Procedure

Anterior approach for Pancoast tumor resection

^a University of Milan, School of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
^b Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
^c Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy

^* Corresponding author: ^* Tel.: +39-02-5748 9664; fax: +39-02-5748 9798 lorenzo.spaggiari{at}ieo.it

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.

Key Words: Anterior approach • Hemiclamshell approach • Lung cancer • Pancoast tumor • Transmanubrial approach