SURGICAL ACCESS TO TUMORS OF THE CERVICOTHORACIC JUNCTION

Background. Surgical resection of tumors of the cervicothoracic juncti on is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of provid ing adequate exposure for vertebrectomy with tumor resection and verte bral column stabilization. Theses approaches do not provide adequate e xposure for a heterogeneous group of tumors which also involve the cer vicothoracic junction. We used a combined cervicothoracic surgical app roach to determine its efficacy in tumor resection. Method. Seventeen patients with a heterogeneous group of malignancies arising in a varie ty of soft tissues underwent combined cervicothoracic resection. The a pproach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy. Results. Complete gross tumor resection was acco mplished in all 17 patients, 15 of whom had negative microscopic margi ns. Extensive reconstruction was employed in 6 patients. Three patient s received intraoperative brachytherapy implants and 5 patients receiv ed external-beam postoperative radiotherapy. Local tumor control was o btained in 12 patients, and 10 patients are currently alive, free of d isease (median: 12 months; range: 3-47 months). There was no inadverte nt sacrifice of neurovascular structures. The sternoclavicular joint w as maintained in all patients. There were 4 major complications, and n o perioperative mortality associated with the surgical procedure. Conc lusion. The combined ''trap door'' technique provides sufficient expos ure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular struct ures. The sternoclavicular joint was maintained in all patients. Preli minary results using this approach for resections of tumors of the cer vicothoracic junction are encouraging. (C) 1995 John Wiley and Sons, I nc.