Abstract
A 48-year-old male was admitted to our hospital with Pancoast symdrome. Chest X-ray, CT and MRI revealed a tumor located widely from the anterior to the posterior portion of the left apical thorax. After preoperative irradiation with 5250cGy, the tumor was resected through a median sternotomy and wide neck incision, consisting of two collar incisions and a vertical incision between them.
The invaded structures were resected : the chest wall (the first rib and vertebral bodies of C6, C7, Ti), the brachial plexus (C7, C8, and Ti) and the vessels (the brachial, jugular, and subclavian veins and subclavian artery). The resected clavicle was implanted in the defect of the vertebral bodies, and the subclavian artery was replaced with a ringed e-PTFE graft 8mm in diameter. Left upper lobectomy and wide dissections of hilar, mediastinal and neck lymph nodes were added as for primary lung cancer. However, because neither tumor cells nor scar formations were recognized in the left upper lobe and lymph nodes, the tumor was finally diagnosed as poorly differentiated adenocarcinoma of unknown primary site.
The anterior thoracic approach associated with wide neck incision provides an excellent operative exposure for surgery of invading apical cancer.
