En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina Elie Fadel, MD, Gilles Missenard, MD, Alain Chapelier,

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En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina Elie Fadel, MD, Gilles Missenard, MD, Alain Chapelier, MD, Sacha Mussot, MD, François Leroy-Ladurie, MD, Jacques Cerrina, MD, Philippe Dartevelle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 123, Issue 4, Pages 676-685 (April 2002) DOI: 10.1067/mtc.2002.121496 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 MRI showing NSCLC invading right thoracic inlet and intervertebral foramen along T1 nerve root (arrow). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 A, Right NSCLC invading thoracic inlet and first two thoracic intervertebral foramina along T1 and T2 nerve roots. B, First step of procedure is anterior transcervical approach that permits assessment of resectability and dissection of tumor in tumor-free margins. Anterior aspect of spine is approached from T1 to T2, and midline groove is made along involved vertebrae to facilitate hemicorporectomy during posterior approach of spine. C, Posterior midline approach is then performed, extending from spinal processes of C7 to T4. After laminectomy of T1 to T3, T1 and T2 nerve roots are divided inside spinal canal. Hemicorporectomy of T1 to T3 and spinal fixation are finally performed. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Specimen showing en bloc resected NSCLC invading thoracic inlet and intervertebral foramen (arrow) along thoracic nerve root. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Postoperative chest radiograph showing spinal fixation with hook in pedicle above and below hemivertebrectomy. On other side, screw or hook is implanted in each pedicle. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 MRI performed 5 years after tumoral resection, showing spinal fixation with hooks, clavicle interposed between remaining vertebral bodies to strengthen spinal fixation, and absence of local recurrence. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Survival curve for patients with NSCLC invading thoracic inlet and at least 2 intervertebral foramina. Vertical bars indicate SE. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 676-685DOI: (10.1067/mtc.2002.121496) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions