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Fadel E, Decaix V. Current management of anterior Pancoast tumors. JTCVS Tech 2024; 25:190-200. [PMID: 38899110 PMCID: PMC11184882 DOI: 10.1016/j.xjtc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Elie Fadel
- Departments of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Victor Decaix
- Departments of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
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2
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Duranti L, Tavecchio L. Challenging repair of the left subclavian vein in a pediatric patient. Updates Surg 2024:10.1007/s13304-024-01858-8. [PMID: 38691329 DOI: 10.1007/s13304-024-01858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
This is a case involving a 3-year-old child who presented with an iatrogenic left subclavian/innominate vein lesion, leading to severe bleeding and intravascular catheter rupture during its removal. We successfully performed a very challenging and minimally invasive repair of the vein, along with the removal of the catheter entrapped in the innominate vein.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Unit, IRCCS Fondazione Istituto Nazionale dei Tumori, Via Venezian1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery Unit, IRCCS Fondazione Istituto Nazionale dei Tumori, Via Venezian1, 20133, Milan, Italy
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Bertolaccini L, Casiraghi M, Galetta D, Petrella F, Mazzella A, Lo Iacono G, Girelli L, Bardoni C, Mohamed S, Musso V, Sedda G, Spaggiari L. Surgical management of superior sulcus tumors: A twenty-year experience of an oncological high volume referral centre. Front Oncol 2023; 12:1080765. [PMID: 36713583 PMCID: PMC9878845 DOI: 10.3389/fonc.2022.1080765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Superior sulcus tumour, which affects the lung's apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years. Methods Retrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 - December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS. Results 54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 - 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 - 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 - 12.5; p = 0.010). Conclusions Superior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,*Correspondence: Luca Bertolaccini,
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Musso
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Todesco A, D'Journo XB, Fabre D, Boulate D. Extrapleural cervico-manubriotomy and clavicular swing for the management of a mesenchymal tumour of the middle scalenus: an adapted anterior thoracic inlet approach. Interact Cardiovasc Thorac Surg 2021; 33:266-268. [PMID: 33860320 DOI: 10.1093/icvts/ivab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/12/2022] Open
Abstract
Surgical approach for resection of tumours involving the thoracic inlet has largely been developed in the context of lung cancer of the superior sulcus. Therefore, initial anterior approaches included a thoracotomy associated with a longitudinal cervicotomy. Here, we describe a variation of the previously described anterior surgical approaches of the thoracic inlet that we performed for the resection of a primary mesenchymal tumour of the left middle scalenus muscle secreting fibroblast growth factor-23 responsible for tumour-induced osteomalacia. This approach allowed a safe control of the great vessels phrenic nerve and brachial plexus as well as a comfortable access to the middle scalenus muscle through an L-shaped incision with a cervico-manubriotomy without thoracotomy. The tumour was resected entirely with the middle scalenus. After 3 months of follow-up, the symptoms resolved entirely.
