-
Journal of Cardiothoracic Surgery Apr 2016The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach...
BACKGROUND
The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for anterior superior sulcus tumors.
CASE PRESENTATION
A patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 (suspected anonymous vein invasion) underwent chemo-radiation induction therapy with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe "en block" with the anterior part of the first and second rib was removed. The whole procedure was conducted with the patient in the supine position; no rib retractors were used. The definitive stage was ypT0N0M0. The patient had an uneventful hospital stay and at the 9 months follow-up she was free from disease and post-thoracotomy syndrome.
CONCLUSIONS
In our opinion such hybrid VATS procedure has several advantages: starting with thoracoscopy it is possibleto exclude previously undetected pleural dissemination and to precisely define the tumor location as well as limits of the thoracic wall resection; time could be spared maintaining the patients in the supine position for both surgical times; postoperative pain and post-thoracotomy syndrome could be minimized avoiding the use of any rib retractor.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pancoast Syndrome; Pneumonectomy; Thoracic Surgery, Video-Assisted
PubMed: 27079507
DOI: 10.1186/s13019-016-0446-7 -
Methodist DeBakey Cardiovascular Journal 2015"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic...
"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation-associated aortic rupture has also been described. This case describes a 60-year-old female who presented with a stage IIIa left upper lobe undifferentiated non-small-cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion. Following carotid-subclavian bypass with Dacron, en bloc resection of the affected lung, ribs, and vertebral bodies was performed. The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease-free at more than 5 years follow-up after completing her treatment course. Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.
Topics: Aorta, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy, Adjuvant; Endovascular Procedures; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neoplasm Staging; Pancoast Syndrome; Pneumonectomy; Polyethylene Terephthalates; Prosthesis Design; Treatment Outcome
PubMed: 26306134
DOI: 10.14797/mdcj-11-2-140 -
Thoracic Cancer Nov 2022Surgical treatment of superior sulcus tumors (SSTs) is clinically challenging. Definitive chemoradiotherapy (CRT) is a standard treatment for SST. In operable cases,...
Surgical treatment of superior sulcus tumors (SSTs) is clinically challenging. Definitive chemoradiotherapy (CRT) is a standard treatment for SST. In operable cases, multimodal therapy (CRT followed by surgery) is another option, at least for experienced institutions. Immune checkpoint inhibitors (ICIs) have recently been developed, and several clinical trials have investigated definitive CRT followed by ICIs for consolidation or maintenance therapy of unresectable local advanced non-small cell lung cancer (NSCLC), including SSTs. Clinical studies of salvage surgery after CRT followed by ICIs are also ongoing. However, the clinical outcomes of salvage surgery after multimodal therapies and histopathological analyses of surgical specimens after such treatments remain unclear. Here, we report the case of a patient with SST comprising squamous cell carcinoma with invasion of the second to third rib and vertebrae who underwent salvage surgery after concurrent definitive CRT followed by the ICI durvalumab, and show the results of clinicopathological analyses of the resected specimen.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Chemoradiotherapy; Salvage Therapy; Pancoast Syndrome; Neoplasm Staging
PubMed: 36193676
DOI: 10.1111/1759-7714.14681 -
Sao Paulo Medical Journal = Revista... Jul 2010Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms...
CONTEXT
Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS) for detecting the level of abnormality in cases of superior sulcus tumors.
CASE REPORT
We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Male; Pancoast Syndrome; Radiopharmaceuticals; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon
PubMed: 21120438
DOI: 10.1590/s1516-31802010000400013 -
The Annals of Thoracic Surgery Sep 2018Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and...
Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and control of apical chest wall structures, but it requires an additional thoracotomy to perform the lobectomy with radical lymph node resection. The presented technique combines the osteomuscular-sparing transmanubrial approach with robotic-assisted upper lobectomy in a severely obese patient, thereby reducing the invasiveness of the surgical approach and the postoperative complications.
