSA) outside its original thoracic surgical field of application, based on the consideration that it could be of interest for the management of a number of head and neck cases in both elective and emergent scenarios. RECENT FINDINGS The main advantages of TOSA compared with transclavicular techniques are its superb exposure of anatomic structures located at the level of the cervicothoracic junction, and superior postoperative aesthetic and functional outcomes. Recently, a number of studies have described the association of TOSA with other minimally invasive approaches, such as video-assisted thoracoscopic surgery and robotic hybrid approaches, with the aim of avoiding association of the transmanubrial route with anterior/posterior thoracotomies, or more extended surgeries, such as the trapdoor or hemiclamshell procedures. SUMMARY TOSA, even though originally conceived to reduce the morbidity ensuing from classic transclavicular approaches for management of Pancoast tumors, may well play an important role in a number of head and neck surgical conditions, including those related to mediastinal goiter and thyroid cancer, management of stenosis and lesions of the thoracic trachea and esophagus, treatment of the junction between innominate, internal jugular, and subclavian veins, epiaortic arteries, thoracic duct, brachial plexus, and low sympathetic chain. Whenever comprehensive control of vascular and nonvascular structures of the upper mediastinal inlet is required, TOSA should be planned and performed by combining the expertise of cooperating professionals.
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Zhong Y, Yang X, Jiang L, Hu R, Jiang Z, Wang M. Reverse "L" surgical approach for the management of giant tumors of the cervicothoracic junction. J Thorac Dis 2020; 12:3995-4001. [PMID: 32944311 PMCID: PMC7475594 DOI: 10.21037/jtd-20-288b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background An isolated cervical or thoracic surgical approach provides insufficient exposure for achieving complete resection of tumors of the cervicothoracic junction. This study examines reverse “L” thoracotomy as a surgical approach to these tumors. Additionally, the feasibility, safety, and effectiveness of reverse “L” surgical incision for tumor resection was also analyzed. Methods Patients with cervicothoracic tumors were identified from an internal database. Subjects were selected on the basis of undergoing reverse “L” thoracotomy from August 2014 to August 2018. The tumor characteristics, surgical technique, completeness of resection, morbidity, and patient outcome were reviewed. Results All patients successfully underwent resection through reverse “L” surgical approach. No patients needed to undergo full sternotomy. There were 6 neurogenic tumors, 4 thyroid adenocarcinomas, 4 bronchogenic tumors, and 7 other cases in the study. The median operative time was 191.0 min (range, 113.0–348.0 min) and postoperative in-hospital stay ranged from 3 to 7 days. Horner syndrome was observed in 1 case. Hoarseness and lymphatic leakage were evident in 3 and 1 case(s), respectively. Hemidiaphragm paralysis was observed in 1 case. Three cases were unsuccessful in achieving R0 resection. The duration of follow-up ranged from 6 to 42 months. Eleven of 13 patients who underwent resection had no evidence of tumor recurrence. Two patients with metastatic disease died of distant progression within 15 months. Conclusions Applying reverse “L” surgical approach is safe, feasible, and effective for the resection of giant tumors of the cervicothoracic junction.
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Affiliation(s)
- Yuan Zhong
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuhui Yang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianyong Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaolei Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingsong Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mariolo AV, Casiraghi M, Galetta D, Spaggiari L. Robotic Hybrid Approach for an Anterior Pancoast Tumor in a Severely Obese Patient. Ann Thorac Surg 2018; 106:e115-e116. [PMID: 29654726 DOI: 10.1016/j.athoracsur.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 11/30/2022]
Abstract
Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and control of apical chest wall structures, but it requires an additional thoracotomy to perform the lobectomy with radical lymph node resection. The presented technique combines the osteomuscular-sparing transmanubrial approach with robotic-assisted upper lobectomy in a severely obese patient, thereby reducing the invasiveness of the surgical approach and the postoperative complications.
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Affiliation(s)
- Alessio Vincenzo Mariolo
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Spaggiari L, D'Aiuto M, Veronesi G, Leo F, Solli P, Elena Leon M, Gasparri R, Galetta D, Petrella F, Borri A, Scanagatta P. Anterior approach for Pancoast tumor resection. Multimed Man Cardiothorac Surg 2014; 2007:mmcts.2005.001776. [PMID: 24415052 DOI: 10.1510/mmcts.2005.001776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tumors arising anteriorly in the apex of the chest were long considered unresectable because of early invasion of vascular structures limiting radical resection through the conventional Paulson approach. These tumors became operable in 1993 when Dartevelle popularized the cervico-thoracic transclavicular technique for resecting these neoplasms. Since then several different surgical approaches to anterior Pancoast tumors have been proposed, drastically improving the rate of radical resections of these tumors. However, there is no consensus on which anterior surgical approach provides the best access to all of the apical non-small cell lung cancers of the thoracic inlet. Moreover, it is still unclear if integrated neoadjuvant and adjuvant treatments can improve the rates of complete resection, local recurrence and long-term survival.