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Affiliation(s)
- Alban Todesco
- Department of Thoracic Surgery, APHM, Hospital Nord, Marseille, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, APHM, Hospital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis-Robinson, France.,Paris Saclay University, Le Plessis-Robinson, France
| | - David Boulate
- Department of Thoracic Surgery, APHM, Hospital Nord, Marseille, France
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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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Uchida S, Yoshida Y, Ohe Y, Nakayama Y, Motoi N, Kobayashi A, Asakura K, Nakagawa K, Watanabe SI. Trimodality therapy for superior sulcus tumour: experience of a single institution over 19 years. Eur J Cardiothorac Surg 2020; 56:167-173. [PMID: 30689794 DOI: 10.1093/ejcts/ezy480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Induction chemoradiotherapy followed by surgery is the standard treatment for superior sulcus tumours (SSTs). However, the protocols, chemotherapy agents and cycles used as well as the mode and intensity of radiotherapy vary between institutions. Thus, the objective of the study was to investigate the effects of trimodality therapy on the outcomes of patients with SSTs. METHODS Sixty patients with SSTs were enrolled between January 1999 and December 2017. Induction therapy consisted primarily of 2 cycles of mitomycin-vindesine-cisplatin or cisplatin-vinorelbine delivered concurrently to the tumour with 40-45 Gy of radiation. Surgery was performed 2-6 weeks after completion of induction therapy. RESULTS Fifty-four (90%) patients underwent radical surgical resection. Complete pathological resection was achieved in 44 patients (81%). There was no 30-day mortality. After a median follow-up of 57.0 months, 19 (35%) patients experienced recurrence, and 8 (15%) patients showed brain metastasis. A pathological complete response (PCR) was observed in 12 (22%) patients. The 5-year survival rate for the entire population (n = 54) was 69% (95% confidence interval 55-81%). The survival rate was better for patients who underwent complete resection than for those who underwent incomplete resection (73% vs 51%, P = 0.46). A better survival rate was evident in patients with PCR than in those without PCR (92% vs 62%, P = 0.12). CONCLUSIONS Trimodality therapy for SSTs was efficacious and associated with favourable outcomes, with acceptable morbidity and mortality. PCR in patients with resected SSTs reveals promising long-term survival prospects with the trimodality therapy.
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Affiliation(s)
- Shinsuke Uchida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Aki Kobayashi
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Muguruza I, Aranda JL, García-Yuste M. [Treatment of lung cancer with chest wall invasion]. Arch Bronconeumol 2014; 47 Suppl 1:27-32. [PMID: 21300215 DOI: 10.1016/s0300-2896(11)70008-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to analyze chest wall invasion, the indication and multidisciplinary nature of treatment, the methods used for parietal reconstruction and the technical problems posed by this procedure in patients with lung cancer and chest wall invasion. Chest wall invasion from adjacent malignancies affects 5% of patients with a bronchogenic carcinoma. Preoperative determination of parietal invasion aids the planning of an appropriate therapeutic approach. Positron emission tomography combined with computed tomography (PET/CT) improves the study of T-factor and metastatic nodal involvement and distant metastases. As a rule, surgical treatment should attempt complete tumoral resection: lobectomy, resection of the parietal pleura and/or of the chest wall--ensuring tumor-free margins--and hilar and mediastinal lymphadenectomy. We also analyzed the distinct prognostic factors for survival, as well as the indication for induction or adjuvant therapy. Chest wall reconstruction involves recreating the most anatomical and physiological conditions possible in the chest cavity and surrounding muscles. The ideal reconstruction would achieve adequate parietal stability and coverage to preserve functionality, with the cosmetic result being an important, but secondary, consideration. Many materials are available for reconstruction and the choice of material should be individualized in each patient. A multidisciplinary team able to plan and perform the resection and subsequent reconstruction, oversee postoperative management and treat complications early is essential.
