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Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach.

Parissis H, Young V - J Cardiothorac Surg (2010)

Bottom Line: Pancoast tumours are now amenable to multimodality treatment with an acceptable survival.Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels.We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiothoracic Dept, Royal Victoria Hospital, Belfast, Northern Ireland. hparissis@yahoo.co.uk

ABSTRACT
Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels. We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.

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Step by step resection of a Pancoast tumor through an Antero-cervical approach. Incision at the anterior edge of Sterno-cleido-mastoid (a). Division of the upper sternum extended into 2nd intercostal space(b). Mobilisation-Excision of supraclavicular fat pad (c). Exposure of the structures at the thoracic inlet by dividing the subclavius, omohyoid with preservation of the accessory nerve. Division of the Scalenus anterior with preservation of the phrenic nerve (d) & (e). Right upper Lobectomy (f): can be performed through the neck incision or a posterolateral thoracotomy.
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Figure 4: Step by step resection of a Pancoast tumor through an Antero-cervical approach. Incision at the anterior edge of Sterno-cleido-mastoid (a). Division of the upper sternum extended into 2nd intercostal space(b). Mobilisation-Excision of supraclavicular fat pad (c). Exposure of the structures at the thoracic inlet by dividing the subclavius, omohyoid with preservation of the accessory nerve. Division of the Scalenus anterior with preservation of the phrenic nerve (d) & (e). Right upper Lobectomy (f): can be performed through the neck incision or a posterolateral thoracotomy.

Mentions: The subclavian artery, the trunks of the brachial plexus, and the phrenic nerve are emerging above the lateral part of the first rib between the anterior and middle scalene muscles. The nerve roots of the brachial plexus, the stellate ganglion, and the vertebral column are situated behind the middle scalene muscle.


Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach.

Parissis H, Young V - J Cardiothorac Surg (2010)

Step by step resection of a Pancoast tumor through an Antero-cervical approach. Incision at the anterior edge of Sterno-cleido-mastoid (a). Division of the upper sternum extended into 2nd intercostal space(b). Mobilisation-Excision of supraclavicular fat pad (c). Exposure of the structures at the thoracic inlet by dividing the subclavius, omohyoid with preservation of the accessory nerve. Division of the Scalenus anterior with preservation of the phrenic nerve (d) & (e). Right upper Lobectomy (f): can be performed through the neck incision or a posterolateral thoracotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992054&req=5

Figure 4: Step by step resection of a Pancoast tumor through an Antero-cervical approach. Incision at the anterior edge of Sterno-cleido-mastoid (a). Division of the upper sternum extended into 2nd intercostal space(b). Mobilisation-Excision of supraclavicular fat pad (c). Exposure of the structures at the thoracic inlet by dividing the subclavius, omohyoid with preservation of the accessory nerve. Division of the Scalenus anterior with preservation of the phrenic nerve (d) & (e). Right upper Lobectomy (f): can be performed through the neck incision or a posterolateral thoracotomy.
Mentions: The subclavian artery, the trunks of the brachial plexus, and the phrenic nerve are emerging above the lateral part of the first rib between the anterior and middle scalene muscles. The nerve roots of the brachial plexus, the stellate ganglion, and the vertebral column are situated behind the middle scalene muscle.

Bottom Line: Pancoast tumours are now amenable to multimodality treatment with an acceptable survival.Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels.We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiothoracic Dept, Royal Victoria Hospital, Belfast, Northern Ireland. hparissis@yahoo.co.uk

ABSTRACT
Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels. We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.

Show MeSH
Related in: MedlinePlus