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Affiliation(s)
- Lorenzo Spaggiari
- University of Milan, School of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Ichiki Y, Nagashima A, Yasuda M, Takenoyama M. Analysis of the surgical treatment for superior sulcus tumors. Surg Today 2012; 43:1419-24. [PMID: 23212702 DOI: 10.1007/s00595-012-0431-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was undertaken to assess the mortality, complication, and major morbidity rates of surgical treatment for superior sulcus tumors (SSTs), and to estimate the significance of prognostic factors. METHODS We retrospectively reviewed the hospital records of 50 consecutive patients undergoing surgical treatment for SSTs between 1992 and 2007. The significance of risk factors for an adverse outcome was investigated. RESULTS Both the thirty-day and in-hospital mortality rates were 0 %. Complications developed in 18.0 % (9/50) of the patients. The overall 5-year survival was 32.7 %. Pathological T4 and N1 or more were the risk factors predicting an adverse outcome. Survival was not significantly influenced by the preoperative symptoms, the histological type, the invaded organ or the curability. CONCLUSION Surgical treatment for SSTs is associated with acceptable overall morbidity and mortality rates. However, special care must be taken for the patients with pathological T4 and N1 or higher tumors. Preoperative chemoradiotherapy followed by surgical treatment has become a logical strategy for SSTs. Preoperative chemoradiotherapy for SSTs may yield better results than surgery alone.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan,
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Smythe WR, Reznik SI. Optimal exposure of thoracic inlet vascular structures: transmanubrial approach. Semin Vasc Surg 2008; 21:21-4. [PMID: 18342731 DOI: 10.1053/j.semvascsurg.2007.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Exposure of the neurovascular structures of the thoracic inlet is limited by the bony thorax and clavicle. A cervicothoracic approach with resection of the medial one third of the clavicle or total claviculectomy provide excellent exposure but may render the patient with a significant cosmetic and functional defect. We describe a transmanubrial approach that preserves rigid fixation of the shoulder girdle and allows full access to the thoracic inlet. This technique is straightforward and may be easily modified to fit the particular needs of the patient, including access to the proximal brachiocephalic vessels, the hilum of the lung and the vertebral bodies of the lower cervical and upper thoracic spine.
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Affiliation(s)
- W Roy Smythe
- Department of Surgery, Division of Cardiothoracic Surgery, Scott & White Memorial Hospital and Clinic, Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA.
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Rusch VW, Giroux DJ, Kraut MJ, Crowley J, Hazuka M, Winton T, Johnson DH, Shulman L, Shepherd F, Deschamps C, Livingston RB, Gandara D. Induction Chemoradiation and Surgical Resection for Superior Sulcus Non–Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol 2007; 25:313-8. [PMID: 17235046 DOI: 10.1200/jco.2006.08.2826] [Citation(s) in RCA: 272] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTraditional treatment for superior sulcus non–small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC.Patients and MethodsPatients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis.ResultsFrom April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites.ConclusionThis combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Abstract
Non-small-cell lung carcinomas of the superior sulcus, frequently termed Pancoast tumours, are some of the most challenging thoracic malignant diseases to treat because of their proximity to vital structures at the thoracic inlet. Originally deemed universally fatal, Pancoast tumours are now amenable to curative treatment because of improvements in combined modality therapy and development of new techniques for resection. This review includes discussion of anatomical considerations, initial assessment, multimodality treatment, and surgical approaches for these cancers.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Sauvat F, Brisse H, Magdeleinat P, Lopez M, Philippe-Chomette P, Orbach D, Aerts I, Brugieres L, Revillon Y, Sarnacki S. The transmanubrial approach: A new operative approach to cervicothoracic neuroblastoma in children. Surgery 2006; 139:109-14. [PMID: 16364724 DOI: 10.1016/j.surg.2005.07.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Revised: 06/27/2005] [Accepted: 07/03/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cervicothoracic neuroblastoma originates from the cervical sympathetic nerves and ganglia and thus presents a problem when dissecting the vascular and nervous elements of the subclavian region. The standard operation is based on thoracotomy or dual cervicotomy/thoracotomy, but these approaches do not provide optimal control of the subclavian vessels. We report our experience in children with cervicothoracic neuroblastoma by using a technique usually performed for apical lung cancer. METHODS Four patients with localized cervicothoracic neuroblastoma with no N-myc amplification were resected after chemotherapy by this approach. The anatomic evaluation was performed preoperatively with angio-magnetic resonance imaging. This transmanubrial approach, performed through a manubrial L-shaped transection and first costal cartilage resection, affords excellent access to the subclavian region with safe control of the vessels and nerves and exposure of the first 4 thoracic intervertebral foramina. RESULTS Removal of more than 90% of the tumor was possible in all cases. The postoperative course was uneventful in 3 cases, and the fourth patient with a left-sided tumor had a transient chylothorax. No recurrence occurred with a follow-up period of 8 to 32 months. CONCLUSIONS The transmanubrial approach is an osteomuscular-sparing technique that seems particularly suitable for the treatment of these tumors, which require a resection that is as complete as possible to avoid postoperative chemotherapy and tumor relapse.
