A logical approach to the thoracic inlet: The Dartevelle approach revisited

Background. Traditionally, Pancoast tumors have been associated with an ext remely poor outlook. Recently, Dartevelle and colleagues have noted a signi ficant survival advantage in patients treated by wide en bloc excision. Methods. Utilizing an illustrative case example, step by step exposure of t he lung apex and first rib is provided with the Dartevelle approach. Results. Safe exposure was provided by this combined transcervical and tran sthoracic approach. Conclusions. The Dartevelle approach appears to be the favored approach to anterior lung apex or first rib lesions. The combined efforts of an Otolary ngolist-Head and Neck Surgeon and a Thoracic Surgeon may allow for safe, wi de en bloc excision of these otherwise difficult to access lesions. (C) 199 9 John Wiley & Sons, Inc. Head Neck 21: 767-771, 1999.