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Affiliation(s)
- Ignacio Muguruza
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
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Mazel C, Owona P, Cogan A, Balabaud L, Grunenwald D. Long-term quality of life after en-bloc vertebrectomy: 25 patients followed up for 9 years. Orthop Traumatol Surg Res 2014; 100:119-26. [PMID: 24394919 DOI: 10.1016/j.otsr.2013.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 09/10/2013] [Accepted: 09/27/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Assess quality-of-life results in patients who have undergone extensive curative surgery for spinal tumor and compare them to the general population in France. INTRODUCTION Life expectancy is not the only criterion to assess the outcomes after massive tumor resections. Residual quality of life is also crucial. An indication for major surgery for spinal tumor should take the patient's long-term functional status into account, but the literature is limited on this question. MATERIALS AND METHODS Twenty-five living patients from a group of 120 operated were assessed, all of whom were operated on by the same surgeon between 1984 and 2007. The mean follow-up was 9 years (range, 3-25 years). The mean age at surgery was 49 years. The patients completed different functional and quality-of-life questionnaires: the Oswestry Disability Index version 2 (ODI), the PROLO, the Karnofsky Index of performance status (KI), the Eastern Cooperative Oncology Group performance status (ECOG), the Short Form-36 Health Survey (SF-36), and the EuroQol-5 Dimensions (EQ5D). In addition, each patient was clinically and radiographically evaluated. Subgroups were identified considering the number of levels resected and histology. Their results on the SF-36 were compared with the results from the general population in France. RESULTS The mean PCS (physical component summary of the SF-36) was 52.4, the MCS (mental component summary, the psychological component of the SF-36) was 47.7, the ODI was 18.2, the PROLO was 7, the ECOG was 1, and the KI was 80%. The resections at three levels were associated with worse results in terms of quality of life, but overall, the results were similar to the French general population data for all categories of the SF-36. CONCLUSION Appropriate indications for massive spinal resection give good oncological and functional results. Although the expected life expectancy justifies this aggressive surgery, postoperative quality of life shows that it can also be successful on a functional level. LEVEL OF EVIDENCE Level IV; retrospective clinical study.
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Affiliation(s)
- C Mazel
- Service de chirurgie orthopédique et traumatologique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Paris XIII, Sorbonne-Paris-Cité, 99, avenue Jean-Baptiste-Clément, 93430 Villetaneuse, France.
| | - P Owona
- Service de chirurgie orthopédique et traumatologique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Cogan
- Service de chirurgie orthopédique et traumatologique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - L Balabaud
- Service de chirurgie orthopédique et traumatologique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - D Grunenwald
- Service de chirurgie thoracique, groupement hospitalier universitaire Est, AP-HP Tenon, 4, rue de la Chine, 75020 Paris, France
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Saji H, Kato Y, Shimada Y, Kudo Y, Hagiwara M, Matsubayashi J, Nagao T, Ikeda N. Three-dimensional multidetector computed tomography may aid preoperative planning of the transmanubrial osteomuscular-sparing approach to completely resect superior sulcus tumor. Gen Thorac Cardiovasc Surg 2014; 63:627-31. [PMID: 24464620 DOI: 10.1007/s11748-013-0368-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
Abstract
The anterior transcervical-thoracic approach clearly exposes the subclavian vessels and brachial plexus. We believe that this approach is optimal when a superior sulcus tumor (SST) invades the anterior part of the thoracic inlet. However, this approach is not yet widely applied because anatomical relationships in this procedure are difficult to visualize. Three-dimensional tomography can considerably improve preoperative planning, enhance the surgeon's skill and simplify the approach to complex surgical procedures. We applied preoperative 3-dimensional multidetector computed tomography to a case where an SST had invaded the anterior part of the thoracic inlet including the clavicle, sternoclavicular joint, first rib, subclavian vessels and brachial plexus. After the patient underwent induction chemotherapy, we performed the transmanubrial osteomuscular-sparing approach and added a third anterolateral thoracotomy with a hemi-clamshell incision and completely resected the tumor.