Topics: Obesity, Morbid; Pancoast Syndrome; Robotic Surgical Procedures; Robotics; Thoracotomy
PubMed: 29654726
DOI: 10.1016/j.athoracsur.2018.03.013 -
Multimedia Manual of Cardiothoracic... Mar 2024We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port...
We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.
Topics: Humans; Robotic Surgical Procedures; Thoracic Wall; Carcinoma, Non-Small-Cell Lung; Pancoast Syndrome; Lung Neoplasms; Thoracoscopy
PubMed: 38526520
DOI: 10.1510/mmcts.2023.063 -
Interactive Cardiovascular and Thoracic... Jan 2013Following trimodality treatment for superior sulcus tumours (SSTs), the 5-year survival rate has significantly improved. Quality of life and potential negative effects...
OBJECTIVES
Following trimodality treatment for superior sulcus tumours (SSTs), the 5-year survival rate has significantly improved. Quality of life and potential negative effects of this strategy have become more important. The objective of this study was to investigate the quality of life and the arm and shoulder function after the resection of superior sulcus tumours following neoadjuvant chemoradiation.
METHODS
Patients were selected from a thoracic surgery database. Between January 2002 and December 2010, 72 patients received trimodality treatment of whom 39 were alive at the start of this study in 2010. The following arm function tests were used: nine-hole peg test, range of motion test and action research arm test. Quality of life was assessed using the Disability of the arm and shoulder and SF-36 questionnaires. Analyses of the arm function were conducted comparing the treated side with the untreated side. For quality of life, patients treated on their dominant side were compared with those treated on their non-dominant side.
RESULTS
In total, 19 patients participated in this study (15 men and 4 women). The median age was 59 years (range 39-73), median radiation dose 50 Gy (range 39-66) and median follow-up 40 months (range 4-101). There was no statistically significant difference in arm and shoulder function between the treated and the untreated arm. However, statistically significantly less pain was found if patients were treated on their dominant side.
CONCLUSIONS
After the resection of SSTs following chemoradiotherapy, the arm and shoulder function on the affected side is comparable with the functions at the contralateral side. Patients treated for an SST on their dominant side are less affected in their quality of life regarding pain compared with those treated on their non-dominant side.
Topics: Adult; Aged; Biomechanical Phenomena; Chemoradiotherapy, Adjuvant; Disability Evaluation; Female; Functional Laterality; Humans; Male; Middle Aged; Neoadjuvant Therapy; Pain Measurement; Pain, Postoperative; Pancoast Syndrome; Physical Examination; Quality of Life; Recovery of Function; Surveys and Questionnaires; Time Factors; Treatment Outcome; Upper Extremity
PubMed: 23049081
DOI: 10.1093/icvts/ivs394 -
Annals of Surgery Jul 1940
PubMed: 17857611
DOI: 10.1097/00000658-194007000-00002 -
Revista Da Sociedade Brasileira de... 2011Actinomycosis is a rare infection that may involve several organs. Thoracic involvement is uncommon (10-20%). This article describes the case of a 33 year-old patient,...
Actinomycosis is a rare infection that may involve several organs. Thoracic involvement is uncommon (10-20%). This article describes the case of a 33 year-old patient, HIV negative, complaining of burning pain in the left posterior chest radiating to the left upper arm and reduced strength and paresthesias. The CT scan showed a mass in close contact with the chest wall. Following a thoracotomy, observation verified a solid pulmonary lesion adhered to the left upper lobe, infiltrating the posterior thoracic wall and apex of the cavity with rich vascularization. An incisional biopsy of the lesion and microbiological study revealed actinomycosis.
Topics: Actinomycosis; Adult; Diagnosis, Differential; Humans; Lung Diseases, Fungal; Male; Pancoast Syndrome; Thoracic Wall; Tomography, X-Ray Computed
PubMed: 21552749
DOI: 10.1590/s0037-86822011000200028 -
British Medical Journal Sep 1954
Topics: Carcinoma; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Pancoast Syndrome
PubMed: 13190215
DOI: 10.1136/bmj.2.4888.631