Extended cancer resection by transmanubrial osteomuscolar sparing approach

The anterior transcervical approach, first described by Cormier (I) for vas cular diseases, than proposed by Dartevelle (2), improved the radical treat ment of the apical chest tumors, permitting a better view and safe resectio n of the subclavian vessels than performed through posterior approach. The anterior transcervical approach is performed by resecting the medial half o f the clavicle, the insertions of the sternocleidomastoid muscle and major pectoral muscle leading to postoperative alterations in the shoulder mobili ty and cervical posture or postoperative development of a respiratory insuf ficiency, particularly when associated with vertebral or extensive chest wa ll resection. The transmanubrial osteomuscolar sparing approach offers the same wide expo sure of the operative field (thoracic inlet and/or outlet) sparing the oste omuscolar components of the cervical and shoulder articulations (3).