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Affiliation(s)
- Frédérique Sauvat
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital, 149 rue de Sèvres, 75015 Paris, France.
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Abstract
Physicians' understanding of the anatomy, biology [9], and treatment outcome [12] for superior sulcus carcinoma has changed greatly during the last decade [2,3]. One of the major advances in this regard has been the introduction of anterior approaches for resection. These approaches increase the likelihood of complete resection and permit resection of tumors that were previously considered technically unresectable. Each approach must be understood in detail to avoid incomplete operations and life-threatening complications. These technical advances, with recent evidence that preoperative chemoradiotherapy leads to higher complete resection rates, overall survival, and local control than do radiation and surgery alone [32], have changed physicians' attitudes toward superior sulcus carcinomas, especially for those tumors (eg, T4) previously considered technically unresectable and oncologically incurable. It is hoped that, in the future, resection of disease invasion of the brachial plexus above C7 will be technically feasible [33], and that new drugs will reduce the risk of systemic relapse after resection.
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Affiliation(s)
- Paolo Macchiarini
- Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, 70 Am Leineufer, D-30419 Hannover, Germany.
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12
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Abstract
For more than three decades following the initial report by Shaw et al. in 1961, the standard treatment of Pancoast lung tumors consisted of induction radiotherapy followed by en bloc resection through a posterolateral thoracotomy. Overall 5-year survival rates with this regime were typically 30 to 40%, with poor prognosis in patients with positive mediastinal lymph nodes, T4 involvement, or incomplete resection. During the past decade, advancements in surgical technique and adjuvant therapy have improved the safety and completeness of resection as well as the probability of long-term survival. Alternative surgical approaches have been developed to facilitate more complete resection of tumors involving subclavian vessels and brachial plexus, and aggressive vertebral body resection has been performed in conjunction with neurosurgeons. Arguably the most important advance in the treatment of Pancoast tumors has been the recognition that induction chemoradiation substantially improves both the rate of complete resection and medium-term survival.
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Affiliation(s)
- David M Shahian
- Department of Thoracic and Cardiovascular Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
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Spaggiari L. Anterior approach versus posterior approach in apical chest tumor: surgeon's choice or oncological need? Ann Thorac Surg 2003; 75:633-4; author reply 634. [PMID: 12607698 DOI: 10.1016/s0003-4975(02)04268-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Ugo Pastorino
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy.
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Spaggiari L, Solli P, Veronesi G, Pastorino U. Intrathoracic myoplasty for prosthesis infection after superior vena cava replacement for lung cancer. Ann Thorac Surg 2002; 74:1231-3. [PMID: 12400776 DOI: 10.1016/s0003-4975(02)03819-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prosthesis infection after lung and superior vena cava system resection for non-small cell lung cancer is a life-threatening complication. We report a case in which an intrathoracic muscle flap transposition was used to cure tracheal fistula associated with prosthesis infection without the explant of the vascular graft.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Affiliation(s)
- U Pastorino
- European Institute of Oncology, Department of Thoracic Surgery, Milan, Italy
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Spaggiari L, Pastorino U. Double transmanubrial approach and sternotomy for resection of a giant thymic carcinoid tumor. Ann Thorac Surg 2001; 72:629-31. [PMID: 11515922 DOI: 10.1016/s0003-4975(01)02710-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The transmanubrial approach allows excellent unilateral exposure of the thoracic outlet. However, selected patients may require a bilateral cervicomediastinal exposure to completely resect the neoplasm. We report the use of a "double" transmanubrial approach for the resection of a giant mediastinal mass requiring bilateral vascular dissection and superior vena cava system resection and replacement.
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Affiliation(s)
- L Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Affiliation(s)
- J Martin
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Abstract
Superior sulcus tumors (also known as Pancoast's tumors) are an unusual presentation of non-small cell lung cancer (NSCLC) that are often initially misdiagnosed. Accurate and thorough staging is necessary prior to treatment and typically includes magnetic resonance imaging if a surgical approach is being considered. Standard therapy has been induction radiation therapy followed by resection, which results in a 5-year survival of about 30%. Complete resection remains the key to long-term survival in localized NSCLC but is difficult to achieve with superior sulcus tumors due to early invasion of bone and to vascular and nervous structures at the apex of the chest. Complete resection has been enhanced by using an anterior trans-cervicomediastinal approach that facilitates resection of anterior-based tumors that invade the subclavian vessels. Recently, induction chemoradiotherapy has been reported to enhance complete resection rates and improve survival compared with historical controls and is likely to become the new standard treatment for localized superior sulcus tumors.
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Affiliation(s)
- C D Wright
- General Thoracic Surgical Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Spaggiari L, Calabrese L, Chiesa F, Pastorino U. Overcoming the transclavicular approach: the transmanubrial approach to the thoracic inlet. Head Neck 2000; 22:629-30. [PMID: 10941167 DOI: 10.1002/1097-0347(200009)22:6<629::aid-hed14>3.0.co;2-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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