Surgical exposure of superior sulcus lung tumors with vascular involvement

Choice of exposure route for surgical excision of superior sulcus lung tumo rs depends on involvement at the thoracic inlet. From December 1985 to Sept ember 1999, we performed surgical treatment of superior sulcus tumors in 42 patients, including 22 with vascular involvement. Various exposure techniq ues were used, including a novel technique combining transverse supraclavic ular cervicotomy and posterolateral thoracotomy in 11 cases, anterior trans clavicular cervicothoracotomy in 7 cases, isolated posterolateral thoracoto my in 3 cases, and cervicosternotomy in 1 case. Vascular procedures consist ed of subadventitial dissection of the subclavian artery in 5 patients, art erial resection-anastomosis in 7, and prosthetic bypass in 10. Postoperativ e mortality was 11.9% in the overall series of 42 patients (n = 5) and 9% ( n = 2) in the subgroup of patients with vascular involvement. During follow -up, 13 patients died of tumor recurrence and 1 patient died of respiratory insufficiency. Actuarial 8-year survival was 22.7 +/- 17.5% overall and 18 +/- 17.9% in the subgroup of patients with vascular involvement. This stud y indicates that the combined exposure route with transverse supraclavicula r cervicotomy and posterolateral thoracotomy was useful for treatment of su perior sulcus lung tumors requiring lobectomy and pneumonectomy.