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Affiliation(s)
- Hisashi Saji
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yasufumi Kato
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yujin Kudo
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masaru Hagiwara
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Cheung IH, Lim E. Video-assisted thoracoscopic surgical lobectomy with limited en bloc resection of superior sulcus tumor. J Thorac Cardiovasc Surg 2012; 144:e148-51. [DOI: 10.1016/j.jtcvs.2012.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/19/2012] [Accepted: 09/12/2012] [Indexed: 11/16/2022]
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Gorter RR, Vos CG, Halmans J, Hartemink KJ, Paul MA, Oosterhuis JWA. Evaluation of arm function and quality of life after trimodality treatment for superior sulcus tumours. Interact Cardiovasc Thorac Surg 2012; 16:44-8. [PMID: 23049081 DOI: 10.1093/icvts/ivs394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Following trimodality treatment for superior sulcus tumours (SSTs), the 5-year survival rate has significantly improved. Quality of life and potential negative effects of this strategy have become more important. The objective of this study was to investigate the quality of life and the arm and shoulder function after the resection of superior sulcus tumours following neoadjuvant chemoradiation. METHODS Patients were selected from a thoracic surgery database. Between January 2002 and December 2010, 72 patients received trimodality treatment of whom 39 were alive at the start of this study in 2010. The following arm function tests were used: nine-hole peg test, range of motion test and action research arm test. Quality of life was assessed using the Disability of the arm and shoulder and SF-36 questionnaires. Analyses of the arm function were conducted comparing the treated side with the untreated side. For quality of life, patients treated on their dominant side were compared with those treated on their non-dominant side. RESULTS In total, 19 patients participated in this study (15 men and 4 women). The median age was 59 years (range 39-73), median radiation dose 50 Gy (range 39-66) and median follow-up 40 months (range 4-101). There was no statistically significant difference in arm and shoulder function between the treated and the untreated arm. However, statistically significantly less pain was found if patients were treated on their dominant side. CONCLUSIONS After the resection of SSTs following chemoradiotherapy, the arm and shoulder function on the affected side is comparable with the functions at the contralateral side. Patients treated for an SST on their dominant side are less affected in their quality of life regarding pain compared with those treated on their non-dominant side.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Center, Amsterdam, Netherlands
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12
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Lentini S, Spinelli D, Pipitò N, Massara M, Benedetto F, Spinelli F. Ministernotomy with subclavian extension for the management of a large intrathoracic pseudoaneurysm. J Card Surg 2012; 27:368-70. [PMID: 22621719 DOI: 10.1111/j.1540-8191.2012.01450.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on the management of a large intrathoracic subclavian pseudoaneurysm treated using an upper J ministernotomy with subclavian extension. This approach allows exposure of the supraaortic vessels and upper portion of the thoracic cavity and may be of help in selected cases.
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Affiliation(s)
- Salvatore Lentini
- Cardiovascular and Thoracic Department, Policlinico G. Martino, University of Messina, Messina, Italy.
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Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet. Gen Thorac Cardiovasc Surg 2010; 58:149-54. [DOI: 10.1007/s11748-009-0484-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/01/2009] [Indexed: 11/26/2022]
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Lebreton G, Baste JM, Thumerel M, Delcambre F, Velly JF, Jougon J. The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients. Interact Cardiovasc Thorac Surg 2009; 9:965-9. [PMID: 19773230 DOI: 10.1510/icvts.2009.211623] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This retrospective study was carried out to evaluate the indications for and outcomes of the hemiclamshell (HCS) approach (longitudinal partial sternotomy with antero-lateral thoracotomy) in patients undergoing mass resection in thoracic surgery. All patients (50) who underwent a HCS procedure in our department, between July 1996 and July 2005, were studied retrospectively, analyzing the indications, morbidity and outcome (pain, neurological or shoulder defects, mortality) at one month and one year. The main indications were apical tumours (38%), tumours of the cervicothoracic junction (46%) and chest wall (10%), and 'bulky' tumours (6%). One-month mortality was 6%. Two patients suffered from a chylothorax and one from phrenic paralysis. The postoperative analgesic requirements were similar to those after other thoracic surgery approaches. Twelve percent of patients suffered pain at one month and 6% at one year. Shoulder dysfunction was observed in 10% of patients at one month and 6% at one year. In conclusion, the HCS surgical approach was associated with an uncomplicated postoperative course. This anterior approach is suitable for apical tumours, tumours of the cervicothoracic junction and 'bulky' lung tumours, providing good access for control of the large vessels and radical mediastinal clearance.
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Affiliation(s)
- Guillaume Lebreton
- Department of Thoracic Surgery, Haut-Lévêque Hospital, University Hospital of Bordeaux, 33604, Pessac, France.
