MODIFIED TRAP-DOOR THORACOTOMY FOR MALIGNANCIES INVADING THE SUBCLAVIAN AND INNOMINATE VESSELS

Thirteen patients with malignancies which had invaded the subclavian v essels and/or distal border of the innominate vessels were operated on through modified ''trap-door'' thoracotomy. The modification is the a dditional resection of the first rib from inside the thorax. Tumors co nsisted of thyroid cancer in 5 patients, thymic tumor in 3, Pancoast t umor in 3, and lymphoma in 2. Invaded vessels were on the left side in 9 cases, on the right in 3, and bilateral in one. Subclavian and/or i nnominate veins were resected in 12 cases and reconstructed in 5. The remaining case was treated with resection of the right innominate and subclavian artery and its vascular reconstruction. Compared to origina l trap-door thoracotomy, the modification provided a more adequate ope ning in the chest wall and more extensive exposure of the entire subcl avian vessels, which made distal vascular control safe and easy. Posto perative complications occurred in one patient, who suffered chylothor ax. In conclusion, modified trap-door thoracotomy is a viable and usef ul approach in the resection of malignancies which have invaded the su bclavian and/or distal border of the innominate vessels.