Minimally Invasive Approaches to Chest Wall and Superior Sulcus Tumors

Object. Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and historically, patients harboring these tumors have been treated with local radiation therapy with, at best, modest results. The value of gross-total resection remains unclear in this patient population; however, with the recent advances in surgical technique and spinal instrumentation, procedures involving more radical removal of such tumors are now possible. At The University of Texas M. D. Anderson Cancer Center, the authors have developed a new technique for resecting superior sulcus tumors that invade the chest wall and spinal column. They present a technical description of this procedure and results in nine patients in whom stage IIIb superior sulcus tumors extensively invaded the vertebral column. Methods. These patients underwent gross-total tumor resection via a combined approach that included posterolateral thoracotomy, apical lobectomy, chest wall resection, laminectomy, vertebrectomy, anterior spinal column reconstruction with methylmethacrylate, and placement of spinal instrumentation. There were six men and three women, with a mean age of 55 years (range 36–72 years). Histological examination revealed squamous cell carcinoma (three patients), adenocarcinoma (four patients), and large cell carcinoma (two patients). The mean postoperative follow-up period was 16 months. All patients are currently ambulatory or remained ambulatory until they died. Pain related to tumor invasion improved in four patients and remained unchanged in five. In three patients instrumentation failed and required revision. There was one case of cerebrospinal fluid leakage that was treated with lumbar drainage and one case of wound breakdown that required revision. Two patients experienced local tumor recurrence, and one patient developed a second primary lung tumor. Conclusions. The authors conclude that in selected patients, combined radical resection of superior sulcus tumors of the lung that involve the chest wall and spinal column may represent an acceptable treatment modality that can offer a potential cure while preserving neurological function and providing pain control.

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A minimally invasive and safe surgical approach to resect anterior superior sulcus tumors

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.02.047 ◽

2020 ◽

Vol 68 ◽

pp. 148-150

Author(s):

Soichi Oka ◽

Kenji Ono ◽

Kenta Kajiyam ◽

Katsuma Yoshimatsu

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Superior Sulcus Tumors ◽

Superior Sulcus

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Combined chest wall resection with vertebrectomy and spinal reconstruction for the treatment of Pancoast tumors

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.5.6 ◽

1999 ◽

Vol 6 (5) ◽

pp. E5

Author(s):

Julie E. York ◽

Garrett L. Walsh ◽

Frederick F. Lang ◽

Joe B. Putnam ◽

Ian E. McCutcheon ◽

...

Keyword(s):

Cell Carcinoma ◽

Chest Wall ◽

Lung Tumor ◽

Tumor Resection ◽

Spinal Instrumentation ◽

Spinal Column ◽

Chest Wall Resection ◽

Spinal Reconstruction ◽

Superior Sulcus Tumors ◽

Superior Sulcus

Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and historically, patients harboring these tumors have been treated with local radiation therapy with, at best, modest results. The value of gross-total resection remains unclear in this patient population; however, with the recent advances in surgical technique and spinal instrumentation, procedures involving more radical removal of such tumors are now possible. At The University of Texas M. D. Anderson Cancer Center, the authors have developed a new technique for resecting superior sulcus tumors that invade the chest wall and spinal column. They present a technical description of this procedure and results in nine patients in whom stage IIIb superior sulcus tumors extensively invaded the vertebral column. These patients underwent gross-total tumor resection via a combined approach that included posterolateral thoracotomy, apical lobectomy, chest wall resection, laminectomy, vertebrectomy, anterior spinal column reconstruction with methylmethacrylate, and placement of spinal instrumentation. There were six men and three women, with a mean age of 55 years (range 36–72 years). Histological examination revealed squamous cell carcinoma (three patients), adenocarcinoma (four patients), and large cell carcinoma (two patients). The mean postoperative follow-up period was 16 months. All patients are currently ambulatory or remained ambulatory until they died. Pain related to tumor invasion improved in four patients and remained unchanged in five. In three patients instrumentation failed and required revision. There was one case of cerebrospinal leak that was treated with lumbar drainage and one case of wound breakdown that required revision. Two patients experienced local tumor recurrence, and one patient developed a second primary lung tumor. The authors conclude that in selected patients, combined radical resection of superior sulcus tumors of the lung that involve the chest wall and spinal column may represent an acceptable treatment modality that can offer a potential cure while preserving neurological function and providing pain control.

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Original “double-step” technique for large superior sulcus tumors invading the anterior chest wall without subclavian vessels involvement

Journal of Thoracic Disease ◽

10.21037/jtd.2018.05.182 ◽

2018 ◽

Vol 10 (S16) ◽

pp. S1850-S1854

Author(s):

Francesco Puma ◽

Jacopo Vannucci ◽

Elisa Scarnecchia ◽

Damiano Vinci ◽

Niccolò Daddi

Keyword(s):

Chest Wall ◽

Anterior Chest Wall ◽

Double Step ◽

Superior Sulcus Tumors ◽

Superior Sulcus

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Posterior midline approach for single-stage en bloc resection and circumferential spinal stabilization for locally advanced Pancoast tumors

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/9/7/071 ◽

2008 ◽

Vol 9 (1) ◽

pp. 71-82 ◽

Cited By ~ 12

Author(s):

Surbhi Jain ◽

Eric Sommers ◽

Matthias Setzer ◽

Frank Vrionis

Keyword(s):

Chest Wall ◽

Posterior Approach ◽

En Bloc Resection ◽

Bloc Resection ◽

Single Stage ◽

En Bloc ◽

Spinal Stabilization ◽

Superior Sulcus Tumors ◽

Superior Sulcus ◽

Pancoast Tumors

The treatment of Pancoast (superior sulcus) tumors that extensively invade the vertebral column remains controversial. Different surgical approaches involving multistage resection techniques have been previously described for superior sulcus tumors that invade the chest wall and spinal column. Typically a posterior approach to stabilize the spine is followed by a second-stage thoracotomy (posterolateral or trap door) for definitive en bloc resection of stage T4 Pancoast tumors. The authors report and elaborate on a surgical technique successfully used for an en bloc resection as well as spinal stabilization through a single-stage posterior approach without any added morbidity. Two patients with histologically proven Pancoast tumors were treated by single-stage resection and stabilization through a posterior approach at the H. Lee Moffitt Cancer Center. A wedge lung resection or lobectomy was performed by the chest surgeon utilizing the chest wall defect. Placement of an anterior cage (in one case) and posterior cervicothoracic spinal instrumentation (in both cases) was performed during the same operation. Average blood loss was 675 ml and surgical time was 7 hours. The median hospital stay was 9 days (range 7–11 days). Both patients did well postoperatively and were free of recurrence at the 2-year follow-up. Radical resection of Pancoast tumors including lobectomy, chest wall resection, costotransversectomy, and partial or complete vertebrectomy with simultaneous instrumentation for spinal stabilization can be performed through a posterior single-stage approach.

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