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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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Chadeyras JB, Mazel C, Grunenwald D. Résection vertébrale monobloc pour cancer pulmonaire : 12 ans d'expérience. ACTA ACUST UNITED AC 2006; 131:616-22. [PMID: 16859631 DOI: 10.1016/j.anchir.2006.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 06/22/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report a single-institution retrospective study of radical en bloc resection for lung cancer invading the spine. METHODS Between 1993 and 2004, 32 patients underwent partial or total vertebrectomy for non-small cells lung cancer with spinal extension. Twenty-one received induction treatment (chemotherapy, N=16; radiation, N=1 and chemoradiotherapy, N=4). Pneumonectomy was performed in 3 patients, lobectomy in 26 patients and wedge resection in 3 patients. Partial vertebrectomy was performed in 26 patients and total vertebrectomy was performed in 6 patients. Tumor stage was IIb in 9 patients, IIIa in 2 patients and IIIb in 21 patients. RESULTS There was no immediate postoperative mortality. Major morbidity was observed in 10 patients (31%), including 4 complications related to spinal surgery. For 28 patients, a completed resection was achieved (87%). 2-years survival was 65% and 5-years survival was 24%. Completed resection and induction chemotherapy appear to be determinant prognostics factors (respectively p=0,01 and p=0,04 in univariate analysis). CONCLUSION Radical en bloc resection with vertebrectomy for lung cancer is technically demanding. Encouraging long-term survival suggest that this surgical approach could be a valid option for selected patients with vertebral involvement of lung cancer.
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Affiliation(s)
- J-B Chadeyras
- Service de Chirurgie Générale à Orientation Thoracique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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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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18
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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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19
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Affiliation(s)
- Ugo Pastorino
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy.
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20
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Affiliation(s)
- U Pastorino
- European Institute of Oncology, Department of Thoracic Surgery, Milan, Italy
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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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Abstract
Transmanubrial osteomuscular sparing approach (TMA) has been recently proposed for the treatment of apical chest tumor to allow a safer subclavian artery control with a less invasive procedure for the patient. The present technique combines the antero-lateral muscle-sparing thoracotomy with TMA for lung cancer patients in whom extended resection of cervico-thoracic structures as well as anatomic lung resection and radical lymph nodes dissection are required.
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Affiliation(s)
- L Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Spaggiari L, Pastorino U. Anterior approach to the superior sulcus tumors: the transmanubrial osteomuscular sparing approach. J Thorac Cardiovasc Surg 1999; 117:1042-4. [PMID: 10336354 DOI: 10.1016/s0022-5223(99)70403-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Spaggiari L, Pastorino U. Subclavian artery involvement by apical chest tumors: a specific indication for the transmanubrial approach. J Thorac Cardiovasc Surg 1999; 117:627-8. [PMID: 10047682 DOI: 10.1016/s0022-5223(99)70351-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Abstract
A new technique extending the incision used for thoracic outlet decompression with a subclavicular approach to the first rib is presented. After the first rib and scalenotomy are removed, the subclavicular incision is continued into the sternum medially and superiorly to the sternal notch. This gives easy access to the innominate-subclavian-axillary vein segment. Eight patients with extensive chronic fibrotic obstruction of the subclavian-innominate vein segment underwent operation with this technique. It allows placement of either long patches of saphenous vein to reestablish normal caliber or replacement, as is our choice, with a small-sized cryopreserved descending thoracic aortic homograft. The operation is carried out in an extrapleural plane preserving the sternoclavicular joint, avoiding the deformity caused by transclavicular techniques. Repair of the sternotomy creates a stable incision. Follow-up to 14 months shows patency of the venous channel with no complications. This surgical approach is recommended to solve the problem of satisfactory exposure of the subclavian-innominate venous channel after decompression of the thoracic outlet.
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Affiliation(s)
- J E Molina
- Department of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, USA
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