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J Thorac Cardiovasc Surg 1999;117:1040
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Cervicothoracic tumors: Results of resection by the "hemi-clamshell" approach

Department of General Thoracic and Vascular Surgery
University of Parma
Via Gramsci 14
43100 Parma, Italy

Cervicothoracic tumors: Results of resection by the "hemi-clamshell" approach

To the Editor:

We read with interest the article of Korst and Burt ¹ concerning the surgical treatment of the tumors involving the cervicothoracic junction using the hemi-clamshell approach. We agree with the authors that, among the different surgical accesses described, the hemi-clamshell is the technique that offers the best chances of removing tumors located in this region apart from the structures involved and the size of the tumor. Nevertheless, in using this approach, we have noticed difficulties in exposing the distal part of the subclavian vessels in 2 cases in which we recently operated. The first was a cancer of the left upper lobe involving also the vertebral bodies from T1 to T3, and the second was a big apical cancer of the left upper lobe involving the subclavian artery and the first rib. In both cases we have modified the standard hemi-clamshell approach by dividing the first costal cartilage and the costoclavicular ligament, thereby obtaining a remarkably improved exposure with a safe control of the distal part of the subclavian vessels. We have taken this technical variation from our experience using the transmanubrial osteomuscular sparing approach proposed by Grunenwald and Spaggiari ² that gives very good exposure of the structures of the thoracic inlet/outlet, even though in our series of 10 patients, 6 required an additional posterolateral thoracotomy to complete the pulmonary upper lobectomies. We believe that the modified hemi-clamshell approach can be a more useful surgical technique in performing radical anatomic resections of pulmonary apical tumors invading the thoracic inlet/outlet, by avoiding the limitation of not completely controlling the subclavian vessels and also permitting resection in cases of invasion of the posterior chest wall.

12/8/97046

References

1. Korst RJ, Burt ME. Cervicothoracic tumors: results of resection by the "hemi-clamshell" approach. J Thorac Cardiovasc Surg 1998;115:286-95. [Abstract/Free Full Text]
   
2. Grunenwald D, Spaggiari L. Transmanubrial osteomuscular sparing approach for apical chest tumors. Ann Thorac Surg 1997;63:563-6. [Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paolo Carbognani Paolo Bobbio Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rusca, M. Articles by Bobbio, P. Search for Related Content PubMed PubMed Citation Articles by Rusca, M. Articles by Bobbio, P.