P128 | EXTENDED CANCER RESECTION BY TRANSMANUBRIAL OSTEMUSCOLAR SPARING APPROACH |
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| Department of Thoracic Surgery, University of Parma, Parma, Italy | |
Objective: To present our preliminary results in the use of extended resection of tumors involving the thoracic inlet and/or outlet by means of the transmanubrial osteomuscolar sparing approach.
Methods: From June 1996 to December 1997 six patients underwent extended resection of anatomic structures of the thoracic inlet/outlet for apical chest tumors through the transmanubrial approach (Ann Thorac Surg 1997; 63: 563-6).
Results:
| Age/sex | Histology/tnm | Approach | Lung resection | Extended resection | Outcome |
|---|---|---|---|---|---|
| 63 y/f | Sarcoma of the 1st rib | AT | - | 1st--2nd ribs | 21 months alive NED |
| 80 y/m | Epidermoid Carc T4N0M0 | AT + TPL | RUL exlnd | Subclavian Artery, 1st--2nd ribs | postop. death for pulmonary embolism |
| 54 y/m | Adenocarcinoma T4N2M0 | AT + TPL + TP | LUL + Wedge exlnd | Hemivertebrectomy T1--T2--T3, 1st--2nd ribs | 11 months death WD |
| 24 y/m | Inflammatory Pseudotumor | AT | - | 1st--2nd ribs | 11 months alive NED |
| 67 y/m | Epidermoid Carc T3N0M0 | AT + TPL | RUL exlnd | 1st--2nd ribs | 19 months alive NED |
| 77 y/m | Adenocarcinoma T4N1M0 | AT | Wedge exlnd | Subclavian Artery + Hemicorporectomy T1 | 2 months alive NED |
Legend: AT = Transmanubrial Osteomuscolar Sparing Approach; TPL = Postero Lateral Thoracotomy; TP = Midline Posterior Thoracotomy; RUL = Right Upper Lobectomy; LUL = Left Upper Lobectomy; exlnd = extended lymph nodes dissection (cervical and mediastinal); NED = no evidence of disease; WD = with disease.
Conclusions: Transmanubrial approach affords an excellent exposure of the thoracic inlet and/or outlet sparing the main osteomuscolar structures. Shoulder mobility and scapular girdle are respected avoiding deformities due to clavicle resection and avoiding the functional impairment due to the muscles section. Extended resections (i.e.: vertebral bodies, subclavian vessels, first ribs) are accomplished with safe control through a wide surgical field.
