Subclavian artery resection and reconstruction for thoracic inlet cancers

Purpose: We previously described an original transcervical approach to rese ct primary or secondary malignant diseases that invade the thoracic inlet ( TI). The purpose of this study was to evaluate the technical aspects and lo ng-term results of the resection and revascularization of the subclavian ar tery (SA). Methods: Between 1986 and 1998, 34 patients (mean age, 49 years) underwent en bloc resection of TI cancer that had invaded the SA. The surgical approa ch was an L-shaped transclavicular cervicotomy in 33 patients. In 14 of the se patients, this approach was associated with a posterolateral thoracotomy (n = 10) or a posterior midline approach (n = 4). In one patient, the proc edure was achieved with a single posterolateral thoracotomy approach. An en d-to-end anastomosis was performed in 16 patients. In one patient, a subcla vian-left common carotid artery transposition was performed. In one other p atient, an end-to-end anastomosis was performed between the proximal innomi nate artery and the SA. The right carotid artery was transposed into the SA in an end-to-side fashion. In 16 patients, prosthetic revascularization wi th a polytetrafluoroethylene graft was performed. Thirty-three patients und erwent postoperative radiation therapy. Results: There were no cases of perioperative death, neurologic sequelae, g raft infections or occlusions, or limb ischemia. There were two delayed asy mptomatic polytetrafluoroethylene graft occlusions at 12 and 31 months. The 5-year patency rate was 85%. During this study, 20 patients died: 18 died of tumor recurrence (5 local and systemic and 13 systemic), one of respirat ory failure, and one of an unknown cause at 74 months. The overall 5-year s urvival rate was 36%, and the 5-year disease-free survival rate was 18%. Conclusion: Tumor arterial invasion per se should not be a contraindication to TI cancer resection. This study shows that cancers that invade the SA c an be resected through an L-shaped transclavicular cervicotomy, with good r esults with a concomitant revascularization of the SA.