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

Object. Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and h istorically, patients harboring these tumors have been treated with local r adiation therapy with, at best, modest results. The value of gross-total re section remains unclear in this patient population; however, with the recen t advances in surgical technique and spinal instrumentation, procedures inv olving more radical removal of such tumors are now possible. At The Univers ity 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 a nd results in nine patients in whom stage IIIb, superior sulcus tumors exte nsively invaded the vertebral column. Methods. These patients underwent gross-total tumor resection via a combine d approach that included posterolateral thoracotomy, apical lobectomy, ches t wall resection, laminectomy, vertebrectomy, anterior spinal column recons truction with methylmethacrylate, and placement of spinal instrumentation. There were six men and three women, with a mean age of 55 years (range 36-7 2 years). Histological examination revealed squamous cell carcinoma (three patients), adenocarcinoma (four patients), and large cell carcinoma (two pa tients). The mean postoperative follow-up period was 16 months. All patient s are currently ambulatory or remained ambulatory until they died. Pain rel ated 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 d rainage and one case of wound breakdown that required revision. Two patient s experienced local tumor recurrence, and one patient developed a second pr imary lung tumor. Conclusions. The authors conclude that in selected patients, combined radic al resection of superior sulcus tumors of the lung that involve the chest w all and spinal column may represent an acceptable treatment modality that c an offer a potential cure while preserving neurological function and provid ing pain control.